Work capability assessment: review, reform, or replace?

When coordinating the Preventable Harm Project over the past ten years, I benefitted from contact with various Presidents of the BPS on more than one occasion. They were always courteous, always very supportive of the research, and always insistent that the BPS would do more to attract attention to the preventable harm demonstrated by the research, and by the fatally flawed Work Capability Assessment (WCA), as used to restrict access to various disability benefits. 

I was therefore encouraged to recently learn that there was a joint response by the BPS and other professional associations for psychological therapies to the Improving Lives Green Paper. What was cause for concern is that, included in the joint recommendations was yet another call for a 'review and reform of the WCA'. As the coordinator of the Preventable Harm Project, I beg to differ.

Published in March 2019 by the Journal of Critical Psychology, Counselling and Psychotherapy, the paper identified as 'Psychological Tyranny Masquerading as Welfare Reform' demonstrated that the WCA most certainly does not need to be reviewed or reformed. It needs to be abolished. 

Having demonstrated that the WCA is not only fatally flawed but was influenced and co-designed by American government corporate advisers, UnumProvident Insurance, and adopted by the Department for Work and Pensions (DWP) to resist funding long-term disability benefit regardless of the preventable harm it was destined to create, the adoption of the WCA was a political decision to remove what had been the past psychological security of the welfare state. It worked very well. 

Thousands have died following a WCA. Yet the government continue to resist conducting a cumulative impact assessment, which could establish a link between the WCA and suicides. Many WCA victims have committed suicide, and others have starved to death following sanctions for being too ill to attend the local Job Centre. Yet no-one is held to account for the deaths, despair and preventable harm created by social policy reforms, and academic papers exposing the government imposed suffering are disregarded (Garthwaite, 2011, 2013). 

Professor Ben Barr and colleagues established in 2015 that the WCA was adopted on a fiscal basis, with a total failure to establish its potential impact or any plans to evaluate its effects. This research demonstrated that using the WCA has had a catastrophic impact on the mental health of the chronically ill and disabled community, when using the Waddell-Aylward biopsychosocial assessment model based on discredited government commissioned research, that disregards medical opinion (Stewart, 2018), and has failed all academic scrutiny (Shakespeare et al., 2016). Having adopted the Waddell-Aylward biopsychosocial model of assessment, the WCA disregards diagnosis, prognosis, past medical history and prescribed medicines, and is the consequence of the influence of corporate America with the UK social policy reforms since 1992.

What greater psychological tyranny exists than to expose the chronically ill and disabled community to repeated non-medical functional assessments for a condition that can't ever improve? Disregarding medical opinion was always destined to cause death, despair and preventable harm (Stewart, 2018b), when using the tabloid press to manipulate the public (Briant et al., 2013), and then watching as prosecuted disability hate crimes climbed by 213 per cent during the coalition government's term in office.

The limitations of informed opinion is that it is usually restricted to academic papers, conducted by academics at universities, whilst overlooking the vast amount of significant research evidence available from other sources. A very good example is the significant 'Fulfilling Potential?' project, conducted by Catherine Hale and supported by Mind and the Centre for Welfare Reform. The psychological pressure created by endless WCA reassessments was evident in the survey responses:

The worst thing, I find, is realising that I am forced into looking for a life that I want but have no chance of having. I seriously feel I may kill myself because being sick, having next to no money, no life, no future, no cure, constant pain and constant disapproval and rejection defeats me.

Most recently, the BPS is calling for the removal of benefit sanctions, but only it seems for people with mental health difficulties. Whilst this may seem reasonable, it is unjustifiable. Published research has established that those with physical health limitations can and do develop a mental health problem due to the WCA, the relentless threat of sanctions, the loss of the financial security of a guaranteed regular income, and the demonisation of the disabled community by politicians and by the press.
 

Most recently, academic research has demonstrated a growing mental health impact of the psychological pressure on the able bodied unemployed community, who are suffering a great deal of mental health anguish due to the difficulties experienced by the introduction of Universal Credit. Once again, the research has exposed that a major change in welfare policies was apparently considered only on a fiscal basis and failed to consider the potential health consequences, with no plans to assess the effects on health and wellbeing of a policy change which will impact on millions of lives in the UK.

Therefore, it is hoped that the BPS will now resist the continued calls for a 'review and reform of the WCA', will join the disabled community and social policy academics who've demanded that the WCA should be abolished, and replaced with an assessment that includes medical opinion. If not, countless numbers will continue to be, quite literally, 'killed by the state' (Elward, 2016), and this government enforced preventable harm of those in greatest need will continue to be the norm.
 

Mo Stewart

Independent Disability Studies Researcher

Author of 'Cash Not Care: the planned demolition of the UK welfare state'. New Generation Publishing 2016

https://www.mostewartresearch.co.uk

https://www.researchgate.net/profile/Mo_Stewart/publications

References 

Barr B, Taylor-Robinson D, Stuckler D, Loopstra R, Reeves A, Whitehead M 2015: 'First, do no harm': are disability assessments associated with adverse trends in mental health? Journal of Epidemiology and Community Health BMJ 2015; 0: 1-7. doi:10.1136/jech-2015-206209

Briant E, Watson N & Philo G (2013): Reporting disability in the age of austerity: the changing face of media representation of disability and disabled people in the United Kingdom and the creation of new 'folk devils'. Disability & Society Volume 28, 2013 – Issue 6.       https://doi.org/10.1080/09687599.2013.813837

Elward, L. (2016). Corporate Welfare Crime: Two Case Studies in State-Corporate Harm. Thesis for Master of Arts Social Policy, ResearchGate. DOI: 10.13140/RG.2.2.20097.04969

Garthwaite, K. (2013). Fear of the Brown Envelope: Exploring Welfare Reform with Long-Term Sickness Benefits Recipients. Journal of Social Policy & Administration Vol 48, Issue 7: pp782-798. https://doi.org/10.1111/spol.12049

Garthwaite, K. (2011). 'The language of shirkers and scoungers?' Talking about illness, disability and coalition welfare reform. Disability & Society 26(3): 369-372. DOI: 10.1080/09687599.2011.560420

Shakespeare T, Watson N, Alghaib O A (2016): Blaming the victim, all over again: Waddell and Aylward's biopsychosocial (BPS)) model of disability. Critical Social Policy 2016, 37(1). DOI: 10.1177/0261018316649120  

Stewart, M. (2019). Influences and Consequences. The Conclusion to the Preventable Harm Project, 2009 - 2019. Sheffield, The Centre for Welfare Reform, 2019.  

Stewart, M. (2019c). Preventable harm: creating a mental health crisis. Journal of Public Mental Health: Vol 18 No 4 2019, pp 224230. DOI 10.1108/JPMH-07-2019-0070

Stewart, M. ( 2018). Psychological tyranny prescribed by the DWP: preventable harm is government policy.  British Journal of General Practice 2018; 68 (677): 579. DOI: https://doi.org/10.3399/bjgp18X700001

Stewart, M. (2018b). Preventable Harm and the Work Capability Assessment. ResearchGate. DOI: 10. 13140/RG.2.2.23209.90722