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Preventable harm: creating a mental health crisis

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Mo Stewart
Mo Stewart
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Purpose The purpose of this paper is to examine the preventable harm created by the adoption of austerity measures in 2010, added to the welfare reforms introduced in 2008 which, collectively, have negative implications for population mental health in the UK. Design/methodology/approach A critical reflection of published research papers and key policy documents in this area. Findings Negative mental health consequences of the combined impact of welfare reforms and austerity measures in the UK since 2010 are identified when relating to disability benefit assessments, and to the increased punitive conditionality applied to disability benefit claimants, as those in greatest need now live in fear of making a claim for financial support from the state or of losing benefits to which they are entitled. Research limitations/implications This paper identifies the creation of preventable harm by social policy reforms, commonly known as “welfare reforms”. The implications for social scientists are the disregard of academic peer-reviewed social policy research by policymakers, and the adoption of critically challenged policy-based research as used to justify political objectives. Practical implications The negative mental health impact of UK government social policy reforms has been identified and highlights the human consequences of the adoption of the biopsychosocial model of assessment. Social implications Reducing the numbers of sick and disabled people claiming long-term disability benefit has increased the numbers claiming unemployment benefit, with no notable increase in the numbers of disabled people in paid employment and with many service users in greatest need living in fear of the next enforced disability assessment. Originality/value This paper demonstrates the preventable harm created by the use of a flawed disability assessment model, together with the adoption of punitive conditionality and the increased suicides linked to UK welfare reforms which are influenced by American social policies.
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1
Preventable Harm:
Creating A Mental Health Crisis
an article by
Mo Stewart
Abstract
Purpose – The purpose of this paper is to examine the preventable harm created by the
adoption of austerity measures in 2010, added to the welfare reforms introduced in 2008 which,
collectively, have negative implications for population mental health in the UK.
Design/methodology/approach – A critical reflection of published research papers and key
policy documents in this area.
Findings - Negative mental health consequences of the combined impact of welfare reforms
and austerity measures since 2010 is identified when relating to disability benefit assessments,
and to the increased punitive conditionality applied to disability benefit claimants, as those in
greatest need now live in fear of making a claim for financial support from the state or of losing
benefits to which they are entitled.
Practical implications - The negative mental health impact of UK government social policy
reforms has been identified and highlights the human consequences of the adoption of the
biopsychosocial model of assessment.
Social implications - Reducing the numbers of sick and disabled people claiming long-term
disability benefit has increased the numbers claiming unemployment benefit, with no notable
increase in the numbers of disabled people in paid employment and with many service users in
greatest need living in fear of the next enforced disability assessment.
Originality/value - This paper demonstrates the preventable harm created by the use of a
flawed disability assessment model, together with the adoption of punitive conditionality and
the increased suicides linked to UK welfare reforms which are influenced by American social
policies.
Keywords Welfare reform, Preventable harm
Paper Type Research paper
2
Introduction
The prevalent intimidation of chronically ill and disabled people by the Department for Work
and Pensions (DWP) is a public health concern, not least because of the relationship between
physical and mental health and the fact that deteriorating mental health can accelerate a
deterioration in physical health (Doherty and Gaughran, 2014).
This intimidation by the DWP (Garthwaite, 2011) has historic relevance, and was very carefully
planned. Since the adoption of neoliberal politics (Birch, 2017), every UK government has
worked towards the eventual demolition of the welfare state (Stewart, 2016, p.5). Included in
this ultimate goal is the future adoption of private healthcare insurance to replace social security
funding for long-term sickness and disability benefit, as first suggested in 1982 by the
Conservative Prime Minister, Margaret Thatcher (Travis, 2016). In 1994 the John Major
Conservative government invited the American corporate healthcare insurance giant
UnumProvident Insurance to advise on future UK welfare claims management. By 1995 Unum
adviser John LoCascio co-authored an academic paper with the UK government’s medical
adviser Mansel Aylward. “Problems in the assessment of psychosomatic conditions in social
security and related commercial schemes” (Aylward and LoCascio, 1995), which challenged
the role of general practitioners and argued that family doctors should not be expected to
determine a patient’s incapacity.
In 2005, Mansel Aylward left his role as the government’s medical adviser when appointed as
the Director of the new UnumProvident Centre for Psychosocial and Disability Research at
Cardiff University, which was funded with £1.6million by the American corporate government
advisers (Cover, 2004). Representing the Blair Labour government, in 2005 the DWP
commissioned Mansel Aylward and his colleague Gordon Waddell to produce research to
identify future welfare reforms. “The Scientific and Conceptual Basis of Incapacity Benefits”
(Waddell and Aylward, 2005) was published in October 2005, and recommended the use of a
biopsychosocial (BPS) model of assessment to assess future disability benefit claimants, which
was a non-medical that totally disregards medical opinion. The methodology used by Waddell
and Aylward was the same one that informed the work of UnumProvident (Rutherford, 2007,
p47) and recommended the use of sanctions, which meant the removal of a claimant’s total
income from between one to four weeks, with the average being four weeks. Some sanctions
can last as long as six months or longer (Bloom, 2017).
The 2005 government commissioned report “The Scientific and Conceptual Basis of Incapacity
Benefits” (Waddell and Aylward, 2005) recommended the reduction of Incapacity Benefit (IB)
claimant numbers by one million (p.12), the reduction of the value of the disability benefit to
the same funding used for unemployment benefit (p.99), and the use of benefit sanctions for
non-compliance of conditionality by claimants (pp.165-167). In time, these recommendations
would be adopted by the DWP and would create preventable harm, which negatively impacted
on public mental health (Mehta et al, 2018; Saffer et al, 2018; Barr et al 2015).
