years prompted by the objective to reduce the number of people and the
national expenditure on the medical benefits system. A large percentage
of people on the medical benefits system have a mental health diagnosis
and they are likely to be the prime target of the new Work Capability
Assessment.
The WCA testing system isn't very good. Mental illness is complex.
Understanding a person and how their mental illness affects their life,
how their capacity and capability can vary with time, how a change to an
environment with lots of triggers can make a person more ill and other
factors is difficult for the patient's healthcare team (MDT -
multidisciplinary team). They have the most knowledge and experience of
the individual. They have the responsibility for that person's medical
care, illness and welfare. The MDT and other professionals involved in
the diagnosis and care of an individual are well placed to make the
decision on an individual's capability and positive or negative impact
of work given appropriate training. A doctor or other mental health
professional who has never met the individual before and doesn't have
the time to get to know them is least placed to make a safe and accurate
assessment of the individual's capability to work. They probably do not
have the time to go through the patient's medical history and notes to
understand the full picture. The team involved in the patient's care are
the second best placed to make the decision about an individual's work
capability.
The best placed person is the individual themselves. I don't think the
views of the individual are part of the WCA but I'm not sure. I hope
they are.
--
The changes to the welfare system have a history of government policy
development behind the targets. The government will aim to meet those
targets.
The changes in the welfare system came without the expectation of the
recession. The recession is doubly unusual because of the bank bailout.
The effects of the recession are yet to be felt but the budget was a
sign that the UK is moving into a period of austerity (which may,
perhaps, have a positive effect on the mental health of the nation).
Unemployment is rising which means there are more people looking for
work, people with career history's that don't have big gaps in. The cut
in government spending and the move to greater efficiency and tighter
spending in the commercial sector will mean the economy will slow down.
The government has had limited ambitions in setting up the sort of work
programmes and other measures used in the 20th century to maintain or
boost an economy in a recession. The cuts in government spending will
directly impact on the mental healthcare system and it will be less able
to meet the increased support needs that are inevitable as people move
off benefits.
These factors make it a very bad time to be attempting to move people
off medical benefits enmasse and quickly. The WCA is already causing
concern and distress to many people in receipt of medical benefits. Most
want to work but know the potential negative impact and without the job
opportunities or the support systems they are faced with the prospect of
extreme poverty (rather than just poverty) of job seeking benefits.
--
The government is missing two opportunities. One is the option of
promoting volunteering and permitted earnings opportunities. This needs
to be part of the program of change to the welfare system.
There is a simplistic assumption that people who do work get paid for it
or get paid the right wage. It is incorrect. (btw - I'm holding back on
a rant about collective fetishism and socialist ideals of equality).
Many people on medical benefits volunteer or get a little extra income
through permitted earnings. Many do the work that people are paid to do.
The work contributes to GDP and Gross Domestic Happiness (if that
measure ever gets introduced).
These opportunities allow people the safety of the medical benefits
system but allow them to contribute as well. Many make a significant
contribution. It is not recognised enough.
A national program to promote volunteering and permitted earnings
opportunites, government assistance (e.g. tax breaks or other
incentives) to set these opportunities up, training and increased
funding for support to help people maintain employment and incentives
for people to volunteer or work permitted earnings would be an adjunct
or an alternative to forcing people who aren't well back to work to
crappy jobs if they can find any at all.
The mentally and physically disabled are capable of contributing to the
nation. They are capable of working and working hard however employment
is far harder for them than average people. The emotional maelstrom that
everyone feels with high pressure jobs, deadlines, competing demands,
never enough time, the juggling of priorities and the failures are more
intense and can be harder to deal with for some people. Those trials and
tribulations can make a person worse and that can have detrimental
effects. The medical welfare system creates a safety net and it protects
health in the long term - physical and mental.
My personal experience of coming off medical benefits, returning to work
and supporting myself was that I ended up with a mental state that could
have ended up with me being hospitalised. My journey is probably not the
average case but it is an example of what can go wrong (and right).
Other people may not have survived psychosis as well as I did (and I
didn't do very well). Sending people back to work and making them more
ill is not good for physical and mental health, and it could increase
costs by increasing healthcare and welfare costs in the long term.
Supporting people over a period of time towards recovery with a well
funded healthcare system and workplace environments ready for those with
common mental disorders and severe mental illnesses will take time. This
is an evolution in society and in healthcare. It is progress but it will
take time. The new WCA is not the way forward, especially given the
change in the UK's economy.
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