This is a follow up of a previous article on the Health and Work Conversation: Claiming ESA under Universal Credit: Nobody is unfit for work anymore. Click here to read the article
During the Health and Work Conversation, claimants will be asked to fill a questionnaire. It is important to know that this questionnaire can be filled at home and not straight away.
This questionnaire asked questions to help claimants to have a better conversation with their work coaches, and to help them find the best support for claimants according to DWP. What follow are the comments of a Consultant clinical psychologist Dr Jay Watts on the unsuitability of this questionnaire for people with mental health conditions:
JW: It is important to read this new demand on claimants with the wider context in mind. This context is one where the DWP is experienced as punitive, willing to sanction claimants at every turn, with little understanding of the nature of mental health problems, and professionals linking the rise of suicides and mental health epidemic with an austerity regime that belittles and scapegoats disabled people. Professionals like me lack confidence in the DWP’s capacity, or interest in, excluding a wide enough proportion of ‘vulnerable adults’ from this process, who may be made suicidal by yet another requirement. This process is to occur before claimants have their WCA and is mandatory. FOIs tell us that the DWP will presume claimants are fit to work before the WCA, though this demand will be damaging to many. It is likely to increase the time claimants are left waiting before their WCA verdict, leaving claimants in a purgatory that is damaging to mental health.
Some thoughts on the form.
This is not a ‘conversation’ because the terms of reference have been predecided.
DWP: “It’s about helping you get into work when you’re able to in the future.”
It should not be ‘when’ it should be ‘if’. To set up a ‘when’ and indeed to insist on this ‘conversation’ is deeply damaging – it sets up failure in comparison to a (newly created neoliberal) norm. There are many people with mental health problems who will never be able to work. This form is yet another method of equating worklessness with worthlessness, and undermining the other ways disabled people contribute to society.
DWP: You and your work coach will use simple tools to talk about an action that you want to do, and plan how you can do it.
JW: The ‘simple tools’ are not proveably based on positive psychology. But the language of positive psychology runs through every word of this document. One of the core principles of psychology is that intervention should only occur when recipients are able to consent freely. This process is mandatory, and It thus represents a misuse, dare I say it abuse, of power. This is even more problematic in the wider context where many disabled people have been cut off from mental health support and social care. How can it be ethical to deny someone with a history of sexual abuse desperately needed and asked for therapy via the NHS on one hand, whilst insisting they comply with a forced exercise under conditions of extreme stress to return them to work with the other.
What if there is no “action” the claimant wants to do, or is capable of. Not dying is a big enough task these days. Work coaches are to have minimal training, with FOIs suggesting courses will run for 1.5 days max. This is inadequate to understand the complex nature of mental health problems.
DWP: “There are no right or wrong answers”.
JW: Nonsense. There clearly are. What are the consequences of this? Will a copy of the ‘work conversation’ be shared at JobCentre+? If yes, even if these are explicitly not supposed to be used for sanctioning, not having the ‘right attitude’ during the work conversation will bias people to sanction.
DWP: ‘Do you need to take part? Yes
JW: Why yes to ‘do you need to take part’. For many people work is impossible and the idea they should work can feed in to or trigger mental health deterioration. Having to do this could quite literally produce the conditions that make suicide the only option.
DWP: What kinds of things do you like doing in your life and at work?
JW: The inability to like anything, to enjoy life, to feel pleasure or anything but emptiness, is a core symptom of many mental health problems. This is made worse by people’s material circumstances for example poor housing, and poverty. Shining a light on what people like, or the lack thereof, can therefore be dangerous especially in a context where claimants feel obliged to perform. Claimants tell mental health professionals again and again that they simply do not feel safe enough to complete DWP forms openly. These types of questions situate claimants as performing dogs, a task that can be the final straw for many. Liking anything obviously a distant country when in mental distress/poverty. It is an absurd question and most people will not be able to fill in this form as they actually feel due to being so scared of the DWP taking away means to live. Ditto ‘what are you good at?’
DWP: ‘How does your health affect your life and your ability to work?’
JW: This is a very difficult question; people do not have the answer to this easily accessible. Claimants are likely to underestimate the effects of health on life, because guilt fuelled by the ‘striver or skiver’ discourse means people emphasise the good days, leading to inappropriate work plans which will place further pressure on claimants. Work coaches will be under huge pressure to produce encouraging statistics for their supervisors and the DWP, shaping how they ask questions ad hear answers.
DWP: ‘What work have you done in the past, if any?’
JW: Many mental health and physical disabilities start after a few more functional years of adult life. There has often been a period where activity was possible before breakdown. This question is potentially dangerous in that it asks people to reflect on potentially a lost time that can never be got back, forcing into relief the difference between now and then. This is likely to provoke a mourning, an increased depression, a shame, that causes a deterioration in mental health. It may make claimants feel ‘you are not what you were, you should be, and you are not wanted otherwise’ with devastating effects.
DWP: ‘What are some of the things that have made you proud in your life and at work?’
JW: It is none of DWP business. Again it could be damaging if nothing comes to mind, or if something special is thought of which then gets connected with the DWP (so basically a good memory and, say, fear get tied together so the good memory gets polluted). This is not a safe conversation for this environment.
DWP: ‘Is there anything else in your life that makes it difficult for you to work?’
JW: Claimants could answer: not having treatment for my mental health issues due to NHS cutbacks, unstable housing, being continually threatened with sanctions and having my benefits cut by the DWP, but most people will feel too scared to say it as it is, or won’t have that awareness of quite how much say austerity is a causal factor because of the ongoing governmental agenda to make claimants feel it is they who are failing somehow as work is really a possibility for all.
DWP: ‘Tell us how and what you want to do’.
JW: There is no freedom to answer this properly.
The stated aims of ‘My 4 steps’are to boost confidence and motivation to work again. This form will not help with this. It is more likely to undermine confidence and worth with potentially devastating consequences.
DWP: ‘Step 1 want’.
JW: What people want is often something like being able to leave the flat. This is something that work coaches are simply not qualified to help with. The whole four-step programme is again obviously based on ideas from CBT and Behavioual Therapy though not proveably. These should not be worked on outside a trusting therapeutic relationship, where power dynamics are considered, and when the person feels safe. All these requirements are not possible in a ‘work conversation’ DWP setting.
How are these work coaches going to be trained to work with disabled people? What are they going to do when suicidal material comes up? GPs and secondary services no longer have capacity to help when a referral cites suicide risk.
How are they going to screen for people who could be made suicidal by this task. Guilt and shame are central to so many mental health problems (and obviously the governmental discourse have made many claimants feel like this). This form will press on those emotions, making live more unbearable and increasing suicide risk. The suggestions in the form that this is not for now will not help. They set up a trajectory of moving to work which is not achievable for many, making people feel they do not have a worth otherwise. This is not only unethical but will end up increasing healthcare costs.
Some people want help to return to work. Claimants and professionals have repeatedly told the DWP that this should be made available outside the DWP setting, where informed consent is genuinely possible, and where hindrances can be explored safely. Making these ‘conversations’ mandatory is not only likely to be ineffective and damaging for those for whom work is impossible, but will place additional strain on claimants who already feel persecuted by the increasing number of hoops the DWP demand claimants jump through. Demanding claimants fit adhere with an ideal which is unrealistic for many, and which suggests other ways of living are undesirable and meaningless, will adversely affect the mental health of many claimants, increasing the number of suicides connected with an increasingly brutal governmental regime.