The British government has recently acted to prevent people with mental health difficulties qualifying for the higher rate mobility component of Personal Independent Payment (a benefit intended to help towards the additional costs faced by disabled people).
The basic facts are:
- when introducing Personal Independence Payment in 2013 (which replaces Disability Living Allowance) the government claimed to be giving ‘parity’ to mental health and physical conditions in developing the eligibility criteria
- recently a Tribunal Judge took the government at its word in terms of treating mental health and physical conditions equally and ruled that criteria 1f - “Cannot follow the route of a familiar journey without another person, an assistance dog or an orientation aid" - could also apply for mental health reasons. This would qualify people with mental health conditions for the higher mobility rate of PIP
- in response, the government introduced an amendment so that criteria 1f now reads: “For reasons other than psychological distress….”.
There has been much criticism of the government’s action, but it’s important to also set this particular controversy in a wider context.
As Alan Roulstone identified, we are seeing a time of increasing concern expressed by government that ‘too many’ people have been classified as entitled to support because of illness, impairment or disability. This trend started in the 1990s but has intensified since 2010. It is no accident that the current controversy focusses on whether people experiencing mental ill health are ‘really disabled’. According to the Adult Psychiatric Morbidity Survey the incidence of mental health problems has increased since 2007 and this poses a problem for any government attempting to reduce the amount of money spent on disability benefits.
When Mobility Allowance - the forerunner to Disability Living Allowance - was first introduced, entitlement was established by a medical professional certifying that a person’s mobility was impaired. Disability Living Allowance, introduced in 1992, not only extended the benefit to recognise additional daily living costs but also used a form to be completed by the applicant which, although medical evidence could be required, recognised an element of self-assessment.
In contrast, Personal Independence Payment, which replaced DLA in 2013, relies on the notion of a ‘more objective’ assessment process which involves an initial form to be completed by the applicant, a face to face assessment carried out by one of two companies contracted by the government, and a Department for Work and Pensions (DWP) decision maker. Entitlement is determined by scoring against a range of both ‘moving around’ and ‘daily living’ descriptors. While medical evidence can be required it is secondary to the scoring system. As with the Work Capability Assessment, the focus is (supposedly) on function rather than on diagnosis.
The replacement of DLA with PIP was motivated by the political goal of reducing public expenditure. Although there has long been a tendency to divide disabled people into the ‘deserving’ and ‘undeserving’ in governments’ attempts to minimise collective responsibility, this became much more explicit and associated with changes in social security policies since 2010. Public debate on disability benefits during the last seven years has been dominated by the question of who is ‘really disabled’ - politicians are focussing not only on what collectively funded support should be made available to disabled people but also on who is to be recognised as disabled.
Disability Living Allowance was a popular benefit with no stigma attached to receiving it. Increasing numbers of people claimed it - partly because more disabled children were surviving, partly because of increasing take-up by people with learning disabilities and people with mental health difficulties (encouraged by government and disability organisations in the late 1990s and early 2000s). An ageing population also meant that growth in expenditure was inevitable as, although an initial claim could not be made after the age of 65, it could continue to be received as people grew into old age.
This increase in expenditure posed a problem for the government elected in 2010 intent on reducing public expenditure. The replacement of DLA with PIP was intended to reduce projected expenditure by 20%. The new form of assessment introduced for PIP aimed to achieve this by reducing recognition of impairment, illness or disability. Esther McVey, then Minister for Disabled People, told Parliament in December 2012 how the government expected that almost 60% of people to be moved from DLA onto PIP would either receive a reduced benefit on reassessment or would receive no benefit at all: “By October 2015 we estimate we will have reassessed 560,000 claimants. Of these 160,000 will get a reduced award and 170,000 will get no award”.
George Osborne, when Chancellor of the Exchequer, then tried to reduce further the numbers qualifying by restricting the eligibility of people who rely on aids and adaptations to go about their daily life, and thereby to make a projected saving of £1.3bn. A public outcry, including opposition from many Conservative MPs, resulted in this proposal being withdrawn. [See my previous blogpost on this, which attempted to correct some of the many misleading statements made by politicians and journalists at the time]
While we have been living through the state’s attempts to reduce the numbers of people generally recognised as ‘disabled’, the current controversy about PIP - which will be debated in Parliament on April 19th - sees a particular onslaught on the realities of the lives of people who experience mental ill health. This was starkly illustrated by the head of the Prime Minister’s Policy Unit, interviewed on the BBC on 26th February. George Freeman articulated the way in which people with mental ill health are considered by some politicians to not ‘really disabled’. Explaining why the government was acting to reverse the Tribunal’s ruling (referred to above), he said: ”These tweaks are actually about rolling back some bizarre decisions by tribunals that now mean benefits are being given to people who are taking pills at home, who suffer from anxiety…..We want to make sure we get the money to the really disabled people who need it”. [my emphasis]
No doubt George Freeman had in mind that the ‘really disabled’ people are those whose impairment and consequent additional costs are visible. This is to betray a lack of knowledge about disability and in particular of the way that mental ill health can be as incapacitating as physical impairment, if not more so, as pointed out by Baroness Jane Campbell in a recent House of Lords debate on the PIP amendment:
People in my position, with a highly visible, severe impairment, tend to find it easier to demonstrate and receive support the we need to get from A to B, than those experiencing mental health challenges…… But let us be in no doubt: the impact of panic attacks and anxiety - not to mention schizophrenia, dementia and autism - on being able to “plan and follow a journey” are equally, if not more fraught with profound obstacles, as the effects of visual or physical impairments. As Jenna Guillaume put it:
‘Suddenly, for no reason at all, as I step out of my front door, the prickles in my chest get sharper and my head gets foggier. My heart pounds faster as it tries to defend itself from impending danger. My breathing becomes shallow as I desperately try to get air into my body and brain... I try to grasp onto something, anything, to keep me tethered and whole’.