3
The manipulation of British public opinion began with the 2006 Green Paper (DWP, 2006),
which promised increased support for sick and disabled benefit claimants qualified by claimant
responsibilities. In reality this meant the adoption of punitive benefit sanctions by the DWP in
cases of non-compliance (Webster, 2015) that removes 100 per cent of disability income, which
is linked to starvation (Gentleman, 2014) and death (Elward, 2016; Ryan, 2015).
The Creation of Preventable Harm
From 1997 to 2010 the Labour government(s) made welfare reform the top priority when
adopting a “workfare” agenda in an effort to reduce the unemployment totals. The Labour
Prime Minister, Tony Blair, was keen to reduce the future financial burden of the welfare state
when using neoliberal politics and adopting American social and labour market policies
(Daguerre, 2004; Daguerre & Taylor-Gooby, 2004), which was the continuation of the
Thatcher neoliberal social policy agenda (Scott-Samuel et al, 2014).
By definition, ‘preventable harm’ is identified as the “presence of an identifiable, modifiable
cause of harm” in healthcare (Nabhan et al., 2012). The removal of the clinical opinion of
family doctors for claimants of long-term sickness and disability benefit was destined to cause
preventable harm with the adoption of IB in 1995. IB had replaced invalidity benefit, which
was previously allocated using the opinion of the family doctor. IB was introduced with the
adoption of the All Work Test, using a non-medical assessment conducted by doctors employed
by the government (Rutherford, 2007).
Despite the All Work Test, which marginalised the opinion of the family doctor, by 2005 the
numbers of IB claimants had reached 2.7 million and included 39 per cent claiming IB for a
mental health problem, which was almost one million people (Rutherford, 2007). There was
therefore a need to adopt a more stringent restriction to disability benefit, and this would be
achieved by the DWP with the adoption of the Waddell–Aylward non-medical BPS assessment
model (Stewart, 2018a, b).
Guided by UnumProvident Insurance, there was a growing political consensus that too many
people were workless when supported by IB (Freud, 2007, p. 1). Eventually, there would be a
significant change in political direction to reverse this trend (Rutherford, 2007, Stewart, 2018a,
b), with political claims of the need to reduce IB claimant numbers by 1m, suggesting that
chronically ill people suffering with a mental health condition were of no concern.
Introduced in October 2008 by the Gordon Brown Labour government, IB was replaced with
the Employment and Support Allowance (ESA). To access the ESA sick and disabled claimants
were required to subject themselves to the compulsory Work Capability Assessment (WCA),
which is the adoption of the critically challenged (Shakespeare et al, 2016) Waddell and
Aylward BPS model of assessment. The WCA was adopted for the assessment of all new ESA
claimants and the future reassessment of all IB claimants. As a functional assessment which
disregards medical diagnosis, prognosis, past medical history and prescribed medicines
(Stewart, 2018a, b), the ESA assessment process using the WCA is fatally flawed (Patrick
4
2012: BMA 2013; WPSC 2014; Garthwaite, 2014; Barr et al., 2015; Baumberg et al., 2015;
Mehta et al., 2018).
Several months after the publication of the Waddell and Aylward (2005) report,
UnumProvident (2006) Insurance provided a supplementary memorandum as written evidence
to the Work and Pensions Select Committee regarding the ESA and WCA, where the company
identified their “non-medical” assessment model:
At UnumProvident we have a non-medical, enabling model of rehabilitation and we are working
with our partners at the UnumProvident Centre for Psychosocial and Disability Research at
Cardiff University to better understand what makes people at risk of long-term or chronic illness.
(UnumProvident, 2006)
The WCA was demonstrated to negatively impact on public mental health when using
neoliberal politics (Watts, 2018; Mills, 2018). Recommended by the former banker and Labour
government adviser David Freud (Freud, 2007) the WCA was conducted by the private sector,
at an eventual cost to the public purse of £1.6 billion (PAC, 2016), over a three year period, to
conduct disability assessments for the ESA and related disability benefits. The distress created
for disability benefit claimants by repeated WCAs for serious health conditions, particularly
those that cannot improve, created a negative impact on public mental health. These adverse
trends in public mental health associated with the WCA were identified in 2015 by Dr Ben Barr
and colleagues (Barr et al., op cit) and were reported by Lewis Elward:
As well as this wave of unnecessary and preventable deaths, the WCAs impacts include 279,000
additional self-reported mental health cases and 725,000 additional anti-depressant prescriptions,
and such mental health distress levels contributed to the 590 associated suicides between 2010-
13. (Elward, 2016 p.29)
Led by Prime Minister David Cameron, the election of the Conservative-Liberal Democrat
Coalition government in 2010 was guaranteed to increase preventable harm for many with the
adoption of austerity measures to add to the ongoing welfare reforms. Funding for public
services was to be drastically cut, as was funding for the Local Authorities who provided social
care in the community (Cummins, 2018). The adoption of austerity measures addded to the
reduction of social care in the community was always going to cause preventable harm, and so
the Coalition government needed to distract attention from its policies, and to lay the blame at
someone else’s door.
This was achieved as Iain Duncan Smith MP, when Secretary of State for Work and Pensions,
spent five years discrediting claimants of disability benefit at every opportunity (Stewart,
2017), which the tabloid press willingly reported (Hall, 2011). This amounted to what has been
described as a “thinly-veiled character assassination” against disability benefit claimants
(Garthwaite, 2011).
