Written evidence submitted from Name Withheld (PEA0340)
I am an individual with enduring mental health problems, and am in receipt of PIP and ESA after having undergone assessments for both.
My submission addresses, but need not be limited to, the following term of reference:
“Are some groups of claimants particularly likely to encounter problems with their assessments – and if so, how can this be addressed?”
1. The application processes for ESA and PIP can be deleterious to sick and disabled people – the intended recipients of those benefits – due to the excessive toll they place on the health of people who are, by definition, in an already compromised state of health.
1.1 As the guidelines for submitting written evidence demand that such evidence be limited to specific terms of reference, and as those terms of reference are in themselves highly limited, I make my case with particular reference to claimants who, as a group, suffer from stress-sensitive conditions, including, but not limited to, people with mental illness and multiple sclerosis sufferers.
1.2 Note, however, that all individuals are vulnerable to mental and physical illness in response to stress; where an individual is physiologically and/or psychologically compromised by pre-existing health-conditions (the defining feature of PIP/ESA applicants), that vulnerability is increased.
1.3 In addition to exacerbating stress-sensitive conditions, the current hostile application process can, by its nature, precipitate stress-related illness in individuals who previously did not exhibit those illnesses. Not only is this unethical, it is also counterproductive, with the potential to increase the financial burden on the State.
2. Claimants who suffer with stress-sensitive conditions are, as a group, particularly predisposed to encountering problems with the assessment processes due to the compounding of those health conditions by the stress of the processes.
2.1 Such claimants are forced to choose between safeguarding their health – by non-participation in the process – and accessing the financial help which they need and to which they may be entitled. Consequently, this group are particularly compromised in their ability to access PIP and ESA.
3. Where a system has attracted the degree of notoriety now associated with both the ESA and PIP application processes, every stage of those processes can provoke a degree of stress in participants that, in other circumstances, would seem extraordinary.
3.1 The current application processes are widely perceived among sick and disabled people and their families as tools serving not to assess and facilitate access for the eligible, but to obstruct access for the weak. Applying for PIP and ESA is both perceived and experienced as a battle – perversely demanding extraordinary resilience, tenacity, and strength of mind and body – against a callous and corrupt system. Along with the extraordinarily high level of anecdotal accounts online and in the media, detailing unacceptable conduct and untenable decisions by the DWP and its contractors during the application processes, the statistical evidence, for example of percentage of decisions overturned at appeal, corroborates this perception.
3.2 This perception of the application processes – as a battle that may be seriously injurious to health – is an inevitable and substantial deterrent from applying for ESA and PIP, and is a particular problem for individuals with stress-sensitive conditions. 3.3 The self-denial of a PIP/ESA award by individuals, as a consequence of the DWP creating a hostile application process, can reasonably be characterised as constructive denial, equivalent to constructive dismissal, and equally immoral and unacceptable.
4. Where a system operates in such a way that it serves to obstruct access of an entire group, the system is effectively discriminating against that group.
4.1 Equal rights legislation creates the legal imperative of non-discriminatory access to services for disabled people.
4.2 The DWP, through the hostility of its application processes, is obstructing access for the very people those benefits are intended to assist – the sick and disabled – with the most profound impact falling on those with stress-sensitive conditions.
5. It is a notable conflict of interests that it can serve the government’s economic interest to foster overtly hostile application processes. A reduced uptake in disability/sickness benefits – from individuals being deterred from applying, or losing their lives, such as to suicide, as a result of health conditions exacerbated by the harsh application processes – could be expected to reduce the government’s welfare bill, the express aim of the welfare reform.
5.1 This conflict of interests is keenly felt by recipients of the service and their families.
5.2 Such a conflict in interests creates an imperative on a government to conduct itself with utmost rigour in empirically demonstrating itself to be above reproach. It must reassure its citizens that it conducts itself ethically and accountably in the face of potential economic self-interest.
5.3 The degree of incompetence that has been experienced and reported, and in the context of this conflict of interests, has been substantially damaging to the government’s reputation and to an impression of ethical conduct and accountability, creating an overriding impression of corruption.
5.4 The premise of the disability benefits reform is, in itself, punitive, aiming to reduce the welfare bill not by focusing on the prevention or treatment of disabling health conditions, but instead entirely on restricting eligibility for sick and disabled people, including those who have previously been entitled to financial aid. This inhumane approach has left sick and disabled people feeling under siege.
5.5 This is further compounded by the widely denounced practice of sanctioning working age benefits, including ESA recipients in the WRAG, and the correlation with rising destitution, use of foodbanks, and homelessness.
5.6 This does not constitute an ethical welfare programme. It could be more accurately described as economic genocide.
5.7 The consequent climate of paranoia and antipathy towards the government and its welfare reforms, including the PIP/ESA application processes, is now deeply ingrained.
