Work Capability Assessments and Mental Health

A judicial review in May found that the WCA (Work Capability Assessment) was unfair to those with mental health problems. The case brought by two anonymous people suffering from mental illness highlighted the problems evidencing an inability to work for those suffering depression. For five years in the late 1980s I escaped the need for an assessment. I was lucky that my mental illnesses had not resulted in more than about 6 months off work at a time. On the two occasions I had extended sick leave from teaching I was lucky enough to get a period of full pay followed by a period of half pay. I struggled back to work and walked through treacle for a year before resuming my normal fast-thinking self. I was expert at hiding what was going on inside my head.

When I broke down immediately after taking early retirement, my debility meant that I could not apply for jobs – in fact it was the prospect of an interview in a town I did not know and a disastrous attempt at agency work while ill that sent me spiralling downhill. I had refused to take ‘sick’ retirement which would have given me a higher pension as I wished to avoid being labelled. So I had a small teachers’ pension, a couple of lodgers and nothing else. With a mortgage and the associated on-costs my budget was not just tight, it was strangled.

So I was relieved to get what was known then as Incapacity Benefit which softened the financial situation.  There was talk of having to attend an interview and assessment after six months so I prayed I would feel well enough before then to take up some occupation. I had recovered sufficiently in the past so positive self talk told me there was no reason why this should not happen again although I felt  despair on a daily basis.

But what to do was the problem. I was in hospital for two weeks under a section and then expected to attend a day clinic and see a doctor once a week. Finding a job was impossible under such circumstances. But, the daily interaction would, no doubt, help my mental state and I missed the daily contact of understanding colleagues.

Even now, nearing the end of 2013, there seems to be no ‘in between’ in that murky stage of recovery and the leap from unemployment and employment can feel like standing at Beachy Head. What can mental health patients do to get back into the workplace? If your job has been held over for you then you are one of the lucky ones and, hopefully, your employer will allow you to go back on a very part-time basis and build up your hours. The truth may have to be faced, though, that work – or at least full-time work – may not be right for you. My own teaching occupation is challenging and stressful and brings into play performance anxiety, a state not conducive to mental healing.

So, the recuperation stage is a good time to re-evaluate your chosen career. But, changing your occupation while struggling in recovery is not only difficult, it is impossible. Learning new procedures and working alongside new and probably unsympathetic colleagues who are all so sharp and ‘in the flow’ can make you feel worse. In 1996 I witnessed a fellow ex-patient struggling on a local supermarket till and my heart sank. She was in obvious distress, with her brain unable to cope with simple instructions. I subsequently vowed to avoid that route although as a teenager I did work in a   shop and loved it.

But changing career takes courage which is lacking at the lowest times of depression and patients need to get well first. Meanwhile there are forces at work determined to make life difficult for you.

In the autumn edition of Single Step, the magazine from Depression Alliance @DepressionAll, Andrea Twist cites her own difficulties applying for ESA (Employment Support Allowance). The process requires that applicants have considerable insight into their mental health condition which, when you are unwell, is absent. She found it impossible to apply on her own behalf and required help from a local advice worker. Completing the application form was distressing as the process brought home to her how depression had devastated her whole life.

Andrea cites the experience of another sufferer. Anthony, who experienced being asked questions such as ‘can you tie your own shoe laces?’ and ‘can you wash yourself?’ At no stage were open questions used such as ‘how does depression affect your life?’ or ‘what causes it?’

If I had been asked any of the above in 1996 I would, like Anthony, have scored zero points and been deemed capable of work but I could still not form a sentence or get through a morning routine in the short time necessary to get out of the house by 8.30. My concentration was non-existent, my memory poor and I lacked the co-ordination to use a keyboard which had previously been my strength.

It is clear that more needs to be done to make WCAs more mental-health-friendly. When out of work, those with depression have exceedingly low self-esteem, little hope and poor communication skills. Let’s hope that after the result of the Judicial Review in May processes and interview procedures will be re-assessed and more appropriate questioning used.

Meanwhile, as usual, those with depression will have to be their own advocates or find someone to act for them. If faced with a WCA you should do the following to ease the difficult time ahead.

1                 Spend time writing down how your mental health condition affects your everyday life, your ability to manage money, shop for yourself and run your home.

2                 Compile a timeline of your mental health history and your working periods. You probably have a better work record than you think.

3                 Write down what has contributed to your illness in the past if it concerns work. Examples might be working to unreasonably tight deadlines, unsympathetic employers, shift work, lack of exercise. 

4                 List how you are working towards recovery such as following a simple daily routine, attending day time groups, walking, swimming, meeting supportive friends and using your local library to borrow books on your condition.

5                 Gather evidence of your condition such as GP reports, psychiatric notes and reports. Rethink Mental Illness is asking that the DWP take over this responsibility so here’s hoping they are successful.

6                 Visit or contact your GP, CPN (Community Psychiatric Nurse), support worker, facilitator of a local support group you have attended. They may provide letters.

7                 Take someone with you to the assessment to take notes and speak for you if you become distressed.

8                 Join a local support group (Depression Alliance has lists) to show willingness to work with your condition.

9                 Finally DO NOT play down or minimise your condition. This is something sufferers of depression tend to do.

10              Never use phrases like ‘I’m fine’ or ‘Its ok’.  You are NOT fine and it is NOT ok.

In October an appeal lodged against the decision was dismissed. It remains to be seen what will transpire with damaging cuts which can devastate the well-being of depressed patients, even life-threatening.

Depression Alliance http://www.depressionalliance.org/  Membership is £24 a year (£5 if on benefits). This website lists support groups in different areas of the country. More about support groups in another post. You can write or email for an information pack.

Depression Alliance
20 Great Dover Street
London
SE1 4LX
Email: information@depressionalliance.org

I blog regularly about mental health at  www.dicastlewriter.wordpress.com and welcome comments. You can also follow me on twitter @dinahcas

Andrea Twist blogs at www.andreatwist.wordpress.com and you can follow her @andrea_twist

If you are unemployed you can view www.inmyshoesnorthlondon.blogspot.co.uk  which has contributors who write on unemployment.

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