Tag: Michael O’Sullivan

Research finds damaging mental health discrimination ‘built into’ Work Capability Assessment. Again.

Research conducted by academics at Edinburgh’s Heriot-Watt and Napier universities confirms what many of us already knew: that the government’s “fit for work” assessment is causing permanent damage to some people’s mental health, from which they are not recovering. 

The researchers say in their report that the Work Capability Assessment (WCA) experience “for many, caused a deterioration in people’s mental health which individuals did not recover from”.

The study comes at the same time as John Pring, journalist from the Disability News Service (DNS) has exposed private provider Maximus in their use of “brutal and dangerous” questions about suicide intention directed at people with mental health problems during their assessments. 

Dr Jay Watts, a clinical psychologist and academic, told DNS that people should only be asked about suicidal ideation by a trained mental health professional who can offer help, or someone in an “existing trusting relationship with the individual”.

Watts said that WCAs were “degrading and humiliating experiences for most if not all claimants” and were carried out in a space which was “not a trustworthy one”.

She said: “Individuals are required to parade their distress and feel compelled to answer intrusive questions (for the means to live relies on this).”

She went on to say: “To ask about suicide or self-harm in this context brings huge risks.”

She added that such questioning “can be suggestive if the environment is unsafe.”

She said that claimants were “battered with multiple questions about that which is most personal” in disability assessments and questioned about suicide while the assessors are “typing away” on their keyboards.

Watts concluded: “I have no doubt that questions on suicidal ideation, and the degrading manner in which they are asked, are one reason behind the suicide spike associated with the WCA process.”

The tragic case of Michael O’Sullivan, who killed himself after being found fit for work by the government’s disability assessors, has also cast a spotlight on the harmful consequences of the work capability assessment, particularly in relation to people with mental health problems. 

Though O’Sullivan’s suicide is the first to have been judged a direct consequence of being found fit for work, the DWP has conducted 49 internal reviews into benefit-related deaths since 2012, according to data released following freedom of information requests by the Disability News Service.

Of these, no fewer than 40 were conducted following the suicide, or apparent suicide, of a person claiming benefit. This is both profoundly shocking and entirely unsurprising. It is the wholly predictable result of a system designed and operated by people who appear to lack even the most basic understanding of the realities of living with mental illness.

Despite providing reports from three doctors, including his GP, stating that he had long-term depression and agoraphobia, and was unable to work, O’Sullivan was taken off employment support allowance (ESA) and placed on jobseeker’s allowance. The decision to find him fit for work was made after an assessment by a Department for Work and Pensions (DWP) doctor, a former orthopaedic surgeon, who did not factor in the views of any of the three doctors treating O’Sullivan.

Work capability assessments discriminate against people with mental health problems and should be “redesigned entirely”, according to Professor Abigail Marks from Heriot-Watt University’s Centre for Research on Work and Wellbeing. This recent study also established, through dozens of in-depth interviews of people who had been through the tests, that “in the worst cases, the WCA experience led to thoughts of suicide”. Mental health charities said the contents of the interviews “reflect what we hear from people every day”.

The researchers interviewed 30 people with existing mental health conditions who had taken the tests throughout 2016. The majority of subjects suffered from depression or anxiety, whilst a smaller number had more complex issues like bipolar disorder or borderline personality disorder. In addition, the team interviewed individuals from advocacy organisations, Citizens Advice Bureau and a former employee of Ingeus, one of the private Work Programme providers.

Marks said: “It is unacceptable that healthcare professionals who act as assessors for the WCA, for example, physiotherapists, nurses, occupational therapists are not fully qualified or trained to assess mental health conditions, yet they seem to be able to override participants’ own GPs, community psychiatric nurses, and therapists.

The WCA must be entirely redesigned, and focus on the potential barriers to work for both physical and mental health problems.”    

The report also highlighted that WCAs make non-Work Programme work experience, or other voluntary work, almost ‘impossible’ for people with mental health conditions. 

