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Leading Psychiatrists Say Benefits Overhaul Risks Disabled People’s Mental Health

5 min read

The Royal College of Psychiatrists (RCPsych) has called on the government to ditch controversial plans to tighten disability benefit assessments and scrap protections relating to disabled people’s mental health.

The Department of Work and Pensions (DWP) recently closed its consultation on plans to remove or downgrade the “descriptors” used to assess whether certain disabilities reduce people’s ability to work, and on changing or scrapping the “substantial risk” regulations around the mental health impact on individual claimants of being required to look for work or prepare for the workplace. 

The proposals have already provoked strong opposition from disabled people’s organisations, who protested outside the DWP’s Westminster offices last week.

In its response to the DWP consultation, RCPsych described the planned changes as “premature” and not properly thought through, and said they “should not be taken forward”. 

The planned changes “may be unhelpful and … unfair and detrimental to the health and welfare of people with mental illnesses as well as those with learning disabilities or neurodevelopmental conditions,” its consultation response added.

Instead RCPsych recommended a “comprehensive review” of how eligibility for out-of-work disability benefits is assessed.

The DWP’s plans concern the Work Capability Assessment (WCA), which determines eligibility for out-of-work disability benefits. Applicants are scored according to descriptors of physical and mental disabilities, and then assessed as being either fit for work, having “limited capability for work” (LCW), or having “limited capability for work and work-related activity” (LCWRA, also known as the support group). 

Those found fit for work receive no out-of-work disability benefits. Those classed as just LCW are required to undertake “work-related activity” to prepare for the workplace. Those in the Support Group – the most severely disabled – don’t have to undertake work-related activity. 

This latter group has risen from 21 per cent of WCA outcomes in 2011 to 65 per cent in 2022 – during which time horrific reports of disabled people dying after failing the WCA have gradually reduced.

The DWP’s proposals would remove or water down the role of four descriptors in assessing people’s ability to work or undertake work-related activity. The DWP argues that the rise in working from home – which has regularly been criticised by senior Conservatives – means more disabled people can undertake paid work, though RCPsych pointed to data showing only 12 per cent of job adverts offer home or hybrid working. 

The changes would lead to more disabled people being found fit for work, more being placed at risk of having their benefits sanctioned, and fewer classed as LCWRA. According to RCPsych, people in the LCW group receive £44.70 a week less in benefit than those in the support group if they’re on the old-style Employment Support Allowance benefit, and £90 a week less if they’re on Universal Credit.

“It is very likely that such reductions in income measures will result in a serious increase in hardship and debt,” RCPsych said in its response.

RCPsych’s consultation response warned that low-quality jobs can be as damaging for people’s mental health as unemployment, and that benefit cuts and the threat of sanctions can worsen people’s health conditions – leading to increased pressure on mental health services. 

“There is clear and definitive evidence that forcing people to seek work when they are not ready, and may never be ready, is dangerous,” said Dr Jay Watts, a consultant clinical psychologist and psychotherapist. 

“It is very difficult to get into the limited capability work group, and it is not based solely on diagnosis; one has to have very low functioning, and clinicians such as me can't get majorly disturbed, very high-risk patients in sometimes without multiple calls.”

The DWP is also planning to water down – or scrap entirely – the substantial risk regulations, under which an applicant is placed in the Support Group if evidence shows that not doing so would create a substantial risk to their mental or physical health. The DWP argues this safety net was meant to be used in exceptional cases, but is instead used in 15 per cent of Support Group awards. It says JobCentre work coaches can offer claimants “tailored” work preparation activity – and decide whether this activity should be mandatory or voluntary.

But RCPsych said the DWP had not provided evidence that the substantial risk rules are being used inappropriately – just more frequently than intended.

“Being at ‘Substantial risk’ is not inherently restricted to a given percentage of claimants,” RCPsych said in its response. “It is for whatever percentage of claimants would otherwise be placed at such risk, something that is bound to vary over time, and for people with mental health conditions presents a real and frequently seen matter.”

A DWP spokesperson said: “We know 1 in 5 of those in this group want to work with the right support – that is why we consulted on changes to the Work Capability Assessment to reflect the modern world, review rules which were written more than a decade ago and ensure those who can work are supported in doing so.

“These proposed reforms, which include an extra £2 billion to support those with health conditions and disabilities to get into and stay in work, are about helping people to improve their lives.”

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