The term ‘anxiety’ may sound manageable, but unexpectedly and unpredictably collapsing in agony in public places can overwhelmingly restrict people’s mobility.
Speaking to a young woman with ADHD and Tourette's syndrome last week, I heard about her recent train journey, where she suffered a severe anxiety attack. The train had to be stopped and the emergency services called. This expensive scenario could have been avoided if her PIP had not been reduced from the high to standard rate award a couple months ago, allowing her to continue paying for a travel companion or use taxi's.
People whose support needs and additional costs stem from conditions which are not immediately visible and do not conform to the traditional view of disability are easy targets in the current climate. The House of Commons Library calculated that “reversing the effect of the mobility activity 1 judgment could affect 336,500 claimants (with 282,500 no longer entitled to any mobility component). The latter changes could affect people with a wide range of conditions including learning disability, autism, schizophrenia, anxiety conditions, social phobias and early dementia”.
The government’s attempt to reverse the Tribunal’s ruling is not only undemocratic (as Labour’s Shadow Work and Pensions Spokesperson, Debbie Abrahams, pointed out) but it is also discriminatory - and ironically goes against what the government originally said was one of the justifications for the new form of assessment when PIP replaced DLA. Maria Miller the then Minister for Disabled People said, “PIP is designed to assess barriers individuals face, not make a judgment based on their impairment type”. Yet, as MP Stephen Timms pointed out during the emergency debate on the new regulations:
The changes in the regulations are different from the original intention. They introduce an explicit judgment based on impairment type; the original intention was to have no such distinction. The regulations introduce a distinction that was not in the benefit’s original intention. They say that someone is in if they struggle to plan and follow a journey, but if their problem is because of psychological distress, they are out. It is an explicit judgment, it is explicitly contingent, and it carves out a large group of people with mental health problems.
In the complete reversal of its position when PIP was introduced, the government has made clear not only its motivation behind current policy on disability benefits but also a prejudice against people experiencing mental health difficulties. Penny Mordaunt, the current Minister for Disabled People, told the Social Security Advisory Committee in February this year that:
people who cannot follow a journey because of a visual or cognitive impairment are likely to need more support (in their lives generally) than someone who experiences psychological distress, for example as a result of a social phobia or anxiety, when they undertake a journey’. Letter from the Minister for Disabled People, Health and Work to SSAC. 24 February 2017
Not only is this making diagnosis the basis for eligibility - which the government expressly said PIP was not intended to do - but Penny Mordaunt also expressed a singular lack of understanding about ‘psychological distress’ when she claimed in a letter to Jane Campbell that such experiences “can be overcome by reassurance”.
The government is so intent on reducing public expenditure that - having failed so far in its attempts to sufficiently reduce the total amount spent on funding disabled people’s additional costs - it now appears to be using unscrutinised changes to the assessment process to reduce eligibility. Evidence has emerged that higher percentages of people lost their entitlement to PIP or had it reduced when they were reassessed in 2016 than in 2014 or 2015, and the Department for Work and Pensions and their contractors have been accused of changing their procedures and practices to bring this about. There is also evidence of a recent spike in the numbers of people scoring no points at all in their assessment for PIP.
Last year (2016) saw an increase in caseloads amongst advice agencies (Citizens Advice told the Work and Pensions Select Committee they had seen an increase of a third) and increasing reports of ‘inaccuracies’ in the assessment reports written by Atos and Capita, the two companies responsible for carrying out PIP assessments (one advice agency told the Select Committee that the only part of the process which worked well was the appeals process).
Underpinning all of this is the intention of reducing the numbers of people recognised as needing support in order to reduce the amount of money that has to be raised via taxes. While the debate is about who is ‘really disabled’ or ‘deserving’ - with the word ‘vulnerable’ being used to mean the ‘deserving and really disabled’ - it is fuelled by a particular political approach to the kind of economy and society that most of today’s politicians subscribe to. This is not only an issue for disabled people therefore but it is about the very nature of our society and what we all want for our futures.