Dr Gavin Maclean, research assistant at Edinburgh Napier University, said: “Many of the participants in the study found the experience of the WCA so damaging that they stopped engaging in work-based activity and did not return to it.

This could further reduce their long-term employability and potentially increase their dependency on benefits.”

Dr Sue Cowan, assistant professor of psychology in the School of Social Sciences, said: “For people with severe and enduring mental health conditions, voluntary work may be as ‘good as it gets’, as one of our participants stated.

This does not mean a failure to obtain more. Rather, it is a recognition that an individual is making a choice, and the current system does not recognise or support that in any way.

The assumption that engaging in voluntary work means an individual is fit for employment should be scrapped; there has to be much greater flexibility about undertaking training while on ESA and much greater value must be placed on voluntary work and work-preparation activity.”

The qualitative study highlights in particular a lack of expertise in mental health problems among WCA assessors and advice from the WCA that was not consistent with what people going through the assessment had been told by their own GPs. In one case recorded in the study, a participant recounted a doctor “actually physically gasping” during an appeal because of the poor quality of evidence recorded by a WCA assessor. 

Some participants reported being in tears or having panic attacks during the tests, and others told the researchers that the assessments were “making me feel worse”.

The researchers said that the extreme stress having to deal with multiple stigmas of being unemployed and having a mental health condition became “self-reinforcing and self-perpetuating”, leading to the deterioration of peoples’ condition.

It says in the report: “Our research has reinforced the fact that people with mental health problems face more stigma and discrimination than those with physical health conditions and that this discrimination is built into the WCA.” 

Professor Marks, the lead author of the study, who is based at Heriot-Watt University, told the Independent that people who worked closely with such cases reported that deterioration in mental health conditions was an “almost universal” response to the tests.

Key causes of extreme stress were said to be a claimant’s fear of losing their lifeline income, the prolonged nature of tests, a lack of specialist mental health training amongst assessors, and the fact the test was “clearly geared towards people with physical disabilities.”

This said, many people with physical disabilities have also stated that the WCA experience has had an adverse effect on their mental health. 

Marks says: “A lot of the people we spoke to were in a position where they are preparing to go back to work before their assessment – they were doing training courses, community initiatives, or volunteering.” 

“They said that after the assessment, because the assessment had caused them so much stress, they were unable to go back and take part in those activities because their mental health had had such a deterioration.

“Talking to the advocacy workers, as well, they said it was almost universal that after people had gone through an assessment there was a significant decrease in their mental health.” 

In October last year the Government announced that it would stop repeat Work Capability Assessments for people with chronic conditions, characterising the repeat assessments it was scrapping as “unnecessary stress and bureaucracy”.

Mental health charity Mind said the WCA was clearly “not fit for purpose” and that its lengthy and costly appeals processes could well make matters worse.

“The findings of this report are concerning but sadly not surprising, as they reflect what we hear from people every day,” Ayaz Manji, the charity’s policy and campaigns officer, said.

“People with mental health problems tell us that the current fit-for-work test causes a great deal of additional anxiety. We know the assessors rarely have sufficient knowledge or expertise in mental health, meaning many people don’t get the right outcome and then have to go through a lengthy and costly appeals process. 

“The current approach is not fit for purpose and needs to be replaced by an open and honest conversation based on each person’s individual needs.”

Debbie Abrahams, the shadow work and pensions minister, said the study was more proof that the WCA “is not only unfit for purpose, but is causing harm to some disabled people”.

She added: “That’s why I have committed Labour to scrapping these assessments completely and replacing them with a holistic, person-centred approach.”

As usual, a Department for Work and Pensions spokesperson dismissed the interviewees’ experiences as not “statistically significant”.

Apparently, qualitative data doesn’t count as “empirical evidence”, or contribute to it. Or put another way, if the government don’t want to count it, it doesn’t count.

The spokesperson said: “Only thirty people were interviewed for this report, which fails to acknowledge any of the significant improvements we have made to our assessments – particularly for people with mental health conditions.” 

“Last year alone at least 35,000 work capability assessments took place in Scotland to help ensure people get the right level of support that they need.”

