Posts Tagged ‘incapacity benefit’

Mental Health and the Benefits System

Andrea sits down in front of her careers adviser, John, clearly very agitated.  She rushes to get her words out.  “I’ve just come from the Job Centre, and they say I’ve got to have a CV.  Can we get it done today?”

“Yes, we could work on a CV,” the adviser replies.  “But it sounds like it’s the Job Centre that wants this CV.  What do you want?”

Andrea insists that she must have the CV today, otherwise her benefit will be cut. It’s clear that this is the only reason for the CV, and the threat of having her money cut is uppermost on her mind.  She’s typical of many clients referred by the Job Centre.

John has met Andrea before, and when they met a month ago, Andrea had told him that she was on medication for depression and anxiety and had been on Incapacity Benefit for a few years, but had recently been switched back to Job Seekers Allowance, as a result of a medical assessment. Her GP, however, doesn’t think she is ready to work yet.

When they last met, they talked about Andrea’s ideas for the future.  She was once a Care Assistant, but she said “I can’t go back to that work.  Because I just don’t care and it’s not fair on the older people for me to be in that job.  I need to do something else.  Something practical with my hands, so I don’t have to talk to people all the time.”

John offers to ring up the Job Centre and negotiate a more sensible deadline for the CV, and Andrea immediately relaxes.  After some haggling on the phone, it is agreed that the Job Centre will give Andrea more time to create the CV, provided she spends time with the Careers Adviser on “preparation”.

With the immediate threat of being left without money tackled, Andrea is now able to tell John what has happened since they last met.  Her sister-in-law told her that there were jobs going in a local meat-packing factory.  “I really thought about it, ” says Andrea, “but then I got so worried, I had to take more medication, and just go off for a walk.  I was gone all day. My husband knows me, he knew I was getting worse and he wanted me to go back to the GP.  I don’t know why thinking about that job set me off, but it did.  I didn’t feel right for a couple of weeks.  I think my sister-in-law thinks I’m just lazy.”

They talk about the reasons she wants to work – to be busy, to have more money, to get back to a normal life, to be out of the house.  They also talk about the reasons that she doesn’t feel ready.  She can’t face crowds of people.  Some days, she can’t get out of bed in the morning.  She lacks energy.  She has panic attacks when things feel out of control.  “It seemed like a good job for me, just what I wanted, but it just felt like too big a step.”

Andrea and John spend some time thinking about “small steps”.  Andrea comes up with the idea of an exercise class, a craft class at the adult education centre and ringing her friend to go to a nearly town for a shopping trip on the bus.  John suggests voluntary work – maybe in a charity shop to get used to being around people and having a regularly place to be each week.  Eventually Andrea creates an action plan that includes calling into the adult education centre and a local charity shop.   They agree to meet again in a few weeks to review progress and do the dreaded CV.

Andrea looks anxious as soon as the CV is mentioned.  “A CV isn’t just for getting a job,” John reassures her.  “We can use it as a way to think about all your experiences and what you can do.”

This is real career guidance.  Professional careers advisers work from a Code of Ethics, and putting the client’s needs first is at the heart of this.  A professionally qualified careers adviser will explore the deeper issues that prevent people from achieving their goals, rather than focus immediately on job applications.

Professional career guidance, however, is being cut back all over the UK, and replaced by “job search advice” or “employment support”, offered by staff who are often trained only to a very basic level, and who often work in a very target-driven environment – if they don’t get clients into jobs quickly, their organisations won’t fulfil  the targets in their contract and they will be out of a job.  Some of them are on temporary contracts or have performance-related pay, so the can’t afford not to get their clients into work quickly.

You can’t really blame these advisers for pushing their clients to get back into work quickly, but it’s often a very inappropriate approach for clients with mental health problems, who may need to take many small steps towards being “job-ready”.  The process of getting back to work has to proceed at a pace appropriate to the client – it can’t be rushed. Many clients with mental health problems do want to get back to work, but they recognise that they need support (perhaps part-time or flexible hours, a reduced workload or social support), and many employers would rather just employ someone else.  A paid job is often a very the long-term goal.

