By Jonny Benett

The central tenet that forms the basis of ‘social security’ is an attempt to provide security for people to live in society with the same inherent freedoms enjoyed by the rest of the populace.  The UK, as part of a commitment to these principles, recognises the UN Convention of the Rights of Persons with Disabilities (CRPD), including Article 19, which ensures the ‘equal right of all persons with disabilities to live in the community, with choices equal to others’.

As part of the uprooting of the benefits system, there is set to be substantive and unprecedented changes to Disability Living Allowance (DLA).  The proposals seek to replace the existing system with a new Personal Independence Payment (PIP), which will include both a more rigorous assessment procedure and an overall cut of 20% of its previous budget of £12.6bn.

The government has claimed that this is the ‘best way forward’ for a ‘failing system’.  However, the evidence for this has been less than forthcoming, with a consultation resulting in a 74% rejection of the proposal.  What is significant about these figures, when responses are analysed, is that the majority recognised the shortcomings of the current system, and there is a grounded acknowledgment that reform is necessary.  Why then, should a consultation on the proposed PIP come back with such overwhelming rejection?  In a report headed by Dr S J Campbell (Responsible Reform – ‘A Report on the proposed changes to Disability Living Allowance’), it seems many of the respondents deemed that the changes were not driven by a desire to improve the efficiency and efficacy of the system, but by cutting the costs of the benefit.

The changes to DLA can be seen in the context of massive cuts to the benefits system, partly in response to the supposed unfettered abuses of the existing system by ‘benefit scroungers’ and fraudsters.  Such an argument is curious, especially in relation to DLA, when considering evidence revealing that fraud cases have resulted in costing the DWP 0.5% of its overall budget for DLA, disproportionate to the proposed 20% cut.

In reality, the consultation period – a process whereby individual’s affected by changes to legislation have the chance to respond to government proposals before they reach parliament – was wildly insubstantial, creating what the report calls a ‘trust deficit’, and a feeling among respondents that they have no stake in legislation that affects them in the most direct sense.  The result of this is that the government risks falling short of due democratic process, part of which is placing person centeredness at the heart of any changes to DLA.  Equally worrying, by placing reforms to DLA in the same basket as others benefit cuts, it leaves open the possibility that people living with disability will be labelled benefit scroungers, the latest demographic in a long line of scapegoats (after migrant workers, assylumn seekers and the unemployed) of an imploding socio-economic system.

A key element of the proposed introduction of PIP is the adoption of a new assessment procedure in line with the infamous Work Capability Assessment (WCA) developed for Employment and Support Allowance (ESA).  This much derided procedure has been proven to be intrinsically flawed from both a financial perspective and, crucially, a human one.

The Democratic Deficit

Consultation is a mechanism usually used to legitimise proposals before being presented as bills in parliament.  However, in the case of DLA reforms, the consultation period took place during a hectic Christmas period, where responses were likely to be low, and was cut two weeks shorter than the recommended period.  Crucially (when assessing ‘legitimacy’), the Bill was presented to parliament before the consultation was over, meaning responses could not be taken into account when drafting legislation for the new PIP.  This has compounded a feeling (felt across much of the UK and especially by those living with disabilities) that proposed legislation is not taking into account the opinions of those it will affect, but are in fact castrating them from the legislative process all together.  This ‘trust deficit’ is quantifiable by the fact the government deemed the consultation period redundant enough as a mechanism that it did not wait for the responses before presenting the Bill.  Either that, or there may have been one or two influential figures within the DWP expecting negative feedback.  Without doubt, the responses were negative – 74% against the proposal for PIP, with a mere 7% in full support of it.  These figures become more powerful when considering at no point during the consultation was the 20% reduction in expenditure mentioned.

I currently work in a Social Housing Project where the primary diagnosis’s for its resident’s are schizophrenia and personality disorders.  It was unsurprising to find out that there wasn’t one resident aware of these proposed changes before a workshop was set up on the subject.  It is of no surprise that in a mental health system that often maintains a person’s subservience to diagnosis, medication and benefits, that there is little information offered on changes to how that subservience manifests.  Following on from this workshop, a group was established with residents to develop personalised letters expressing their concerns about the changes, which are to be sent to Maria Miller MP, the Minister for Disabled People.  Whilst being an example individual’s taking control, it is a depressing reality that this was only facilitated by a workshop put on by the Project.  Thousands of other’s will still be unknowing of the Government’s intentions.

For those living with mental health disability, the introduction of PIP could well have a deciding influence on their abilities to recover with any level of autonomy and independence.  One of the key proposed changes is a cutting of the current 3 tiered system of DLA applications to 2, in an attempt to ‘make the benefit easier to understand and administer’, which is to be based on the desire to reach those ‘with the greatest need’ (those for whom living with a disability is costly).