In fact, 37 interviews were conducted for the study. Furthermore, there is much evidence outside of this study that supports the findings. Qualitative evidence often provides richer, more in-depth, detailed evidence than quantitative studies tend to permit. Yet the government insist that citizens’ own accounts are not important, regularly dismissing them as “anecdotal”.

The government have also failed to conduct a quantitative investigation into the established correlation between WCAs and a deterioration in mental health conditions.

In 2015, the “fit for work” tests, introduced to assess eligibility for disability benefit ESA, were again found to have caused relapses in patients with serious mental health conditions, Dr Jed Boarman, consultant with the Royal College of Psychiatrists, called for an  overhaul of the process.

Boardman, a consultant psychiatrist at the South London and Maudsley NHS trust, also said the WCA discriminates against those with mental health issues. 

Boardman, who treats patients with serious and long-term mental health problems, said: “People with severe long-term problems get very distressed about being assessed, probably because mistakes are made, because the process isn’t perfect, because they don’t feel they are being listened to in their interviews.

“You do see people relapsing as a consequence of getting distressed.”

His comments followed a study, published the previous month, that linked the WCA tests with an additional 590 suicides, increased mental health problems and hundreds of thousands of antidepressant prescriptions.

The study, published by the Journal of Epidemiology and Community Health, showed a correlation between worsening mental health and assessments under the WCA.

The Department for Work and Pensions described the study as “misleading.”

The study’s main author, Benjamin Barr, said it was crucial the DWP takes seriously concerns that WCAs are “severely damaging” mental health. He called on the department to release data it holds to researchers to allow further analysis of the health impact of the controversial test.

Boardman added: “Their primary criticism of our study is that we don’t have data specifically on people going through the WCA and consequent mental health problems,” said Barr, from the University of Liverpool. “They have data on who has died following the WCA and they could facilitate linkage of that data with health causes.”

Thousands of claimants have died after being found fit for work, according to statistics released in August 2015 by the DWP, following a freedom of information request and a determined and successful court appeal by Mike Sivier of Vox Political. Ministers insisted that the figures they have released could not be used to link claimant deaths to welfare reforms, but the government has refused to release figures that would make it possible to assess whether the death rate for people found fit for work is higher than normal.

Boardman and Mark’s concerns are echoed by psychologists and benefit advisers working with claimants, who say they have gathered a lot of qualitative evidence that WCAs cause much additional psychological distress for those with mental health issues.

Related

Maximus ‘admits’ using brutal and dangerous suicide questions – John Pring

Man leaves coroner letter as he fears Work Capability Assessment will kill him

Doctors bribed with 70-90k salaries to join Maximus and “endorse a political agenda regardless of how it affects patients.”

What you need to know about Atos

The importance of citizen’s qualitative accounts in democratic inclusion and political participation

Dying from inequality: socioeconomic disadvantage and suicidal behaviour – report from Samaritans


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A tale of two suicides and a very undemocratic, inconsistent government

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“No, we have not carried out a review […] you cannot make allegations about individual cases, in tragic cases where obviously things go badly wrong, you can’t suddenly say this is directly as a result of government policy”– Iain Duncan Smith, Secretary of State for Work and Pensions, 5 May 2015.

Back in July, the Information Commissioner’s Office opened an investigation into four of the UK’s largest charities, following allegations that their fundraisers contacted people registered with the government’s opt-out nuisance call database.

David Cameron led the calls for fundraising regulators to investigate whether a 92-year-old poppy-seller, found dead in Avon Gorge after committing suicide, had been under pressure from charities asking for donations.

A spokesperson for the Information Commissioner’s Office, the watchdog responsible for enforcing data protection laws, said: “We’re aware of allegations raised against several charities, and will be investigating whether there have been any breaches of the Data Protection Act or privacy and electronic communication regulations.” 

It was the workers at a London call centre, fundraising on behalf of the charities, who were accused of calling, and being prepared to take money from, vulnerable people, including the elderly and those living with dementia, the Daily Mail reported.

