1. The experience of welfare conditionality for people with mental health issues
Dr Jenny McNeill, Universities of Sheffield and York
Paper authors: Prof Peter Dwyer, Dr Katy Jones, Dr Jenny McNeill, Dr Lisa Scullion and Dr Alasdair Stewart
Paper presented at Australian Social Policy Conference September 2017
Presenting work in progress today of a paper a number of us are working on to explore the experiences and impacts of WC on disabled people with mental health impairments

2. Presentation outline Introduction to WelCond project
Welfare conditionality for disabled people in UK?
Mental health and welfare conditionality
- Work Capability Assessment
- Sanctions and support
- Movements into paid work
Conclusions
What I’ll cover today is:
Introduction to the project and its main aims say a bit about its methods and wider fieldwork that informs it
Briefly outline what we mean by welfare conditionality and how it works for DP in UK
Move on then to consider DP with mental health conditions/impairments and their experiences of WC in relation to 3 particular elements : read slide
Then offer some conclusions - work in progress- but our analysis to date leads us to several imp. issues

3. Welfare conditionality: sanctions, support and behaviour change (2013-2018)
Twin aims:
To consider the ethics and efficacy of welfare conditionality
Fieldwork with three sets of respondents:
Semi-structured interviews with 57 Policy Stakeholders
27 focus groups with 156 frontline welfare practitioners who implement policy
Three rounds of repeat qualitative longitudinal interviews with a diverse sample of (n.482 wave a) welfare recipients who are subject to conditionality i.e. 1,083 interviews in total.
Funded by ESRC grant ES/K002163​/2
Welfare conditionality: sanctions, support and behaviour change is a major five year programme of qualitative research funded by the ESRC
It is a programme of independent academic research
A collaborative project that involves researchers in 6 universities in England and Scotland
In order to do this we are undertaking fieldwork with three sets of respondents as outlined on the slide.
Central to the project is large number of repeat qualitative longitudinal interviews with 480 WSU who are being interviewed 3 times over a two year period.
Exploring welfare conditionality across a range of policy domains and groups (9 groups: jobseekers, lone parents, disabled people, Universal Credit recipients, homeless people, social tenants, individuals/families subject to anti-social behaviour orders/family intervention projects, offenders and migrants)
in 11 Locations in England and Scotland Bath, Bristol, Edinburgh, Glasgow, Inverness, London, Manchester, Peterborough, Salford, Sheffield, Warrington

4. What does welfare conditionality mean in the UK?
Linking welfare rights to ‘responsible’ behaviour esp. job search /activity in PLM (Dwyer, 2004)
‘Creeping conditionality’ (Dwyer, 2004) to ‘ubiquitous conditionality’ (Dwyer and Wright, 2014)
Expansion of benefit claimants groups subject to conditionality
i.e. majority of lone parents, disabled people and under UC low paid workers required to attend work focused interviews, undertake job search or training or face benefit sanctions
Intensification of benefit sanctions for non-compliance (2012)
Assumptions of ‘welfare dependency’
The project is interested in the linking of linking of welfare rights and responsible behaviour (particularly mandatory job seeking, training or attendance at work-focused interviews
Moved from creeping conditionality to an era of ubiquitous conditionality today
We’ve also seen an Expansion of ‘vulnerable’ groups now subject to conditionality (e.g. now targets unemployed lone parents, disabled people)
Underpinning this ramping up of conditionality are basic
Intensification of behavioural conditions (more job search, expectation to engage with work-related activities/training etc)
So there are Harsher consequences/penalties for non-compliance (sanctions! Financial cuts to benefit amounts- up to 3 years)
Assumptions of ‘welfare dependency’- paternalistic ideas that the government needs to intervene to ensure that the right carrots and sticks are used so that people don’t depend on benefits and instead contribute to society through paid work.

