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Is the Welfare Reform Bill ‘Best’ for Disabled People?

January 30, 2012

The purpose of this discussion is to demonstrate that the Welfare Reform Bill currently passing through Parliament is unsuitable for its stated aim and, in certain respects, contradicts the evidence provided to the DWP. It is mainly based on evidence from the meta-analysis contained in the 2006 report ‘Is Work Good for You?’, focussing on this report’s discussion of disability. What it shows is that, although the principle of employment is important (a view shared, after all, by even the most radical disability campaigners, Vic Finkelstein), this view is contextualised in a number of specific ways, the nuances of which are lost in welfare reform which focuses its rhetoric on ‘scroungers’ and the ‘fake disabled’.

What is ‘employment’?

Before examining the evidence to be found in the report, it’s important to be sure what we mean when discussing ‘work’. The report for the DWP concludes:

Despite the diverse nature of the evidence and its limitations in certain areas, this review has built a strong evidence base showing that work is generally good for physical and mental health and well-being. Worklessness is associated with poorer physical and mental health and well-being. Work can be therapeutic and can reverse the adverse health effects of unemployment. That is true for healthy people of working age, for many disabled people, for most people with common health problems and for social security beneficiaries. (38)

This formulation appears to oppose ‘unemployment’ to ‘work’, as though work were defined entirely as a traditional, 9-5 paid employment. However, the use of terms in the report is confused, since earlier in the report ‘work’ and ’employment’ (and indeed ‘worklessness’ and ‘unemployment’) are distinguished. ‘Work’ is defined as follows:

the application of physical or mental effort, skills, knowledge or other personal resources, usually involves commitment over time, and has connotations of effort and a need to labour or exert oneself. Work is not only ‘a job’ or paid employment, but includes unpaid or voluntary work, education and training, family responsibilities and caring (4).

One of the problems with the current debate is that, in political rhetoric and media commentary, this important distinction does not exist (see, for example, the Conservative Party’s statement on Jobs and Welfare). Indeed, the principle, proposed by UnumProvident and upheld by the government to ‘ensure that work always pay better than benefits, and is clearly seen to be doing so’ ensures that, where the studies include all forms of productive activity within the category ‘work’ when assessing its effect on health outcomes, policy cannot.

Is Work Good for You?

With specific reference to disability, the evidence for the overall good of ‘work’ (whether taken to mean ’employment’ or ‘any productive activity’) is admitted to be contingent, even within this report:

The policy statements and guidance in Table 3 are based upon and reflect the available evidence, yet they are essentially expert opinions. Several refer to the evidence on the health benefits of work and the detrimental effects of unemployment in healthy people. Others discuss in general terms the harmful effects of prolonged sickness absence and avoidable incapacity, and the beneficial effects of work for sick people. However, there is little direct reference or linkage to scientific evidence on the physical or mental health benefits of (early) (return to) work for sick or disabled people. (21).

This lack of direct evidence is made clearer when the studies assessed by the report are examined. Taking into account the problems of evidence and referencing for the benefits of work detailed in my earlier post and the UK Action for ME report referenced above, it is interesting to note that much of the information cited in support of the benefits of early return to work for disabled people does not meet the criteria for being most strongly supported. For example, the report is clear that ‘work is not harmful to the psychiatric condition or mental health of people with severe mental illness although, conversely, it has no direct beneficial impact on their mental condition either.’ Indeed, it states categorically that only 30-50% of people with severe mental health problems are capable of work (21).

Things become more complicated, and much less easy to quantify, when the study moves on to discussing ‘common mental health problems’. The information discussed in this area is as follows:

Emotional symptoms and minor psychological morbidity are very common in the working age population: most people cope with these most of the time without health care or sickness absence from work. (Ursin 1997; Glozier 2002)

People with mental health problems are more likely to be or to become workless (sickness, disability, unemployment), with a risk of a downward spiral of worklessness, deterioration in mental health and consequent reduced chances of gaining employment.
(Merz et al. 2001; RCP 2002; Seymour & Grove 2005)

There is a general consensus that work is important in promoting mental health
and recovery from mental health problems and that losing one’s job is detrimental.
(RCP 2002;Thomas et al. 2002; Seymour & Grove 2005)

There is limited evidence about the impact of (return to) work on (people with) mild/moderate mental health problems, despite their epidemiological and social importance. However, there is much more evidence on ‘stress’, which may be the best modern exemplar of common mental health problems.