Those with dementia and Alzheimer’s were allegedly being treated as legitimate targets – as long as they agree to the call and are able to answer a few basic questions over the phone.

Cameron said: “I know there is a code that is meant to protect people from feeling pressured by charities and I hope the Fundraising Standards Board will look at whether any more could have been done to prevent this.” 

However, although Olive Cooke did tragically kill herself, it has since been established by her family and at an inquest that her suicide wasn’t related to charity fundraising requests at all.

So, Mr Cameron didn’t hesitate to make a connection between a tragic suicide and the policy of “charities, who were accused of calling, and being prepared to take money from, vulnerable people.” As it happens, he drew the wrong inference from remarkably little empirical evidence. I say remarkably little, because in similar circumstances involving suicides and deaths in other social groups, David Cameron demands that people don’t make any inferences at all and from much more reliable evidence than he had to draw on in order to conclude that an investigation was warranted into the impact of charities’ fundraising requests.

This said, one tragic death really ought to trigger an inquiry into policy. That is the right thing to do.

The Stark Contrast.

In 2013, a disabled man committed suicide as a direct result of being found “fit to work” by the government’s work capability assessment. In a report to the Department of Work and Pensions, the coroner for Inner North London demanded that the Government department take action to prevent further deaths.

The coroner’s report on the death of Michael O’Sullivan warns of the risk of more such deaths. Michael, a 60-year-old father of two from north London, killed himself at his home after being moved from employment support onto jobseekers allowance, despite providing reports from three doctors, including his GP, that he was suffering from serious long-term depression and agoraphobia and had been certified as unable to work.

The coroner said that Michael’s anxiety and depression were long-term problems, but the intense anxiety that triggered his suicide was caused by his (then) recent assessment by the DWP as being fit for work.

Surprisingly, David Cameron did not lead any calls for an investigation into the policies that caused this tragic suicide, despite the coroner’s report and widely shared, well-documented, (and evidenced) concerns that the Department of Work and Pensions is placing sick and disabled people under enormous strain which is unacceptably harmful and distressing. The Conservative welfare reforms included an increase in benefit “conditionality” which involves punitive sanctions and rigid assessments that are not designed to provide support, but rather, to save money and remove people’s eligibility for lifeline social security benefit, causing them severe hardship, harm, and sometimes, causing their death.

In other words, the Department of Work and Pensions “are prepared to take money from vulnerable people.”  This is the only income that people claiming benefits have to meet their basic survival needs.

Furthermore, Mr Cameron has persistently refused to carry out even basic monitoring of the impact of his government’s policies despite longstanding public concerns about the fact that they are causing sick and disabled people harm. This government have doggedly refused to release information regarding the mortality rates of people who face the negative impact of Conservative policies every day.

David Clapson, 59, was a former soldier and had type-one diabetes, he died in last year after he was sanctioned – his benefit was stopped as a punishment – because he missed an appointment at the jobcentre. The coroner reported that Mr Clapson had no food in his stomach, £3.44 in the bank and no money on his electricity meter card, leaving him unable to operate his fridge where he kept insulin, which has to be kept refrigerated. He died of diabetic ketoacidosis because he couldn’t take his insulin.

In addition to tragic cases like those of Michael and David that are reported in the media, there are many others raised in parliament by MPs and through the work of select committees, which are evidenced on the parliamentary Hansard record of course. Additionally, some of us also keep a record of the growing number of people who have died prematurely because of the welfare “reforms”. 

Furthermore, the United Nations believe there is sufficient evidence to warrant an investigation into the impact of Tory policies, the UK has  become the first developed country to be the subject of an inquiry into “grave and systematic” violations of the rights of disabled people. Wouldn’t you think that this would prompt some concern and scrutiny of policies and impacts from the Government? But it hasn’t.

The government persistently deny there is any correlation between suffering, hardship, an increase in suicide and deaths amongst disabled people and their punitive policies. Yet there is substantial evidence to demonstrate a very clear correlation, and certainly more than enough to warrant an inquiry into the harmful impact of the policies on sick and disabled people. After all, one unrelated death was sufficient to warrant an inquiry into the fundraising policy of charities.