5. ESA (2008) Welfare conditionality for disabled people in UK
Work Capability Assessment (WCA): 3 potential outcomes
Support group – ‘limited capability for work related activity’, no conditionality
Work Related Activity Group – mandatory work preparation requirements
Fit for Work – Jobseeker’s Allowance, full conditionality
Universal Credit ( )
‘Limited Capability for Work Group’, loss of WRAG additional payment from 2017
WCA roundly criticized
Greater focus on physical health than mental health in WCA (Marks, 2017)
Inefficient: 51% of appeals against initial WCA assessments are overturned on appeal (DWP, 2015)
Introduced by Lab Gov in 2008 ESA extended WC for DP for first time (and replaced IB and IS for some)
The WCA is designed to focus on an individual’s capabilities rather than incapacities. It is administered by private contractors and is the key tool used to judge a claimant’s level of impairment
Three potential outcomes of WCA
I won’t go into any detail on Universal Credit but there is a similar process for determining Limited Capacity for Work and importantly there is a loss of the additional WRAG payment
A number of criticisms of the WCA- mainly its greater focus on PH but also the number of appeals which are overturned!
From DWP (2015) between July 2014 to September2014
70 per cent of claimants were entitled to Employment and Support Allowance:
16 per cent of claimants were placed in the Work Related Activity Group
54 per cent of claimants were placed in the Support Group; and
30 per cent of claimants were assessed as Fit for Work

6. Mental Health and welfare conditionality Sample
116 welfare service users (WSUs) who self-declared a mental health impairment at interviews waves a-c
All had experience of conditional out of work benefits e.g. Employment and Support Allowance (ESA) Jobseekers Allowance (JSA) or Universal Credit
Some though not all had other issues e.g. physical impairment, substance misuse, homelessness, public care, prison etc.
Three key questions
What were their experiences re WCA?
How did they experience sanction and support inherent in welfare conditionality?
How effective is conditionality in moving people with mental health problems towards paid work?
For this analysis we wanted to include people with diagnosed mental health conditions and who self-identified as having mental health issues and across the sample we looked at 116 WSUs. Where possible we looked at their second and third wave interview transcripts.
The 116 service users were also selected on the basis of having some experience of conditional welfare benefits at the time of first interview or in the past…so specifically Jobseekers Allowance, Universal Credit or ESA…which I’ll go on to explain a bit about the process of claiming
Some, but not all also had other complex needs and backgrounds…
With this sample we wanted to explore THREE KEY QUESTIONS

7. Findings: Work Capability Assessment
Inappropriate, insensitive, painful, distressing, degrading
It's all very much based on physical stuff, and they don't take into account the emotional and the mental stuff… Just because I can look somebody in the eye, and just because I can speak clearly enough doesn't mean to say that I'm not depressed and not upset. (Female, 49, physical & mental health)
They're not understanding… they open up a lot of wounds. I've always left in tears and heartbroken, really sobbing, and they're not interested in making sure you're all right or anything. (Female, 36, mental health)
For some, the WCA exacerbated the impairments for which they were being assessed
I thought it was very intense and very stressful. I felt as though I had been attacked. (Male, 52, sensory, physical and mental health issues)
I find them very threatening and upsetting which puts my panic levels up, which means that I get in to a loop where I can't read and understand. (Female, 53, sensory, physical & mental health issues)
So I’ll start with our findings on how the WCA is experienced as this is a starting point for assessment for ESA.
Theses were largely experienced negatively and the assessments were criticized for Inappropriate, insensitive, painful, distressing, degrading. And some felt their mental health conditions were ignored.
For some, the WCA exacerbated the impairments for which they were being assessed.
EDSJ003-as far as they were concerned I'd been found fit for work and that was it. They weren't interested on a personal level at all. They weren't interested in individually; just a number to go in there and be dealt with. There was no attempt to understand you on a one-on-one level, not at all.
EDSJ012-I had a medical assessment, with my experience, very deep depression and I've actually got to say the depression was much more disabling than any physical illness I've had. I think I was two years out of hospital after a suicide attempt, went to the medical and they still managed to score me zero points.