6. Whilst the evidence of corruption for many may be compelling, it is irrelevant that it be established as fact: it is not enough for a government and its procedures to be fair and accountable, they must be seen to be fair and accountable.
6.1 The application processes for ESA and PIP do not have the faith of the recipients of the service, or of the larger public. Once the faith of the public has been lost, the process must be comprehensively reformed/overhauled, and that faith be restored through empirical observation and experience that the system is just, competent, humane, and accountable.
7. Experiences and perceptions that undermine faith in the assessment process include, but are not limited to, the following:
7.1 Assessors are perceived to be:
7.2 The assessment process is perceived as deliberately failing to ensure all available information, medical records etc, is available for assessors/decision makers. This is perceived as intended to deny awards to eligible applicants, with the statistical likelihood that a proportion of those applicants will not pursue their claim further.
7.3 The unduly onerous requirements for applicants wishing to make audio recordings of their assessments is perceived as a deliberate means of obstructing accountability; applicants must provide their own recording equipment, in a non-digital medium, capable of producing recordings in duplicate, one of which the applicant is required to present to the assessor.
7.4 Appointments are perceived to be:
7.5 The DWP are perceived to regularly reach untenable decisions on entitlement; this is perceived as calculated to result in a proportion of eligible applicants not pursuing their legal recourse to an appeals process.
7.6 The appeals process is perceived to:
7.7 The frequency of reassessment of benefit entitlement is perceived as excessively high and arbitrary; this is perceived as a deterrent intended to wear down applicants by requiring them to repeatedly endure hostile assessments. It is perceived as harassment by the DWP.
7.8 The results of reassessments are perceived as unaccountably inconsistent; 44% of planned PIP reviews in 2016 resulted in a reduced or refused entitlement, despite PIP being typically awarded for long-term conditions.
8. The problems that individuals with stress-sensitive conditions face with their assessments, due to the stress of the assessment process exacerbating those conditions, must be remedied by reforming the process so that those experiences and perceptions listed above (paragraph 7) are no longer experienced, or perceived to be accurate.
8.1 This would benefit all applicants, not just those with stress-sensitive conditions, and would substantially improve the reputation of the DWP and the government.
9. Below, I detail some of my direct experience, as an individual with a stress-sensitive condition, of the PIP and ESA application processes as an obstruction to access rather than a fair and effective assessment, and the deleterious impact it has had on my health, with consequent increased fears around further assessments, and consequent increased risk of harm during future assessment processes.
10. I have been mentally ill since adolescence, and have spent two and a half years of my life in mental health institutions. I have been continuously in receipt of high levels of care, and disability and sickness benefits, since the age of 19. I was diagnosed with a personality disorder by the country’s leading experts in the field, at the Bethlem Royal Hospital in 1999.
I am vulnerable to severe self-injury and suicide ideation/behaviour, particularly in response to stress. The severity of my self-injury, sometimes resulting in a need for surgery, and typically exposing muscle, has remained consistent throughout my adult life.
10.1 The perceived hostility of the application processes for both ESA and PIP increases my mental and consequently physical vulnerability. Each time I have had to apply for these benefits, the stress and anxiety has resulted in me inflicting deep wounds, exposing muscle, of up to 10 inches length.
10.2 For my ESA application, I enclosed a photograph of such an injury, inflicted in response to the stress of the application, and corroborated by my GP. My GP, my carer and I all stressed and evidenced the need for a paper-based review rather than a face-to-face assessment, due to the extreme anxiety such a prospect provokes in me with consequent risks to physical health.
10.3 The ESA assessor found in my favour on the basis of the paper evidence, and advised the DWP that “I suggest great care is taken with further contact [from the DWP] with this lady in future” because of my vulnerability to self-harm in response to contact from the DWP.
10.4 I am aware from others’ experiences, detailed in many online disability forums, that it is unusual to have been awarded ESA following a paper-based review; I am acutely aware that there is little consistency in the reassessing of awards, and that I am therefore at risk of facing harrowing and degrading treatment in the future.
10.5 For my PIP assessment, despite including the same photograph of self-injury triggered by the ESA application process, and the cautionary advice of my GP and the ESA assessor, I was instructed by the DWP to attend a face-to-face assessment.
10.6 I wrote to the DWP and to Capita repeatedly in the run up to that assessment to request a paper-based review, stressing my vulnerability and enclosing photographs of consequent, newly-inflicted severe wounds. I suggested it would be an act of negligence to oblige me to attend an assessment, knowing my vulnerability. I received no response to these letters.
10.7 Two days prior to the assessment, I inflicted a particularly severe injury with uncontrollable bleeding, and spent the preceding day in hospital, being sutured in an operating theatre and administered IV fluids for blood loss.
10.8 This injury and risk to life was inflicted entirely in response to the stress of being called for assessment. That stress was significantly exacerbated by the notoriety of the assessment procedure, including the fear of being insulted, derided, intimidated and misrepresented.