Yet we are told by David Cameron that “it is quite wrong to suggest any causal link between the death of an individual and their benefit claim” when evidence strongly suggests such a link. An inquiry is the only way that the correlation could possibly be refuted, but the Government realise that a refutation is an unlikely outcome, hence their refusal to allow an inquiry in the first place.

Campaigners have fought to ensure that information about the harmful impact of government reforms was open to public scrutiny. The truth, however, still remains hidden beneath the excessively and purposeful bureaucratic management of this information and political denials of culpability. Mike Sivier, a fellow campaigner and writer at Vox Political, requested a tribunal after he made a Freedom of Information request for access to the information – and it was refused. Over the last three years, many of us submitted FOI requests for the same information and all were refused.

This is not an accountable, transparent or democratic Government. Let’s not forget the political fabrication of case studies of people “helped” by having their lifeline benefits stopped, presumably because they couldn’t find any real people who would attest to such absurd, ideologically driven, class contingent political acts of targeted cruelty. What real person would ever claim that starvation, being cold and facing destitution “helped” them in any way?

After suppressing information for years, the Department of Work and Pensions finally released data about the deaths of sick and disabled people, but the release was partial, and was not responsive to the detailed request made for detailed and specific information. In fact the data was presented in such an intentionally contextless and incomplete way that there wasn’t even scope for analytical cross comparisons to be made. The release was deliberately limited and impenetrable, as the department of Work and Pensions acknowledged when the report was published with this proviso:

“Any causal effect between benefits and mortality cannot be assumed from these statistics. Additionally, these isolated figures provide limited scope for analysis and nothing can be gained from this publication that would allow the reader to form any judgement as to the effects or impacts of the Work Capability Assessment.”

(From the Department of Work and Pensions report Mortality Statistics, 2015.)

I will leave you to draw your own inferences regarding the startling disparity and incoherence apparent in the two distinct government  responses to suicides and deaths in two separate and differentially valued social groups – one that is politically marginalised, one that is not – and the government suppression of information regarding the impact of their targeted, draconian austerity policies.

All lives have equal worth. But I think it’s safe to say that we’re not “all in it together” as Cameron claimed. He believes that some lives are more important and some suicides are more worthy of investigation than others. It is very clear that this government does not care about the lives and welfare of sick and disabled people.

Call me cynical but I wonder which social group are more likely to vote Conservative?

Related

Suicides reach a ten year high and are linked with welfare “reforms”

292533_330073053728896_1536469241_nPictures courtesy of Robert Livingstone

Fit for work assessment was trigger for suicide, coroner says

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A disabled man killed himself as a direct result of being found “fit to work” by the government’s work capability assessment, a coroner has ruled. In a report to the Department of Work and Pensions, the coroner for Inner North London demanded it take action to prevent further deaths.

The coroner’s report on the death of Michael O’Sullivan  warns of the risk of more such deaths. Michael, a 60-year-old father of two from north London, killed himself at his home after being moved from employment support onto jobseekers allowance, despite providing reports from three doctors, including his GP, that he was suffering from long-term depression and agoraphobia and had been certified as unable to work.

The coroner said that Michael’s anxiety and depression were long-term problems, but the intense anxiety that triggered his suicide was caused by his (then) recent assessment by the DWP as being fit for work.

Previously, the loss or reduction of benefits have been cited as a factor in deaths and suicides of claimants by coroners. However it is believed to be the first time the work capacity assessment (WCA) process has been blamed directly for the death of a claimant. Iain Duncan Smith can no longer deny a causal link between benefit cuts and suicide following this landmark verdict.

Michael O’Sullivan died on 24 September 2013, but his case came to light after Disability News Service reported the story.

In a document marked “sensitive”, Mary Hassell, the coroner for Inner North London, told the DWP she concluded the “trigger” for his suicide was his “fit for work” assessment and detailed her concerns over future deaths.

