November 16, 2015

expert reaction to disability assessments linked to suicide

The health impacts of the government’s work capability assessment is the subject of a paper published in the Journal of Epidemiology & Community Health, with the authors reporting that “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.”

Prof. Thom Baguley, Associate Dean for Research and Professor of Experimental Psychology, Nottingham Trent University, said:

• Does this provide evidence of cuts causing suicide and ill health, or is it correlation?

“The study provides evidence that the specific application of this policy (the way reassessment of cases was conducted) increased the suicide rate and outcomes associated with adverse mental health in those people affected. The evidence goes beyond merely establishing a correlation but falls short of establishing a causal link. The researchers have been careful to control for important confounding variables and conducted a range of alternative analyses to eliminate other explanations. However, it is extremely difficult to rule out all other explanations – especially when dealing with aggregated data (averages at the local authority level). This is therefore an important step forward in answering the question rather than a definitive answer.

“On the broader question of whether cuts cause suicide and ill health – there is ample evidence that deprivation is associated with mental health problems and so in one sense this is an uninteresting question. In relation to the specific question of causation it may be very hard to answer with recent data because both cuts and deprivation are influenced by broader economic factors. This is one reason why it is potentially interesting to look at specific policy effects.”

• Just how big an impact does this evidence show there is?

“Yes – in terms of suicide the data suggest an increase of between 2 and 9 suicides per 10,000 re-assessed cases (an average of 6). As this could be the equivalent of several hundred additional deaths nationally it seems that the impact could be substantial. One note of caution is that the effects may be over-estimated – this tends to be more common than underestimation when researchers tried to control for unobserved confounding variables.”

• Are the results surprising?

“At one level the results are not surprising – the fit with anecdotal evidence and it isn’t unreasonable that the financial or other pressures of reassessment could have adverse effects on mental health. What is slightly surprising is that the effects hold up when trying to account for many other explanations and that the effects seem so substantial.”

• Is there anything we can take from this? Does this paper provide sufficient evidence that we should be doing anything different?

“The paper provides evidence that a particular policy (or how it is implemented) may cause substantial harm. This suggests at the very least that further steps should be taken to look at the policy and how it is implemented.”

Dr Jed Boardman, Lead for Social Inclusion, Royal college of Psychiatrists, and Consultant and Senior Lecturer in Social Psychiatry, South London and Maudsley NHS Trust and King’s College London’s Institute of Psychiatry, Psychology & Neuroscience (IoPPN), said:

“This is a high quality piece of work conducted by a respected group of researchers.

“The findings show a strong association between the reassessment rates for Employment and Support Allowance (ESA), carried out through the Work Capability Assessment (WCA) process, in local areas of England and the local trends in suicide, self-reported mental health problems and antidepressant prescribing. For every additional 10,000 people reassessed for ESA, there was an associated additional 6 suicides in each area amounting to 600 additional suicides in England between 2010-2013.

“Whilst the design used in this study cannot determine whether this is a causal relationship, the methods used do rule out several possible additional factors (‘confounders’) that may have provided alternative explanations for the association between the WCA assessments and the outcomes explored in this study. The associations found do seem to be valid.

“The findings of this study are consistent with several others suggesting a link between the austerity and welfare reform measures on peoples’ mental health. The findings are reinforced by accounts of clinicians, of people with lived experience of mental health problems and of many disability groups of the adverse effects of the recent welfare benefit changes and the system of assessments for out of work and disability benefits. It brings into question the wisdom of current spending and welfare reform policies and their effects on health and wellbeing, particularly for vulnerable groups.”

‘’First, do no harm’: are disability assessments associated with adverse trends in mental health? A longitudinal ecological study’ by Barr et al. published in Journal of Epidemiology & Community Health on Monday 16^th November.

Declared interests

None declared