8. Findings: Experiences of Welfare Conditionality
Sanctions
I was referred to a drug and alcohol service to be assessed, and it clashed with the Work Programme appointment…So I called them 'I'm really sorry, I've got this assessment, which I think has to be the priority, because I'll get help and treatment', …then I got a letter from the DWP saying because you missed your Work Programme we're stopping your benefit. I was just beside myself…I was thinking even if I did get a job at the moment I wouldn't sustain it, because I'm depressed and drinking. So I just thought that's madness. (Female, 49, mental health issues)
Lack of support and pressure of conditionality
There are so many demands and things like that set upon you when you're not well. My ailments were depression and anxiety plus the alcohol; you don't need extra things in your life to be worrying about. It's hard enough trying to deal with your issues and get well or get better and that on its own is quite a big thing.(Female, 37, mental and physical health issues)
The point here is that it was counter-productive in terms of recovery...and made things worse.
Powerlessness:
“So, that was it, sanctioned and that was horrendous, I'll never forget that [laughs]. You've just no power over that, somebody can decide whether you're eating that night or not” (GL-AS-002)
Lack of support and lack of care: “They aren't really interested in your emotions or your problems. They're there to get you to go back to work or into a job or into a course to do something…. It's not about feelings. It's not about the person. It's about numbers and money.” (WSU-SH-JM-016, female, 52, single mother, mental and physical health- sanctioned once 7 months before first interview)

9. Findings: Impacts of Welfare Conditionality
Positive for a minority
I feel they've been slowly guiding me. They haven't been really pushing me or on my back. (Female, 59, physical & mental health issues)
Because of that carry on with the benefits I got in touch with [charity] to say, 'What's happening here? I'm preparing to shoot myself‘…then I ended up starting and going to speak for them about my experience…and it's all just branched out…Thank you wee lassie in the benefits system…I love doing what I do….The only thing is it had to take me to get all different experiences to do that. (Female, 54, physical & mental health)
Negative for many
I know I got so close to ending it because I couldn't cope with the pressure they were putting on me. (Female, 32, mental health)
Because there's this feeling in the country isn't there that everyone on disability benefits is defrauding the system…I know that there are, but I'm not. (Male, 45, sensory, physical and mental health)
There were VERY few positive impacts- some argued that advisors listened (the majority disagreed), some that courses were beneficial (majority disagreed). ON EXAMPLE: QUOTE from woman who attributes doing volunteering directly to experience of sanction because support she received following sanction led to volunteering. She was sanctioned twice and threatened with sanction another time…
BUT Mainly negative impact of WC incl sanctions included worsening mental health (social isolation) and in terms of physical health- people directly associated sanctions with being unable to eat and losing weight- impacting medication for some, the pressure of WC halted recovery for some as we’ve seen, people had to rely on friends and family for money or other sources of support which put a strain on those relationships, financially people struggled as they got into debt, at risk of losing their homes if Housing Benefit was also stopped as a result of sanction and impact to people’s self worth and self esteem…
Many interviews touched upon suicidal thoughts because of the stress of conditionality
And another major consequence of welfare conditionality is the stigmatising affect of claiming benefits- people feeling ashamed or having to defend their positions/legitimise their own claims at the expense of others they believe are not as deserving….