While sounding reasonable, this misses a central understanding of disability, an understanding that need is not always equitable to overall cost.  This is especially the case with mental health, where issues are less pronounced and thus cost less overall, but those costs are essential for recovery and independence.  Some of the resident’s that I work with are on the lower rate (3rd tier) of DLA.  A prominent element in people’s letters was recognition of how this DLA gives them the opportunity to develop their lives in ways they want to, and offer them a chance to escape from the overall confines of the mental health system.  Many responses focused on DLA giving them the chance to enrol on university and college courses, which offers structure and incentives for future jobs, as well as the chance that most basic and rewarding of human feeling – achievement.  One resident wrote:

“I use my DLA for expanding my book collection and university fees, as I am currently studying Mathematics at Birbeck.  This allows me not only to learn and explore my academic interests, but also develop new social networks and friendships”

Another response mentioned that DLA has helped him save for a holiday, a very tangible example of breaking from those confines, if only momentarily.  The overarching message though, was that on the most modest of receipts they have the chance to live with a element of freedom and autonomy, helping them escape stigma and offering up a different existence to the one consumed with meetings with psychiatrists and care teams.  This is essential for the recovery of those with mental health disabilities.  This is in accordance with the Recovery Model of disability, the premise of which is based on asking individuals to step out of the ‘sick role’ and recognise themselves as autonomous people with the capacity to live freely and fully despite mental illness.  What was expressed in the letters written was that DLA can facilitate the beginning stages of that autonomy and independence, and can help engender a belief that a mental health diagnosis does not have to define a person.

Further, taking away the 3rd tier of DLA is a false economy, and no real cost effectiveness was dissected.  For those who will be taken out of the DLA threshold as a result of this, they face being thrown on to a 17 year high unemployment scrapheap, or falling back into mental health services.  Both eventualities are extremely costly.

However, the changes are qualified by government by pointing to those who abuse the current system, and place this abuse under the greater culture of worklessness in the UK.  Since the DLA was established in 1992, there has been a clear rise in receipts.  This, in itself, is not surprising when considering it was established with the aim of expanding the failing coverage of disability benefits.  However, the DWP has deemed this inconsequential, and it would appear that growth in the DLA caseload and expenditure count in themselves as evidence that the benefit is being awarded inappropriately.  In relation to mental health, this argument falls apart as soon as figures are subjected to routine analysis.

It can be noted that even with this continuous growth in receipts since 1992, just over 1% of the working age population is receiving DLA for mental health associated reasons, a far lower figure than estimates of the population prevalence of more severe mental health problems.  In the NHS Adult Psychiatric Morbidity Study 2007, the prevalence of common psychiatric disorders with a ‘level of severity high enough to require treatment’ among working age adults was between 6.5% and 8.7%.  Therefore, when reflecting on the 1% that do receive DLA for mental health reasons, the question surely isn’t why have the amount of receipts grown, but why it has taken so long to reach this level, and what can be done to reach further individuals in need of treatment and support?

Human Rights Abuse

The report issued by Dr Campbell also expressed concerns that the DWP may abuse the Human Rights of its citizens living with disabilities.

The argument lies in the proposed adoption of a new assessment procedure (more rigorous and regular than under the existing DLA format), which is designed in the style of the WCA.  The system seems to apply heavy weight to the medical model of disability, the main premise of which states that a disability, which is intrinsic to the individual, may reduce the individual’s quality of life.  In other words, it rejects the societal effects on disability.  Under this procedure, those with mental health disabilities are at an inherent disadvantage as the criteria are very much weighted towards recognition of physical disability.

By its very nature, mental health is far less visible, often invisible, during physical assessment or in everyday life.  It is often only identifiable by trained mental health professionals, with whom initial diagnosis rests.  The issue of fairness arises when considering that the assessments are set to be conducted by ‘General Healthcare Professionals’ – ‘general’ being very much the operative, and in many cases these can be nurses or physiotherapists.  In the majority of cases people living with mental health disability set to be assessed on their right to DLA by people with no necessary history or expertise in the complexities and intricacies of mental health, or the individual.  Such is the level of concern on this measure, that the Office of the Mayor of London released this statement:

“Supporting evidence (for DLA eligibility) should only be sought from healthcare professionals who are familiar with the individual, for example their GP or consultant…It would be difficult for a healthcare professional, in a one-off meeting to elicit a comprehensive response about the daily reality for each claimant”.

In the consultation that took place over Christmas, the greatest response was to the proposed change to the assessment process.

From my own perspective, as someone who has only been working in mental health for a short period, it seems blindingly inappropriate to conduct the same assessment for those with ‘invisible’ or ‘fluctuating’ conditions as the ones set for disabilities where the effects have a degree of permanence and consistency.  This is in stark contrast to the person centred, individually tailored path of recovery that is so essential for those suffering with mental health, and indeed physical health disability.

Further, and no less significant, was a grounded fear from respondents about the possibility of an objective assessment when considering the assessors have already been charged with cutting the cost of the benefit by 20%.

The issue of Human Rights comes into focus when considering the UK’s recognition of the Equality Act 2010.  By recognising this, it is deemed illegal for government legislation to treat one group of disability less favourably than another.  In setting up a blanket assessment procedure for all DLA recipients, that holds a heavy bias towards recognising physical and visible disability, the DWP risks contravention of the 2010 Act.

The proposal for PIP has shown blatant disregard for the UN CRPD, and for the ideals of social security that formed the basis of the DLA in the first place.  The journey the proposal has taken to parliament has led to a democratic deficit and given rise to anger amongst people with disabilities and their representative organisations, as well as a feeling of under-representation.  This has been created by the apathetic approach by the DWP into the concerns the introduction of PIP raises, namely its attempt to indiscriminately slash 20% of its budget, and install an assessment procedure that is not compatible with judging peoples needs, and has a pre-requisite to enable these cuts.

That the UK government seems in danger of contravening major human rights legislation in order to save approximately £2bn from the budget seems absurd, but is testament to a state system intent on maintaining a failed economic system, where neglecting and scapegoating vulnerable people is the keystone.