Discrediting chronically ill and disabled people who were unable to work was very easy to
achieve, was guaranteed to negatively impact on public mental health (Beresford, 2016;
5
Garthwaite, 2014) and was necessary to remove the psychological security provided by the
welfare state, on route to its eventual total demolition (Stewart, 2016). There would be grave
human consequences to this removal of guaranteed financial support by the state for those in
greatest need. The constant threat of sanctions led to fear and a significant rise in suicides of
ESA claimants (DNS, 2015; 2017; Ryan, 2015), with the endless public humiliation of
disability benefit claimants by DWP Ministers negatively impacting on mental health service
users. Professor Peter Beresford (2016) identified the problem:
Welfare reform has been particularly damaging to mental health service users because of the
fluctuating nature of many conditions. And Work Capability Assessments, used to decide who is
fit for work, have been designed in such a way that can actively discriminate against mental health
service users. This leaves people especially vulnerable and puts their mental health further at risk.
(Beresford, 2016)
The Human Consequences of Preventable Harm
A lot of evidence has identified the negative human impact of austerity measures and welfare
reforms on public mental health and, especially, the psychological terror imposed by the
adoption of the fatally flawed WCA, which is unfit for purpose (BPS, 2016). The former
psychological security for anyone whose doctors had deemed them unfit to work has been
removed, and public opinion of claimants has been successfully tarnished (Stewart, 2017).
The WCA “is intrusive, insensitively administered and regularly leads to inappropriate
outcomes in respect of disabled people’s capabilities” (Dwyer et al., 2018). Used to restrict
access to the ESA and its successor benefit, Universal Credit, there are three possible WCA
outcomes which are move to unemployment benefit when deemed to be fit for work, entry to
the Support Group for those with the most severe health problems or, most commonly, entry
to the Work Related Activity Group (WRAG).
Detailed testimony has identified that the imposition of harsh sanctions by the DWP was life-
threatening for some benefit applicants (Mehta et al, op cit), and research results were
published as a response to the numbers of ESA claimants placed into the WRAG following a
WCA. Detailed public surveys (Barr et al., 2015; Mehta et al., 2018) identified the problems
experienced by chronically ill and disabled ESA claimants in the WRAG, which is negatively
impacting on mental health leading many claimants to thoughts of suicide, as demonstrated in
the research conducted by Dr Jay Mehta et al. (2018) in association with Inclusion London:
The impact of Sanctions was life-threatening for some participants. The underlying fear instilled
by the threat of Sanctions meant that many participants described living in a state of constant
anxiety. This state of chronic fear is unlikely to enable people to engage in work related activity
and so is an ineffective psychological intervention. This was exacerbated by the unpredictable
way that Conditionality was applied, leaving some participants unsure how to avoid Sanctions
(p.5)
6
Charlie then described meeting the same advisor who had sanctioned him following the
Christmas break and how it has affected him since (p12):
So finally, when new year had ended I had to go back and sign with that same woman who
sanctioned me. She said that being sanctioned had shown her that I didn’t have a work ethic. Now
I’d been working pretty much solidly since I was 16 and it was only out of redundancy that I was
out of work... The problem I had with that was the woman who sanctioned me was in the same
place and it made me extremely nervous. I now have a problem going into the Job Centre because
I literally start shaking because of the damage that the benefit sanction did to me... So yeah that
was part, the sanction was one of the reasons that triggered the mental health problems I’m having
now... it was awful and I ended up trying to commit suicide... to me that was the last straw and I
went home and emptied the drawer of tablets or whatever and ended up in A&E for a couple of
days after they’d pumped my stomach out.” (Charlie, p12). (Mehta et al., 2018)
Consequently, long-term sick and disabled claimants in need of financial support by the state
live in fear of the DWP, as the ESA is currently being phased out and replaced with Universal
Credit. Claimants have been intimidated over a period of years, are very conscious that public
opinion is against them and that they are treated with suspicion, not empathy (Garthwaite,
2014). Suicides linked to welfare reforms are climbing (Mills, 2018; DNS, 2017a; Ryan, 2015),
and a growing number of benefit-related deaths are associated with sanctions (DNS, 2017) in
what has been described as “Britain’s secret penal system” (Webster, 2015). One NHS
statistical survey revealed that almost half of ESA claimants had attempted suicide at some
point, and consultant clinical psychologist, Dr Jay Watts, reacted to the statistics, as reported
by the Disability News Service:
Being treated like a second-class citizen, being blamed for not being an ideal neoliberal subject,
being denied the basic financial means to survive, being sanctioned for being too ill to make an
appointment – these belittlements monopolise the internal world and the result is now often
suicide. (DNS, 2017, 2015)
Conclusion
The UK has been “importing” American social and labour market policies since 1997
(Daguerre, 2004), and that includes the American system of disability denial via the income
replacement insurance industry. Successfully manipulated by consecutive UK governments,
the previous public empathy for the chronically ill and disabled community has been eroded.
Every chronically ill and disabled claimant of disability benefit is conscious of the fact that
the WCA was designed to restrict access to disability benefit, and they are also very aware
that public opinion is now suspicious of disability benefit claimants. The national press and
media resisted alerting the public to the fact that the Waddell - Aylward BPS model of
assessment, as used for the WCA, has failed all academic scrutiny; identified in 2016 by
Professor Tom Shakespeare and colleagues as having “no coherent theory or evidence behind
this model” and demonstrating “a cavalier approach to scientific evidence” (Shakespeare et
al., 2016).
