Conor D’Arcy, Head of Research and Policy, Money and Mental Health Policy Institute

The government's plans to boost employment must have mental health front and centre

13 March 2023

Over the weekend came news of the government’s ideas to get more of us into work. The number of people who’ve fallen out of the labour market has been a concern for months and the policies trailed on Sunday are part of the government’s response. From what’s been released, it’s hard to be certain exactly what’s planned – and when it comes to the benefits system, the devil is in the detail. 

We should get some more information at the Budget on Wednesday but from what we know so far, it seems like a mixed picture for people with mental health problems. Drawing on a paper we’ve published today on exactly these challenges, here are some reflections on the proposed changes.

Scrapping the Work Capability Assessment is a big opportunity

The biggest suggested shake-up is getting rid of the Work Capability Assessment (WCA). The WCA is intended to judge who is able to work and who isn’t but its design and delivery are deeply flawed. The flaw the government has focused on is that, if the WCA has decided you don’t need to seek work and you then get a job which you don’t keep, you’re at risk of ending up in a worse situation. That can involve, at a minimum, having to be reassessed but it can also mean receiving less in benefits than before you entered employment. Removing that threat in order to make trying a job less risky is one of the aims of this move and is welcome.

What’s not clear is what would replace it. The government presumably still intends to assess people’s health. Currently, the Personal Independence Payment (PIP) is paid to people with a disability in recognition of the higher living costs that can bring, regardless of their employment status. But for this reform to represent a serious step forward, much more needs to change. As things stand, WCA and PIP assessments are not working for people with mental health problems. 

An assessment can involve: 

  • travelling somewhere you haven’t been before 
  • to meet a stranger who isn’t knowledgeable about mental health 
  • who will ask you questions that you haven’t seen in advance 
  • that go into detail about your health but which appear to be written without much understanding of how mental health problems affect us practically
  • all while knowing the outcome will have a massive impact on your income.

Given the challenges common symptoms of mental health problems can pose, each those steps can be sub-optimal, or distressing or even severely damaging to our health. An improved approach would include questions that better capture the difficulties mental health problems can pose. People would be given advanced warning of the specifics of what these questions will include to equip people to answer as accurately as possible. Assessors would also have adequate knowledge of mental health conditions to be able to make an informed decision. 

If the government takes this opportunity to genuinely review how health assessments are conducted, there is huge scope for improvement. With the technical complications involved, the WCA’s toxic reputation and the need to rebuild trust among those who have been through the process, replacing the WCA is likely going to be a long process. Rather than wait for that radical overhaul, the DWP should act now to give people questions in advance and deliver more practical mental health training to Jobcentre staff.

One step forward, two steps back?

Beyond the promising news on the WCA, other elements of the suggested reforms show a real blindspot. It creates a divide between people receiving health-related benefits and those who aren’t, with the proposals suggesting the latter group primarily need greater conditionality.

Our research has shown how that divide is far from clear, with people who are receiving income-related benefits that aren’t linked to your health often experiencing clinically-significant levels of mental distress. It’s true that being out of work can on its own contribute to that distress. But for members of our Research Community – a group of nearly 5,000 people with personal experience of mental health problems – the demands placed on people in order to maintain their benefit claim are often raised as worsening their mental health. 

“My experience was haunting – I didn’t have the voice to explain my anxiety and mental health issues which were compounded by the fact that I was then unemployed and had no money. But I remember the dread I felt when told I may have to retrain or take unpaid work.” Expert by experience 

The trailed proposals include requiring people to work the equivalent of 18 hours a week, rather than the current 15, meeting more frequently with Work Coaches and attending skills ‘boot camps’. The emphasis on getting into a job – any job – and increasing hours – rather than pay – is a longstanding critique of conditionality.

It particularly fails those of us with mental health problems who may be able to manage a specific job for a set number of hours. Being asked to increase your hours or change jobs in order to seek more work can knock people off the careful balance they’ve established between employment and their health needs, leading to people falling out of employment instead.

“My mental health issues were ignored and I was told what I can and cannot do by an adviser who didn’t care less. I felt uncomfortable and ignored.” Expert by experience

As with the WCA proposal, if the staff tasked with meeting more frequently with people and delivering training had demonstrated a better understanding of mental health problems in the past, there would be less cause for concern. But again and again we hear how Work Coaches fail to grasp the practical difficulties that symptoms of mental health problems can present. The extra demands that would be placed on Work Coaches is also notable, with many more people expected to meet with them more often. Managing that higher workload while also significantly improving Work Coaches’ understanding of mental health problems is a massive undertaking.

The need to look at the workplace

The lack of action further upstream remains a huge missed opportunity in this debate. When you’re in work and become unwell, Statutory Sick Pay is too low to have a decent standard of living for long if you don’t have savings to draw on. The right to request flexible work – which can be crucial in achieving that balance between keeping a job and maintaining your health – is a shaky one, and the Employment Bill that the government has mentioned for years is not coming in the near-term. 

“My mental health issues were ignored and I was told what I can and cannot do by an adviser who didn’t care less. I felt uncomfortable and ignored.” Expert by experience

As the Chancellor has noted, what’s needed is “a fundamental programme of reforms to support people with long-term conditions or mental illness to overcome the barriers and prejudices that prevent them working.” While we will wait to see what the Health and Disability white paper due on Wednesday contains, the policies trailed so far don’t give the impression of a joined-up effort to remove those barriers. Our new paper, published today, sets out what we think a meaningful set of reforms should look like.