10. Findings: Effectiveness of WC in moving DP with mental health issues towards work?
Movement into paid work
It was through the Jobcentre. They put me on to the work programme. I started on that first and then he goes, 'Oh there's a chance of a job at (factory)'. I got it straightaway.” (Male, 52, mental health issues and learning difficulties)
Pushing people further away from work
Well, I was planning last year to be going back to work, and then it's the way I was dealt with by the benefits really knocked me back. I mean, it knocked me back, I had a bit of depression again. It caused me a lot of stress, a lot of anxiety, the way I was being treated and trying to deal with the changes and everything (Male, 50, physical and mental health issues)
Inertia/no movement
It is demeaning, condescending, it is painful, it is damaging, it actually makes your disabilities worse if you've got some disabilities. And it is completely unproductive. It doesn't get people work. Nothing in what they've done to me has assisted me in getting back in to the employment market.(Female, 53, sensory, physical & mental health issues)
In this first quote the man worked for 3 months for an agency and it was out of his control that the work ended.
WC ultimately resulted in inertia- for those in WRAG there was little effect in movement towards work and not surprising that no moves towards work for those in the Support Group because they had more severe health conditions.
Indeed the stats for the 116 people show that 10 people were in some form of work in the first interview and with attrition there were 10 people in some form of work (PT/Informal/Self employed) at wave b and 12 people in wave c.

11. Conclusions
Largely negative experiences of welfare conditionality with little effective support for many people with mental health issues
WCA was widely condemned as inappropriate and insensitive
Welfare conditionality exacerbated mental health conditions and caused stress for many
Stigmatization and shame (Baumberg et al, 2012; Walker, 2014)
Welfare conditionality for people with mental health impairments has negative consequences for citizenship and inclusion (Garthwaite, 2011; Manji, 2017)
Is a more positive approach to social security for disabled people emerging?
- Oakley (2016)
- Work and Health Programme (2017)
Largely negative experiences of welfare conditionality with little effective support for many people with mental health issues
The WCA was largely condemned by those who experienced the assessment on the basis that: The tests were inappropriate and insensitive.
They exacerbated conditions and caused stress.
Stigma & shame prevents some from claiming benefits altogether and this can have repercussions for citizenship & inclusion of people with disabilities(Garthwaite)
Oakley’s comments on the UK government’s commitment to halving the ‘disability employment gap’ sees the step away from compulsion and sanction (which previously advocated?) towards greater support and incentives as a more positive approach. It reduces resources by focusing attention on those most likely to enter work. It will be a devolved system and schemes like the ‘Working Well’ in Manchester will operate in this way- initial meeting is compulsory (sanction only if missed) but voluntary to attend afterwards. Also overhaul of WCA- separating out the assessment for eligibility for benefit from assessment of a person’s ability to move into work!
All of this is important know in terms of what the UK Government’s new “Work and Health Programme” will deliver. The voluntary basis would appear to be a positive step forward in the proposed plan (voluntary involvement for majority but mandatory for those unemployed for 2+years). But questions still remain as to the extent of conditionality which will feature in this new regime and while the Green paper refers to voluntary participation of disabled people it makes reference to using mandatory ‘keep in touch’ meetings with Work Coaches.

12. References
Baumberg, B., Bell, K. and Gaffney, D. (2012) Benefits stigma in Britain, London: Elizabeth Finn.
DWP (2015) Employment and Support Allowance: Outcomes of Work Capability Assessments, Great Britain. London: Department for Work and Pensions
Dwyer, P. (2004) Creeping conditionality in the UK: from welfare rights to conditional entitlements?. The Canadian Journal of Sociology, 29(2):
Dwyer, P. and Wright, S. (2014) Universal credit, ubiquitous conditionality and its implications for social citizenship, Journal of Poverty and Social Justice, 22(1):27-35.
Garthwaite, K. (2011) ‘The language of shirkers and scroungers?’ Talking about illness, disability and coalition welfare reform, Disability & Society, 26(3):
Manje, K. (2017) Social Security Reform and the Surveillance State: Exploring the Operation of ‘Hidden Conditionality’ in the Reform of Disability Benefits since Social Policy and Society 16 (2):
Marks, A., Cowan, S. and McLean, G. (2017) Mental Health and Unemployment in Scotland, Heriot Watt University.
Oakley, M. (2016) Closing the Gap: creating a framework for tackling the disability employment gap in the UK, London, The Social Market Foundation.
Walker, R. (2014) The Shame of Poverty, Oxford: Oxford University Press.

13.
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