Clients who are pushed back into work before they are ready, without appropriate support, may find that they can’t actually perform the job at the speed and standard expected, they may feel socially isolated and often find that their condition is exacerbated by the pressure to “keep up”.  Their attendance at work may be poor, especially if they don’t get appropriate support from their employer.  They are unlikely to hold down the job, so the cycle begins again – they are back in the benefit system with even lower levels of confidence.

Incapacity Benefit Or Fit For Work?

A lot has been made in the news this week of the new medical assessments for Incapacity Benefit (renamed Employment Support Allowance last year) and the number of claims that are being dropped or turned down as a result.

I find this rather alarming, for two reasons:

The Fairness of the Medical Assessments

Firstly, I have seen for myself how totally random these medical assessments are.  Recently I spent a morning with an adviser working with clients on Incapacity Benefit/ESA.  The first client had “passed” a recent medical; he suffered from depression, and as he talked, it was clear that having a supportive job, some voluntary work or a course to attend would have actually been beneficial to his mental health.  He wasn’t incapable of work, but would need support to find work and then to remain in that job.  The second client had recently “failed” a medical.  He had cancer and was regularly attending medical appointments and chemotherapy, and as a result, was constantly suffering pain, fatigue and nausea.  Yet he had been told he was fit for work and could no longer claim.

From talking to the adviser, I learned that these seemingly random decisions are very common.  So what is the explanation?

  • Is it lack of competence on the part of the doctors conducting the medical?  They are after all, not specialists.  But surely even a GP could distinguish which of the above two clients was more capable of being in work?
  • Is it a lack of guidelines?  Perhaps one doctor only passes those too sick to walk out of the office, while another happily passes everyone?  This seems unlikely, given the amount of burocracy in typical public sector organisations.
  • Or is it targets?  Maybe if you get seen at the beginning of the month, the doctor is reasonable, but by the end of the month, he has to make his targets, so fails everyone until the target is met.  Call me a cynic, but my money is on this explanation.

Support To Get Back Into Work

Even if these medical assessments were fair, I would still have concerns.  Some distinction does need to be made between those who are genuinely too unwell to work at all, and those who could work in some form, given the right support.

Many people on IB / ESA suffer from chronic conditions – often mental health problems (maybe depression, anxiety, bipolar disorder) or chronic pain (typically, back problems or arthritis).  Many of these people could work, but need a lot of support to become “job ready” and would then need a lot of support from their employer to stay in work.  Simply, taking away their benefit is not going to get them back into work.

Most clients need a whole package of support,which might include:

  • Confidence building
  • Social skills
  • Emotional Intelligence (e.g. anger management)
  • Support to manage their condition
  • Job search skills
  • Basic skills (literacy, numeracy and IT)
  • Guidance in finding a new career direction compatible with their condition
  • Vocational training
  • Counselling
  • Voluntary work

Even with this package, they will find it hard to compete in the jobs market, where a period of poor health is often viewed with suspicion by employers.

Should they find work, they might also need an employer who is sympathetic to their needs and prepared to make enough adjustments for them in the workplace.  They might need part-time hours or flexi time to fit around flare-ups in their health problem.  It’s not always easy to find this sympathetic employer when you need it.

So I do worry.  I worry that we are just moving people off Incapacity Benefit and the Employment Support Allowance and putting them on Jobseekers Allowance.  And this is important for two reasons. It’s not just because you get less money on JSA.  It’s also because the Labour government initiated programmes like Pathways to Work, to give claiments on Incapacity Benefit some of the support they needed to get back into work, and claimants loose their eligibility for these programmes as soon as they are switched to JSA.

I don’t see this government putting in place any of the support that people with ongoing health conditions need to re-enter the labour market.