The elision of ‘common mental health problems’ into ‘stress’ is problematic, as no direct evidence is given for the utility of such a discussion. This problem is made worse by the way in which ‘stress’ is discussed. Rather than assessing the prevalence of different forms of common mental health problem in the workplace, the review complains of an elision between ‘stressor’ and ‘stress response’ in the literature (I do not deny that this is an important distinction to maintain), and the lack of precision in the terms used. In addition to this, the subjective nature of ‘stress’ is bemoaned:

stressors and stress responses and the relationship between them are subjective perceptions, self-reported, open to modulation by the mental state identified as ‘stress’ (whatever its cause), and with confounding of cause and effect (23).

This part of the argument is complex. It is obviously important to assess whether underlying depression or anxiety is making the workplace intolerable, rather than an intolerable workplace being necessarily the cause of anxiety. However, the authors of the report, having drawn attention to this, move on to an assertion by a number of members of the Wessley school of psychiatrists, who are concerned with determining psychosocial causes of diseases, often at the expense of examining physical morbidity, who argue:

The underlying problem is the fundamental assumption that work demands/stressors are necessarily a hazard with potential adverse mental health consequences (Cox 1993; Cox et al. 2000a; Cox et al. 2000b; Mackay et al. 2004), ignoring or failing to take sufficient account of the possibility that work might also be good for mental health (Lazarus & Folkman 1984; Edwards & Cooper 1988; Payne 1999; Salovey et al. 2000; Briner 2000; Adisesh 2003; Nelson & Simmons 2003; Wessely 2004; HSE/HSL 2005; Dodu 2005).

This area is controversial, and I do not pretend to have sufficient knowledge of the area to make an informed decision about the merits and demerits of the work of Wessley and his followers, but from a linguistic point of view, it seems to me that to move from ‘common mental health problems’, to ‘stress’, to the idea that work does not have a necessary risk for mental health is not necessarily one which moves in accordance with the evidence, but rather one which uses rhetorical strategies to give more weight to certain elements of an incomplete evidence set.

What is to be done?

From the above, it may appear that I am engaged in arguing that disabled people should never work, and that many respected scientists are just wrong. This is not the case. Along with the majority of disabled people and politicians, I believe that work (in the sense of productive activity) is an important part of life, and that increasing access to employment for disabled people is important. However, I do not believe that reducing the DLA caseload by 20%, or any of the other cuts to disability related benefits will achieve this. Indeed, the report under discussion also makes it clear that the ‘blunt instrument’ of benefit cuts is ineffective in working towards the social integration of disabled people:

After leaving benefits, many claimants go into poorly paid or low quality jobs, and insecure, unstable or unsustained employment. Many go on to further periods of unemployment or sickness, and further spell(s) on the same or other social security benefits.

Claimants whose benefit claims are disallowed often do not return to work but cycle between different benefits and often report a deterioration in mental health, quality of life and well-being. (29)

In addition to these specific pieces of evidence against the approach the government is taking, there is also much evidence within this report that there is action which could be taken to greatly improve the lives of disabled people, enable more disabled people to take part in meaningful work-activity, and reduce some of the much hated ‘costs to the taxpayer’ of disability support. I provide a lengthy quotation from the report:

work is generally good for your health and well-being, provided you have ‘a good job’. Good jobs are obviously better than bad jobs, but bad jobs might be either less beneficial or even harmful. It is then important to consider what constitutes a good job. Under UK and European legislation, employers have a statutory duty to conduct suitable risk assessments to identify hazards to health and safety, and to reduce the risks to employees as far as reasonably practicable. But health and safety should be distinguished. As well as controlling risks, it is equally important to make jobs accommodating of common health problems, sickness and disability. A ‘healthy working life’ goes even further: it is ‘one that continuously provides working- age people with the opportunity, ability, support and encouragement to work in ways and in an environment which allows them to sustain and improve their health and well-being’ (Scottish Executive 2004). ‘Work should be comfortable when we are well and accommodating when we are ill’ (Hadler 1997). The evidence reviewed here suggests that, in terms of promoting health and well-being, the characteristics that distinguish ‘good’ jobs and ‘good’ workplaces might include:

•    safety
•    fair pay
•    social gradients in health
•    job security
•    personal fulfilment and development; investing in human capital
•    accommodating, supportive & non-discriminatory
•    control/autonomy
•    job satisfaction
•    good communications

This list is tentative, but clearly goes far beyond physical and mental exposures, demands and risks. Further research is required into the characteristics of a ‘good’ job, and further consideration is required of the links between good jobs, health and productivity to support the principle that ‘good health is good business’.

In short – ‘work’ is good for health only when this work is mentally challenging and occurs in an inclusive, accessible and safe space. Given that the government’s current economic policy is determined to attack each and every one of the bullet points in the above list, it cannot also argue that work remains a ‘good’. The current situation is unsatisfactory to everyone – the work capability assessment and culture of hatred and suspicion towards disabled people offers no incentive to even attempt to get better, as disabled people are scared even to enjoy those days when they are able to participate fully in society due to the risk of being ‘shopped’ to the DWP. In addition, the government’s own literature makes it clear that removing benefits from people does not encourage a return to work – especially in an increasingly competitive job market where there is anecdotal evidence for a very low standard of ‘supportiveness’ from JC+ employees.

If the government wished to achieve its stated objectives, it would start by strengthening accessibility legislation, strengthening employee rights, improving wages and job security and investing in industries with a potential for job satisfaction. It would be supporting these measures with a retention of DLA, unassessed, to enable disabled people to afford the extra costs of disability and of the (negative) impacts of work on disability. It would not be undermining the labour market with unpaid ‘workfare’ programmes with what should be some of the largest local employers (for better or worse). In short, it should be supporting disabled people and workers in fact, not merely in rhetoric. And all the evidence for this can be found in its own report.

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5 Comments leave one →
  1. January 30, 2012 6:21 pm

    This careful analysis exposes the dangerously misleading nature of the political rhetoric. I have never enjoyed the type of ‘good workplace’ and have repeatedly failed to cope with the countless menial, low paid jobs i previously worked in.

    I can’t say more than ‘what a brilliant article’ this is. If only more people could read it. There is a need to enlighten people about mental health issues and the work environment. And this needs a deeper understanding than the rhetorical lip service approach hitherto employed by this government in particular.

  2. January 30, 2012 8:54 pm

    You make many pertinent points but I am not sure about one set of references. You cite an individual with the surname of Grove. Would that be Bob Grove, former joint chief executive at the Centre for Mental Health?

    I am familiar with the views of Bob Grove. I have known him over a good many years. He was well aware of the extent of mental ill health in the working population. I do not remember him using the word “stress” as an alternative for the phrase “common mental health problems”. He was aware of the difficulties but he was also aware of the possibilities. He did think constructively about ways of helping people work despite their mental health problems.

    Bob has retired now but I cannot imagine him as a supporter of the Welfare Reform Bill.

    • January 30, 2012 9:03 pm

      Yes, this is Bob Grove, and I hope I have not implied that he supports the elision made by the authors of the DWP report. Grove’s work is indeed aware of the issues and possibilities related to employment in mental health, and it is the authors of the DWP report who have cited the work of Grove and Seymour, before making the move from ‘common mental health problems’ to ‘stress’ on the basis of ‘limited evidence’.

      Grove’s paper is cited as part of this limited evidence, not as a justification for the move made by the report. I hope this makes things clearer, since I also cannot imagine Grove supporting the Bill, since it doesn’t really consider any of the issues he brings up in his work

  3. January 30, 2012 9:55 pm

    I accept what you say. Thank you for the clarification.

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  1. Work, the Social Model, and the Welfare Reform Bill « Los the Skald

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