The report, known as a Prevention of Future Deaths or Regulation 28 report, Hassell wrote:

“I found the trigger for Mr O’Sullivan’s suicide was his recent assessment by a DWP doctor as being fit for work. During the course of the inquest, the evidence revealed matters giving rise to concerns. In my opinion, there is a risk that future deaths will occur unless action is taken.”

At an inquest into his death last year, Hassell said that O’ Sullivan was suffering from long-term anxiety and depression “but the intense anxiety which triggered his suicide was caused by his recent assessment by the Department of Work and Pensions [benefits agency] as being fit for work and his view of the likely consequences of that”.

The inquest heard that in his assessment, the Department of Work and Pensions (DWP) assessing doctor, a former orthopaedic surgeon, did not factor in the views of any of the three doctors treating O’Sullivan. She also said that he was never asked about suicidal thoughts, despite writing them down in a DWP questionnaire.

Under a heading marked “matters of concern” in her report to the DWP, Hassell said the assessing doctor did not take into account the view of any of the three doctors who were treating O’Sullivan. She said:

“However, the ultimate decision maker (who is not, I understand, medically qualified) did not request and so did not see any reports or letters from Mr O’Sullivan’s general practitioner (who had assessed him as being unfit for work), his psychiatrist or his clinical psychologist.

In my opinion, action should be taken to prevent future deaths and I believe that you and Jobcentre Plus have the power to take such action.”

In its 16-page response to the coroner’s report, the DWP admitted it had got it wrong. It said that its policy to request further evidence when a claimant mentions suicide on claim forms was “regrettably not followed in this case”.

It also said the WCA process remained under “continual review and development”, including through five independent reviews, and concluded:

“We have noted the issues in this case and will continue to monitor our policies around assessment of people with mental health problems while we await the outcome of related litigation.”

The Department of Work and Pensions has conducted at least 60 internal investigations into suicides linked to benefit changes since 2012. Last month, DWP data showed the equivalent of nearly 90 people died every month after being declared fit for work and losing their benefits between 2011 and 2014.

A Department of Work and Pensions spokesman said last Monday that improvements have been made to the system since the coroner’s report. The spokesman said:

“Following reforms to the work capability assessment, which was introduced in 2008, people are getting more tailored support to return to work instead of being written off on long-term sickness benefits as happened too often in the past.”

People were not dying in their thousands before the introduction of the Tory austerity measures. The so-called “reforms” to the work capability test have been going on according to the DWP for the past five years, yet we see no improvement in outcomes.

Reducing a response regarding a suicide brought about by departmental and wider negligence to petty political point scoring, casualising tragic, needless and premature deaths that are linked with the welfare “reforms” and Conservative small state fetishism, is an outrage. This is not an acceptable or appropriate response from the DWP.

This tragic case along with the recorded, detailed evidence of many others, has been presented to the government by campaigners, opposition MPs, and by the parliamentary work and pensions committee as part of their inquiries related to the reforms, clearly demonstrating that government policies are causing harm to people. This case alone ought to have triggered an independent inquiry regarding the impact of the “reforms”, but instead we are presented with persistent and aggressive denials of a causal link between an increase in premature mortality and Tory policies, such as the non-medical WCA, (which was  re-designed by the Tories when they re-contracted Atos to deny people their entitlement to benefits,) without any grounds for those denials whatsoever.

This is a government that has abdicated its responsibility – its democratic, ethical, moral and legal duties towards those people who need the most support. Furthermore, by modelling such callous indifference towards the social groups that they have also stigmatised and scapegoated, this government are also pushing public moral and rational boundaries, too,  leading to desensitisation, and a normalisation of prejudice, discrimination and of a government’s actions that are designed to intentionally punish and coerce unemployed, sick and disabled people rather than support them.

We must challenge that and keep pushing back, because the alternative –  bystander apathy – is untenable. To do nothing is to give a silent consent to a continuing and devastating cumulative policy impact on the poorest and weakest citizens that is tantamount to eugenics, albeit by stealth.

Kitty

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Pictures courtesy of  Robert Livingstone.