7
The influence of corporate America on future UK welfare reforms has been ongoing since
1994 when UnumProvident Insurance became official government advisors for welfare claims
management, and successive UK governments have successfully manipulated the British
public on route to the future demolition of the UK welfare state, (Stewart, 2016). The identified
preventable harm created by various DWP policies to make this political ambition happen is
totally disregarded, and chronically ill and disabled people who are unable to work feel
persecuted. Claimants with physical disabilities are being afflicted by the onset of mental health
problems as this perceived DWP persecution continues. The DWP justify extremes of benefit
conditionality whilst overlooking the human consequences of sanctions, which do not increase
the numbers moving into paid employment and are deemed to be “psychological tyranny”
(Stewart, 2018b) and “the application of welfare conditionality consistently had the opposite
effect and pushed disabled people […] under the threat of sanctions […] further away from work”
(Dwyer et al., 2018).
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Pre-print text
Accepted for publication in the Journal of Public Mental Health
doi: 10.1108/JPMH-07-2019-0070
... The result was the pushing of claimants into a position where they did not want to deal with the system, beyond the basic engagement required for claiming and receiving benefits (Redman and Fletcher, 2022). This culminated in the grim irony of a system supposed to engage with claimants and to support them back into the labour market having the opposite effect; this however could also be argued as intentional (Stewart, 2019). The narratives collected strongly suggest the need to question the fundamental foundations of the social security system on practical, economic, and humanitarian grounds. ...
... Conducting in-depth qualitative interviews with people who had been sanctioned and were homeless, Reeve (2017) found that the conditions of welfare receipt exceeded the capabilities of many claimants and ignored the practical and systemic barriers that made compliance difficult. Thus, rather than refusing to engage, claimants were actively harmed by a system that overlooked vulnerabilities and circumstances (Stewart, 2019). ...
... Collectively, the evidence presented in this article demonstrates a public health emergency and preventable harm (Stewart, 2019) created by the social security system as part of an active demolition of the welfare state as we know it. Poor mental health, insecure housing, low investment in health services, and a meagre, authoritarian social security system are inter-linked social problems. ...
A constant threat? A narrative exploration of the relationship between benefit receipt, mental distress and the threat of homelessness
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  • Sep 2023
Resistance to housing and welfare reforms on economic, ‘practical’ grounds was shattered by the covid-19 pandemic, which demonstrated that where there is a will there is a way when it comes to providing housing. Despite a purported ‘right’ to adequate housing, many people in the UK face profound challenges accessing stable accommodation. Drawing from a biographical-narrative study, this article details experiences of men who have the right to adequate housing denied and thus experience housing insecurity. Subsequently, it explores how such insecurity exacerbates pre-existing mental health problems. The core argument of the article is that welfare reforms produced the sense of a constant threat of homelessness and destitution for the 17 male participants in the study who claimed sickness benefits. This sense of constant threat manifested itself through (a) the production of present homelessness at the time of the research and (b) and underlying anxiety, fear and threat of homelessness. The article contends that the UK social security system perpetuates the structural and emotional drivers of mental distress, creating a deleterious cycle of poverty, insecurity and ill-health, concluding that the provision of stable housing is an upstream intervention to improve mental health and reduce social exclusion.
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... Continuing with Thatcher's 'dark legacy' (Young, 2013), the Blair administration(s) (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007) commissioned 'policy-based' reports to justify the future threat to the welfare state, with psycho-coercion and preventable harm guaranteed by adopting a flawed disability benefit assessment model (Stewart, 2018a;2018b). Commissioned by 'New Labour', and exposed as being self-referenced (Ravetz, 2006), the Waddell-Aylward (2005) monograph recommended their discredited (Shakespeare et al, 2016) biopsychosocial (BPS) non-medical functional model of assessment to limit access to disability benefits, which was adopted for the Work Capability Assessment (WCA) in 2008 (Stewart, 2019a;2019b). Blair adopted American social and labour market policies (Daguerre. 2004) using similar rhetoric as the previous Conservative administrations, as the 2006 green paper (DWP 2006) introduced the future use of the WCA to restrict access to the new ESA disability benefit, which replaced Incapacity Benefit (IB). ...
... Another influential report commissioned by the Blair administration was provided in 2007 by former City banker David Freud. Commonly known as the 'Freud Report' (Freud, 2007), it was created in less than six weeks and was commissioned 'to offer examples of how to limit the costs of out-of-work benefits, and to progress the government's Welfare to Work agenda' (Stewart, 2019a;2019b). All recommendations from the 'Freud Report' (2007) were eventually adopted, including the recommendation to use private contractors to conduct the WCA to restrict access to the new ESA disability benefit by creating 'disability denial' (Stewart, 2021). ...
... They were all disregarded by the DWP, as is the growing mental health crisis directly linked to the fear of the next WCA, and the constant DWP threat of sanctions. To date, the DWP have disregarded all published research which identifies the ongoing and inevitable public health crisis created by social policy reforms and the use of the WCA (Boardman, 2020;Dwyer, 2018;Dwyer et al, 2019;Barr et al, 2016;Gentleman 2011;2014;2015;Patrick, 2012;Mills, 2017;Cummins, 2018;Stewart, 2018a;2019a;2019b;. ...
