Monday 14 July 2014

Changing the Rules- Is this Ethical?

Yesterday, I learnt of a new expectation for ESA claimants. It seems that ministers at the Department for Work and Pensions will now be expecting mentally ill claimants to undergo therapy for Anxiety and Depression, if they are to keep their benefits. You can read more about it here and here.

Employment and Support Allowance (ESA) is an out of work* benefit for people who are not well enough to work. It involves a (fairly lengthy currently) assessment period and in most cases, claimants have to take part in a face to face Work Capability Assessment. They are supposed to be contacted fairly soon after this assessment, with their results. They will either be found fit for work or having limited capability for work. If it is found that they are fit for work, then their assessment rate ESA is stopped, they are encouraged to apply for Jobseeker's Allowance and expected to look for work. This decision can be appealed, however. If they are found to have limited capability for work then they will be placed in one of two groups; the Work Related Activity Group (for those who might be able to work soon) or the Support Group (for those who are unlikely to be able to work/soon.) More details are found on the website here .

Currently, people found to have limited capability for work are not expected to undergo treatment as a condition for receiving Employment and Support Allowance. Those in the Work Related Activity Group are expected to take part in Work Focused Interviews however. This is usually face to face, but it is possible to request phone appointments if you are unable to travel. I will provide further information, and my own experience of requesting phone appointments, in my next post. At these Work Focused Interviews, your adviser will discuss barriers to work with you. You may also be offered support with CV writing, building confidence and group sessions. These are referred to as Work Related Activity, and they must take your medical conditions into consideration. It is a good idea to ensure the adviser knows how your medical conditions affect your ability to work. I understand that this will already have been discussed with a healthcare professional at your Work Capability Assessment but, in my experience, communication between these two parties tends to be very lacking. The three things that your adviser is not allowed to do is, expect you to look for work, expect you to take part in work, and expect you to undergo medical treatment against your will.

Bringing us back to the point of this post,  the idea of giving early access for "talking therapies" to claimants almost seems like a positive one. With long waiting lists, difficulty accessing therapy and early discharges from therapy (therapists leaving their posts, clients missing appointments, lack of funding etc) you'd be forgiven for thinking early access, provided by the government, is a good thing. But this is barely touching the surface of mental illness, and the complexities of it. Talking therapies (such as Cognitive Behavioural Therapy) are only likely to help a person's mental health, if they are ready and take part on a completely voluntary basis.  Forcing a person to take part in any kind of treatment, is likely to result in more stress and pressure, which in turn will likely halt progress or even worsen their condition(s). Forcing a person to take part in therapy, with the threat of sanctions if they don't, is completely unethical, cruel, and potentially dangerous.

The article includes a statement from a senior government source; which I have quoted below:

"A huge number of claimants on ESA who cannot work have treatable mental health issues such as depression and anxiety. We know that depression and anxiety are treatable conditions. Cognitive behavioural therapies work and they get people stable again but you can’t mandate people to take that treatment. But there are loads of people who claim ESA who undergo no treatment whatsoever. It is bizarre. This is a real problem because we want people to get better."

I believe this statement is problematic. It appears to imply that firstly, Depression and Anxiety are easily treatable and will always improve with therapy (namely CBT), secondly, that these mental illnesses aren't that serious and thirdly that the only reason claimants of ESA (with Anxiety and/or Depression) aren't getting treatment, is because they chose not to. Now I'm unsure as to whether the government are including these people in their research or not (and will edit accordingly as I learn more) but, with cuts to mental health funding, comes increasingly longer waiting lists. Some people who are claiming ESA for mental illnesses (Depression and Anxiety in this case) may have already requested or agreed to a referral for talking therapies; such as CBT, so are waiting a very long time for their first session. Just because someone is not currently receiving treatment, does not mean they haven't tried. It may also be that CBT just didn't suit them. Maybe their condition is too severe for this (but is not considered severe enough to warrant entry into the Support Group.) Maybe their condition is too complex for therapy to be of much help currently. Maybe it has been decided that their condition is not severe enough for anything more than some self help material. A better idea would be to give people the option of requesting this early access. 

I'm going to leave the post here for now, and will add more sources either later on today or tomorrow. I'd be really interested in hearing people's views on this topic though, so feel free to comment. 


*Although ESA is an out of work benefit, there are exceptions where a claimant can do voluntary work, or permitted work. More information about permitted work, can be found on this page.


It appears that this new expectation will not go ahead. It was merely a discussion, that was misinterpreted by journalists, although the fact that it WAS discussed does not instil much confidence in myself and I'm sure many others. I will try to keep an eye on any sneaky proposals the DWP publish in future.

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