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‘First, do no harm’: are disability assessments associated with adverse trends in mental health? A longitudinal ecological study – published in the Journal of Epidemiology and Community Health

November 18, 2015

Journal healthThis report states: “The programme of reassessing people on disability benefits using the Work Capability Assessment was independently associated with an increase in suicides, self-reported mental health problems and antidepressant prescribing. This policy may have had serious adverse consequences for mental health in England, which could outweigh any benefits that arise from moving people off disability benefits.”

Doctors and disability rights organisations have raised concerns that the Work Capability Assessment has had an adverse effect on the mental health of claimants,

“Given that doctors and other health professional[s} have professional and statutory duties to protect and promote the health of patients and the public, our evidence that this process is potentially harming the recipients of these assessments raises major ethical issues for those involved.”

Since 2010 over a million claimants of the main out-of-work disability benefit in the UK had their eligibility reassessed using a new functional checklist.

Over recent years many countries, including the UK, the Netherlands and Australia, have introduced more stringent functional assessment checklists to reduce the growing number of people receiving disability benefits. While in most countries these more stringent criteria have only been applied to new benefit claimants, the UK and the Netherlands have gone further—reassessing their entire caseloads.

Nearly 40% of those who have appealed against the initial assessment decision have had this decision overturned, and five independent reviews have raised concerns about the fairness and effectiveness of the process. In particular the reviews indicated that the process was impersonal and mechanistic and did not adequately capture the impact of many chronic health conditions.

Psychiatrists in one survey reported that some patients had experienced an increased frequency of psychiatric appointments, medication usage and self-harm following their WCA. These anecdotal reports, however, provide limited scientific evidence for the mental health effects of the WCA.

The WCA and reassessment policy, was introduced without prior evidence of its potential impact or any plans to evaluate its effects.

As austerity measures designed to reduce public spending increasingly target social protection systems for people with disabilities, the cumulative impact of these developments needs to be assessed. Although the explicit aim of welfare reform in the UK is to reduce ‘dependency’, it is likely that targeting the people living in the most vulnerable conditions with policies that are harmful to health, will further marginalise already excluded groups, reducing, rather than increasing, their independence.

The report is online here

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