THE ADOPTION OF PSYCHO-COERCION TO MANIPULATE THE UK DISABLED COMMUNITY: THE CREATION OF THE POLITICS OF FEAR
Article
Full-text available
  • Sep 2022
The 1982 Thatcher Cabinet minutes identified the intention to adopt ‘the politics of fear’ to coerce the British public to accept the need for private income replacement health insurance, to remove the financial burden of the National Health Service and the welfare state. Every administration since Margaret Thatcher adopted social policies to move towards this ultimate political ambition, which has bipartisan support. The difficulty was that the psychological security of the UK welfare state was embedded within the public psyche and removing it would take a long time. Forty years later, that ambition has now been achieved. Thatcher’s devotion to neoliberal politics, which is an ideology that supports free market competition with an emphasis on minimal State intervention, meant that the political ambition to reduce the financial burden of the welfare state would be relentlessly pursued by successive administrations. The breakthrough to justify introducing the ‘politics of fear’ followed the 2008 global financial crisis. The Brown ‘New Labour’ administration was obliged to fund a fifty billion pounds bank rescue package, which increased over time and significantly increased the national debt. Elected in 2010, the Coalition administration used the size of the national debt to justify the introduction of austerity measures, which were designed to reduce the costs of the welfare state and guaranteed that those in greatest need would endure preventable harm. This was the beginning of the end of the UK welfare state as funding was removed from essential public services, which generated human suffering on a vast scale.
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... Together with former orthopaedic surgeon Gordon Waddell, Aylward produced the 2005 commissioned monograph (Waddell-Aylward, 2005) when Director of the UnumProvident Centre for Psychosocial and Disability Research, at Cardiff University, and funded with £1.6million by the American insurance corporate sponsors (Cover, 2004), emphasising the link between corporate America with future UK social policy designs. This influential commissioned research (Waddell-Aylward, 2005) recommended the adoption of the BPS non-medical functional assessment to reduce IB claimant numbers by one million (p12); the reduction of the value of IB to the equivalent of the income for unemployment benefit (p99); and the use of financial sanctions which removes all benefit income for noncompliance by claimants (p165-167); which guaranteed that some disabled claimants would starve to death when 'killed by the State' (Elward, 2016, p30;Stewart, 2019;Pring, 2020 Continuing with Margaret Thatcher's social policy legacy, the ambition of the Blair Labour administration was to make access to disability benefit as difficult as possible by adopting American neoliberal social and labour market policies (Daguerre, 2004); which was achieved as all the Waddell-Aylward (2005) recommendations were eventually adopted by future social policy reforms. What is not commonly known is that, historically, UnumProvident Insurance have a disturbing reputation in the US for failing to fund or to intentionally delay payment of genuine health insurance claims (Langbein, 2007) and, in 2008, the American Association for Justice identified the company as being the second worst insurance company in the United States (US) (AAJ, 2008). ...
... Those in greatest need learned to live in fear of the flawed WCA that disregards all clinical history (Stewart 2019(Stewart , 2020, forces chronically ill people to search for work (Butler, 2015;Hale, 2014), who could be sanctioned with all access to funding removed by increasingly severe social policy conditionality with the added possibility of starving to death (Pring, 2020). This ongoing prevalent intimidation of the chronically ill and disabled community by the DWP is a public health concern, not least because of the relationship between physical and mental health and the fact that deteriorating mental health can accelerate a deterioration in physical health (Doherty and Gaughran, 2014;Hale, 2014;Barr et al, 2016;Dwyer et al, 2019). ...
... At UnumProvident we have a non-medical, enabling model of rehabilitation and we are working with our partners at the UnumProvident Centre for Psychosocial and Disability Research at Cardiff University to better understand what makes people at risk of long-term or chronic illness. [Evidence provided for the Work and Pensions Select Committee, 2006](Stewart, 2019). ...
The Public Health Crisis Created by UK Social Policy Reforms
Article
Full-text available
  • Aug 2022
As the world is preoccupied by the pandemic, and the British public are beginning to comprehend the full impact of Brexit, the predictable public mental health crisis created by the demolition of the UK social safety net has been disregarded by successive administrations. Few people realized that preventable harm was the inevitable creation of social policy reforms, gradually adopted by every administration since Thatcher, en route to her political ambition which was the demolition of the welfare state to be replaced by private health insurance. In order to demolish the welfare state it was first necessary to remove the past psychological security provided by the welfare state. This has been achieved, with disability denial created by significant social policy reforms since 2008. To justify the adoption of harsh and unnecessary austerity measures, which were introduced without ethical approval, the Coalition administration elected in 2010 vehemently challenged the integrity of the chronically ill and disabled community and routinely accused disability benefit claimants of fraud; whilst failing to produce evidence to support their claims. Their often hostile rhetoric encouraged a 213 percent increase in prosecuted disability hate crimes, and successive administrations disregarded the thousands of deaths directly linked to the Work Capability Assessment, which was adopted using a discredited and dangerous biopsychosocial model of assessment to restrict access to long-term disability benefit. Influenced by corporate America since 1992, the UK social policy reforms guaranteed that many of those in greatest need were destined to die when, covertly, killed by the State.
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... To access the ESA, claimants must endure the compulsory Work Capability Assessment (WCA). The WCA was created by adopting the Waddell-Aylward non-medical biopsychosocial (BPS) functional assessment model when influenced by American government advisers UnumProvident Insurance * (UnumProvident 2006(UnumProvident , 2002Stewart 2015, which is an assessment model that disregards diagnosis and prognosis (Stewart 2018c) and is directly linked to negative impacts on public mental health (Beresford 2013;Hale 2014;Barr et al 2015;Cummins 2018;Mehta et al 2018;Stewart 2019b). ...
... The ongoing reforms, and perceived DWP reluctance to fund out-of-work disability benefits, have meant that chronically ill and disabled ESA claimants have learned to live in fear of the enforced WCA (Beresford 2013;Patrick 2017;DNS 2017;Mehta et al 2018;Stewart 2018aStewart , 2019b). The addition of the 2010 austerity measures (Elliott and Wintour 2010) would increase the preventable harm of those in greatest need (Cummins 2018;Stewart 2019c), when added to the 2008 welfare reforms already introduced by the New Labour government (DWP 2006;DWP 2008). ...