10.9 As a result of that severe injury, I arrived with my carer for the assessment on crutches, anaemic and hypotensive, in a state of acute mental and physical vulnerability. Upon entering the building, I was informed that the appointment had been cancelled without notification.
10.10 This blatant disregard for my welfare precipitated an immediate descent into an attack of extreme distress in which I repeatedly banged my head, screaming agitatedly and protesting the corruption of the system, including its condemnation by Amnesty International, and the UK government being at that time under investigation by the UN for its treatment of disabled people.
10.11 My carer attempted to restrain me, whilst also trying to reason with the assessor, who appeared coldly unconcerned by my extreme distress. The reception area was shared with other businesses, meaning my acute mental crisis in a public space directly impacted on other members of the public.
10.12 It was humiliating, degrading and deeply traumatising to be pushed into an episode of extreme mental breakdown in a public space.
10.13 This incident was entirely avoidable; I was explicit in my application of the risk of such an outcome, stressing that when my mental health is compromised, I protect my own and others’ welfare by avoiding public spaces. Had the DWP not insisted on a face-to-face assessment, this crisis would not have occurred. The DWP chose to ignore this information with complete disregard for my welfare, and for the impact on the public.
10.14 There is now the substantial risk, having been deeply traumatised by this experience, of my inflicting far greater injuries of a life-threatening nature, and/or making attempts on my life, in the run-up to or during another face-to-face assessment. During the experience of the cancelled assessment, I experienced intense regret at not having razor blades with me; had I done so, I would have very likely inflicted severe lacerations to my body during that crisis and with minimal regard for my life. Given the acute trauma of that experience, I am now at substantial risk of employing such strategies in future as a way of enduring an intolerably distressing situation.
10.15 As I made clear in my application and subsequent communications with the DWP, the management of my mental health includes actively avoiding situations which are likely to be deleterious to me. The assessment procedure seriously and comprehensively undermined mine and my carer’s management of my mental health. There is no other circumstance in my life where I am subject to such extreme stress and intense fear of persecution and mistreatment.
10.16 I refused to leave without being assessed, because of the tremendous personal cost in having attended the appointment, and the likely consequences for my health of being summoned again subsequently.
10.17 The assessor’s response was to call the police, reporting ‘threatening’ behaviour, although the police themselves described the callout as a welfare concern and no charges were pressed.
10.18 The police offered to assist in obtaining a paper-based review, in light of my extreme distress and vulnerability; with this prospect, I was able to leave the centre with my carer.
10.19 Following that cancelled assessment, the DWP reached the decision that I was ineligible for PIP at any level.
10.20 I wrote a detailed letter in defence of my claim, highlighting the many substantial and untenable inaccuracies in the DWP’s reasoning.
10.21 Following a mandatory reconsideration, I was awarded PIP at an enhanced rate for daily living, after previously not reaching the basic threshold in either category. This award was for a two-year period, and was made without the face-to-face assessment that the DWP had previously insisted was essential.
10.22 One year on, and that purportedly two-year award is now subject to review. Online research indicates that misinforming applicants about the duration of their award is standard; this further serves to deepen perceptions of dishonesty and unaccountability in the assessment process.
10.23 I am deeply frightened of being called again for a face-to-face assessment during this current review. The impact on my welfare is likely to be devastating and potentially life-threatening; the experience of brown envelopes arriving in the post, the hallmark of DWP correspondence, instantly triggers suicidal feelings in me.
10.24 I feel under pressure to provide fresh evidence of my ongoing vulnerability to severe self-injury and suicide ideation, in an attempt to preempt being called to an assessment a second time, which I am concerned I may not survive.
10.25 It is difficult to know how to provide evidence of my vulnerability and consequent care needs, other than in the form of photographs of recent wounds; the conflict of interests that that engenders in the management of my mental health to reduce my vulnerability to self-injury is substantial. I do not know how to otherwise demonstrate to a hostile and remote agency something as intangible as mental fragility, given the lack of weight afforded to my extensive psychiatric history and the written testimony of myself, my carer, my GP, and the ESA Advisor.
10.26 It is an extraordinary burden of proof and an inhumane demand that disabled people demonstrate to the DWP often difficult-to-quantify conditions, above and beyond the testimony of their carers and medical professionals.
10.27 It is a cruel irony that, in order to be awarded the disability benefits that afford me the financial means to meet my care needs, I, and others like me, can be required by the government, in contravention of medical advice, to expose myself to the extraordinary stress of a hostile assessment process, widely perceived to be corrupt, that is more of a threat to my welfare than any other aspect of my life.
10.28 The DWP’s treatment of disabled people amounts to cruel and degrading treatment, and as such is incompatible with our human rights.
11. The DWP – if it does not already do so – ought to have a duty of care towards vulnerable clients. If it currently has a duty of care, it is comprehensively failing to exercise it.