... Conducted by the unaccountable private sector, the DWP adopted the Waddell-Aylward BPS nonmedical functional assessment ( Waddell andAylward 2005, 2010) to be used for the WCA, which would negatively impact on the welfare and the survival of many chronically ill and disabled ESA claimants (Hale 2014;Patrick 2016;Dwyer 2018a;Stewart 2018cStewart , 2019aStewart , 2019bStewart , 2019cHale 2019). Eight years after the DWP adopted the flawed WCA in 2008 (Barr et al 2015;Demos 2015;BPS 2016) the non-medical Waddell-Aylward BPS model of assessment was exposed by academics as having 'no coherent theory or evidence behind this model ' (Shakespeare et al 2016).This was the academic confirmation needed by the disabled community to confirm their contention that the WCA was dangerous, bogus and totally unfit for purpose (Hale 2014;, with evidence mounting of disability benefit claimants being systematically 'killed by the state' (Elward 2016). ...
Influences and Consequences. The conclusion to the Preventable Harm Project 2009 – 2019
Article
Full-text available
  • Nov 2019
The adoption of neoliberal politics, together with American social and labour market policies, guaranteed the creation of the preventable harm of the UK disabled community who are unfit to work.
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... Although superficially this may appear to be an acknowledgment of structural issues such as unemployment impacting on suicide (Stewart, 2019(Stewart, , 2020, the document is completely silent on why a Jobcentre (a service supporting people into employment and administering benefits for people who are unemployed) is a location in which there may be vulnerable and suicidal individuals. The Jobcentre is only considered in terms of its ability to act as a location of surveillance and intervention rather than being recognised as site within a nexus of structured inequalities that make lives less liveable (Mills, 2018;Stewart, 2019). ...
... Although superficially this may appear to be an acknowledgment of structural issues such as unemployment impacting on suicide (Stewart, 2019(Stewart, , 2020, the document is completely silent on why a Jobcentre (a service supporting people into employment and administering benefits for people who are unemployed) is a location in which there may be vulnerable and suicidal individuals. The Jobcentre is only considered in terms of its ability to act as a location of surveillance and intervention rather than being recognised as site within a nexus of structured inequalities that make lives less liveable (Mills, 2018;Stewart, 2019). ...
Self-inflicted. Deliberate. Death-intentioned. A critical policy analysis of UK suicide prevention policies 2009-2019
Article
  • Jan 2022
Purpose With encouragement from the World Health Organisation, national suicide prevention policies have come to be regarded as an essential component of the global effort to reduce suicide. However, despite their global significance, the construction, conceptualisation and proposed provisions offered in suicide prevention policies have, to date, been under researched; this study aims to address this gap. Design/methodology/approach we critically analysed eight contemporary UK suicide prevention policy documents in use in all four nations of the UK between 2009 and 2019, using Bacchi and Goodwin’s post-structural critical policy analysis. Findings The authors argue that across this sample of suicide prevention policies, suicide is constructed as self-inflicted, deliberate and death-intentioned. Consequently, these supposedly neutral definitions of suicide have some significant and problematic effects, often individualising, pathologising and depoliticising suicide in ways that dislocate suicides from the emotional worlds in which they occur. Accordingly, although suicide prevention policies have the potential to think beyond the boundaries of clinical practice, and consider suicide prevention more holistically, the policies in this sample take a relatively narrow focus, often reducing suicide to a single momentary act and centring death prevention at the expense of considering ways to make individual lives more liveable. Originality/value UK suicide prevention policies have not been subject to critical analysis; to the best of the authors’ knowledge, this study represents the first attempt to examine the way in which suicide is constructed in UK suicide prevention policy documents.
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... For social scientists, whose peer-reviewed published research papers exposed the relentless suffering created by increasingly extreme and authoritarian social policy reforms in the United Kingdom (UK), there are few who identify today's suffering of those in greatest need with the political decisions and social policies of the distant past (Stewart, 2017;2018a;2019b). In reality it was Margaret Thatcher , in a 1982 Cabinet meeting, who announced her ultimate political ambition as being the removal of the UK welfare state, to be eventually replaced by private health insurance; in keeping with the welfare programme in the United States (US) (Travis, 2012;. ...
The adoption of preventable harm, masquerading as social policy reforms
Preprint
  • Jul 2021
I am the research lead for the Preventable Harm Project, that I led for ten years. The research demonstrates the plan by successive administrations to eventually replace the UK welfare state with private health insurance, identified as being Thatcher's 'dark legacy'.
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... This guaranteed the creation of preventable harm as the chronically ill and disabled community were coerced and intimidated by the DWP, using psychological tyranny to limit the number of successful disability benefit claimants. 2 The BPS model of assessment is the invention of the health insurance industry, adopted to limit funding health insurance claims in the US. The chronically ill and disabled community are aware of the adoption of the BPS assessment by the DWP, used to limit access to disability benefits. ...
A catastrophic indifference to human need: the mental health crisis created by the DWP
Article
Full-text available
  • Jan 2021
The adoption of a fatally flawed assessment model to limit access to long-term disability benefits has caused a mental health crisis in the UK
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Burden and benefits-related suicides: “misperception” or state crafted reality?
Article
  • Jan 2022
Purpose This article aims to focus on deaths by suicide in relation to UK welfare reform as a case study to question one of suicidology’s most dominant theories – the Interpersonal Theory of Suicide (Joiner, 2005) and its influential ideas on “perceived burdensomeness” – as well as wider ideologies on suicide and mental health reflected in this approach. Design/methodology/approach This article draws on evidence from disabled people’s campaigning groups (primary sources) and research literature (secondary sources), which shows the negative psychological impact of burden discourse and how this shows up in people’s accounts of feeling suicidal, in suicide notes and in family accounts of those who have died by suicide. It uses this evidence to problematise the Interpersonal Theory of Suicide (Joiner, 2005), specifically its ideas about “burden” as an individual misperception, and the assumption that suicide is always the outcome of mental health problems. Findings The findings highlight the systemic, intersectional and cumulative production of suicidality by governmental “welfare reform” in the UK, through positioning welfare claimants as “burdens” on society. They show that by locating the problem of burdensomeness in individual “misperceptions”, the Interpersonal Theory allows the government’s role in crafting stigmatisation and conditions of suicidality to be overlooked and to be reproduced. Originality/value The article raises urgent ethical questions about the application of approaches, such as the Interpersonal Theory of Suicide, to benefits-related suicides and calls for approaches to benefits-related harm and suicide to be rooted in social and disability justice.
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SHAPING FUTURE SUPPORT: THE HEALTH AND DISABILITY GREEN PAPER A BRIEFING BY MO STEWART RESEARCH LEAD THE PREVENTABLE HARM PROJECT
Technical Report
Full-text available
  • Sep 2021
This is a briefing regarding the planned future social policy reforms in the UK.
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State Crime by Proxy: Corporate influence on state sanctioned social harm*
Article
Full-text available
  • Dec 2018
In the UK there are three words that identify the government enforced suffering of sick and disabled people, and they are: Work Capability Assessment (WCA). This report identifies the influence of a corporate healthcare insurance giant with successive UK governments since 1992, the influence of a former government Chief Medical Officer and the use of the WCA, conducted by the private sector, as the government permit state crime by proxy when justified as welfare reform.
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The Impact of Austerity on Mental Health Service Provision: A UK Perspective
Article
Full-text available
This is a discussion paper which examines the impact of austerity policies on the provision of mental health services in the United Kingdom. Austerity is a shorthand for a series of policies introduced by the Conservative and Liberal Democrat Coalition government in the UK from 2010 onwards. In response to the fiscal crisis following the bail out of the banks in 2008, it was argued that significant reductions in public spending were required. The background to these policies is examined before a consideration of their impact on mental health services. These policies had a disproportionate impact on people living in poverty. People with health problems including mental problems are overrepresented in this group. At the same time, welfare and community services are under increasing financial pressures having to respond to increased demand within a context of reduced budgets. There is increasing recognition of the role that social factors and adverse childhood experiences have in the development and trajectory of mental health problems. Mental health social workers, alongside other professionals, seek to explain mental distress by the use of some variant of a biopsychosocial model. The extent of mental health problems as a one of their measures of the impact of inequality. More unequal societies create greater levels of distress. There is a social gradient in the extent of mental health problems—the impact of severe mental illness means that many individuals are unable to work or, if they can return to work, they find it difficult to gain employment because of discrimination. The paper concludes that austerity and associated policies have combined to increase the overall burden of mental distress and marginalisation within the UK.
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Demonising disabled people: public behaviour and attitudes during welfare reforms.
Article
Full-text available
  • Jul 2017
Demonising disabled people: public behaviour and attitudes during welfare reforms [Blog contribution: Welfare Conditionality: sanctions, support and behaviour change] Independent researcher Mo Stewart identifies the ease with which public behaviour can be manipulated and changed by government when aided by the press. Public behaviour has also changed during welfare reforms It is the service-users' behaviour that government seeks to change with government policy when linked to harsh sanctions but, in reality, it is public opinion and behaviour that has also changed when influenced by political rhetoric. Behaviour change is not difficult to achieve when there is full access to the national press and media and when unfounded political claims, which are guaranteed to be reported, can manipulate public opinion over time which eventually creates a behaviour change in society. This has come to pass in recent years with the concept of State funded welfare in the UK. Welfare reform, together with austerity measures introduced by the Coalition government in 2010, and the preventable harm created by government knowingly demonising claimants of long-term disability benefit suggesting wide spread welfare benefit fraud, now sees welfare dependent chronically ill and profoundly disabled service-users living in fear of the British government and the British press. In reality, the published government figures demonstrated welfare fraud at 0.7%, not 75% as claimed in the national press to influence public opinion. The political manipulation of public opinion was at its most fierce during the Coalition government's term in office, for five years from 2010, as the introduction of austerity was destined to cause distress, so it was necessary for the government to offer the public someone else to blame. The very easy targets of a quickly evolved political smear campaign were the long-term chronically ill and disabled people, who were totally dependent upon welfare funding for their financial survival. This relentless political attack against those in greatest need was created to suggest that the UK could no longer justify the welfare budget, that following the 2008 banking crisis suddenly the UK was required to 'live within our means', with the suggestion that the public sector deficit
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Corporate Welfare Crime: Two Case Studies in State-Corporate Harm.
Thesis
Full-text available
  • Dec 2016
This dissertation examines the neoliberal welfare state, where privatisation has transformed welfare recipients into the ‘consumers’, ‘customers’ and ‘commodities’ required for profit generation and maximisation. The social harm perspective provides the necessary framework to conceptualise such processes, as its broader investigative scope better explains the mechanisms of harm production and relocates harm as crime. This dissertation argues that corporations are criminogenic by nature, largely due to 1) their organisational cultures; 2) the pressures of capitalism; and 3) the passive legal and political structures which fail to reprimand business for their deviant acts. Corporations are unable to conduct business without breaking laws and inflicting harm, and for this reason, it is argues that it is irresponsible for the state to subject vulnerable people to corporate control. The dissertation provides two case studies to better conceptualise such processes. The case studies analyse the outsourcing of elderly social care, and the many harms that occur as a result of the state’s insistence of engineering this welfare function as a market. This dissertation goes onto discuss differing aspects of the Work Programme, where the state have devised differing formats to punish the non-working population for not aligning with capitalism's ideals, and corporations play a central role in this. This dissertation argues that the states ‘othering’ of their responsibilities is a purposeful ploy to distance themselves from the harms associated with neoliberal welfare formats and potential legal ramifications. This dissertation asserts that such processes can be viewed as state crime by proxy, as the state is as intimately linked to harm production as the corporations facilitating their functions on their behalf.
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CASH NOT CARE: ~ the planned demolition of the UK welfare state A detailed research text by
Article
Full-text available
  • Oct 2016
manipulated the British public by making unsubstantiated claims that later proved to be unfounded. Despite Duncan Smith's constant accusations there is not, nor has there ever been, any evidence of vast numbers of chronically sick and disabled people enjoying a life of idleness on long-term benefit because they are too idle to find work. The most recent DWP figures identify no more than 0.7% of ESA claimants as being fraudulent, with DWP errors being much higher. The WCA was significantly altered by the Coalition government in 2010 to make it much more difficult to qualify for the ESA benefit. By totally disregarding diagnosis and prognosis, desperately ill people have been prevented access to ESA because they were physically capable of collecting a pen from the floor, when using the fatally flawed WCA functional assessment model of disability that removes all credibility from occupational medicine. Enforced destitution was inevitable as claimants were refused access to the ESA but were also deemed too ill to work, and so were prevented access to Unemployment Benefit by the Job Centres. Death totals were always guaranteed to soar as a British government now starve to death some of the most vulnerable people in the UK. As a former healthcare professional, and following six years of research, I can confirm that the WCA has no clinical credibility and it is demonstrated to be a dangerous assessment model, disregarding diagnosis and prognosis and using unqualified basic grade DWP 'Decision
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'First, do no harm': Are disability assessments associated with adverse trends in mental health? A longitudinal ecological study
Article
Full-text available
  • Nov 2015
  • J EPIDEMIOL COMMUN H
Background: In England between 2010 and 2013, just over one million recipients of the main out-of-work disability benefit had their eligibility reassessed using a new functional checklist-the Work Capability Assessment. Doctors and disability rights organisations have raised concerns that this has had an adverse effect on the mental health of claimants, but there are no population level studies exploring the health effects of this or similar policies. Method: We used multivariable regression to investigate whether variation in the trend in reassessments in each of 149 local authorities in England was associated with differences in local trends in suicides, self-reported mental health problems and antidepressant prescribing rates, while adjusting for baseline conditions and trends in other factors known to influence mental ill-health. Results: Each additional 10 000 people reassessed in each area was associated with an additional 6 suicides (95% CI 2 to 9), 2700 cases of reported mental health problems (95% CI 548 to 4840), and the prescribing of an additional 7020 antidepressant items (95% CI 3930 to 10100). The reassessment process was associated with the greatest increases in these adverse mental health outcomes in the most deprived areas of the country, widening health inequalities. Conclusions: 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.
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‘Dead people don’t claim’: A psychopolitical autopsy of UK austerity suicides
Article
  • May 2017
One of the symptoms of post financial crisis austerity in the UK has been an increase in the numbers of suicides, especially by people who have experienced welfare reform. This article develops and utilises an analytic framework of psychopolitical autopsy to explore media coverage of ‘austerity suicide’ and to take seriously the psychic life of austerity (internalisation, shame, anxiety), embedding it in a context of social dis-ease. Drawing on three distinct yet interrelated areas of literature (the politics of affect and psychosocial dynamics of welfare, post and anti-colonial psychopolitics, and critical suicidology), the article aims to better understand how austerity ‘kills’. Key findings include understanding austerity suicides as embedded within an affective economy of the anxiety caused by punitive welfare retrenchment, the stigmatisation of being a recipient of benefits, and the internalisation of market logic that assigns value through ‘productivity’ and conceptualises welfare entitlement as economic ‘burden’. The significance of this approach lies in its ability to widen analytic framing of suicide from an individual and psychocentric focus, to illuminate culpability of government reforms while still retaining the complexity of suicide, and thus to provide relevant policy insights about welfare reform.
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Blaming the victim, all over again: Waddell and Aylwards biopsychosocial (BPS) model of disability
Article
  • May 2016
The biopsychosocial model (BPS) of mental distress, originally conceived by American psychiatrist George Engel in the 1970s and commonly used in psychiatry and psychology, has been adapted by Gordon Waddell and Mansel Aylward to form the theoretical basis for current UK government thinking on disability. Most importantly, the Waddell and Aylward version of the BPS has played a key role as the government has sought to reform spending on out-of-work disability benefits. This article critiques Waddell and Aylward’s model, examining its origins, its claims and the evidence it employs. We argue that its potential for genuine interdisciplinary cooperation and the holistic and humanistic benefits for disabled people as envisaged by Engel are not now, if they ever have been, fully realised. Any potential benefit it may have offered has been eclipsed by its role in Coalition/Conservative government social welfare policies that have blamed the victim and justified restriction of entitlements.
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