Nobody should have been surprised by the Department for Work and Pensions’ response to the revelation that suicide and mental illness soared in roughly equal measure to the amount of work capability assessments taking place, between 2010 and 2013.
As predicted on This Blog yesterday evening, a spokesperson said: “The authors themselves caution that no conclusions can be drawn about cause and effect.”
But this is interesting: “It is concerning that they provide no evidence that the people with mental health problems highlighted in the report even underwent a Work Capability Assessment.”
No, they didn’t – but there were several factors affecting this: Firstly, the availability of accurate information, and secondly, whether this was a study that needed to focus exclusively on benefit claimants.
Professor Louis Appleby, a government adviser on suicide and mental health, thinks it was. He tweeted: “True figure for suicide linked to WCA likely to be less than in today’s study: could work out exact number if DWP gave access to individual cases.”
But we don’t have access to individual cases. The DWP has made it abundantly clear that Conservative Government ministers have deliberately chosen not to record medical information such as the cause of a claimant’s death – and in any case (again by deliberate choice), no effort has been made to keep track of claimants whose benefit claim has been halted.
It would, therefore, be pointless to rely on information from the DWP!
But Jonathan Portes of the National Institute for Economic and Social Research (NIESR) told This Writer that, in any case, the DWP’s response “reflects a basic misunderstanding of how you do this sort of analysis! Looking at WCA cases would be precisely wrong. You need to be able to control for selection – to do that here, [you] need to look at [the] whole population.
“Let’s try [an] example. Does Coke make you fat? You can’t just look at people who drink coke & ask if they’re fatter, but if in areas where Coke [is]cheap, [and] people [are] on average fatter, *controlling for everything else*, that does tell you something.”
So, in order to ensure that the correct cause is ascribed to any particular effect, those who carried out the study had to examine the health of the population as a whole, and eliminate elements that could relate to everybody, rather than just those who took the work capability assessment. They needed to rule out “unobserved confounding” – unseen elements contributing to the results.
Is that what happened?
Here’s what the study’s authors had to say: “We found no significant association between the reassessment rate and trends in self-reported mental health problems and suicides in the over 65-year-old population, (ie, people over retirement age and therefore not subject to the WCA reassessment process).
“We also found no association with trends in heart conditions in the working age population, or trends in prescribing of cardiovascular drugs (ie, health conditions that would not plausibly be affected by the WCA reassessment process, in the short term at least).
“These test results suggest that the observed association between the reassessment process and mental health outcomes in the working-age population is not due to unobserved confounding.”
That comment would not have been possible if the study had focused on benefit claimants exclusively, and not the general population.
The study was subjected to further tests, though: “As our main analysis was based on aggregate data, it is possible that changes in composition of these populations could explain the results. To explore this further we analysed individual level data from the Labour Force Survey in a multilevel model, further controlling for a number of individual characteristics including age and sex, labour market status (employed, unemployed and inactive), number of physical chronic illnesses and level of education. This analysis gave very similar results as that based on aggregate data.
“In additional analysis we also controlled for differential trends by the level of rurality in each area and trends in initial assessments for out-of-work disability benefits and found these did not change our results.”
So – in the words of Mr Portes, “controlling for everything else” – the study produced the same increase in antidepressant prescribing, mental illness and suicide, indicating that the significance of these rises was that they coincided with the imposition of the work capability assessment on benefit claimants.
In This Writer’s opinion, the DWP comment was a rather desperate attempt at ass-covering. Ministers had believed they had eliminated any way of relating their flawed, tick-box assessment – which takes no account of medical conditions in establishing whether a person is fit for work, remember – with the deaths or suicides of claimants. Now they have discovered that they were mistaken.
Again we come back to the issue of freedom of information. All the way down the line, the facts about the effects of these tests have been deliberately hidden from the public by a government that is happy to remove our privacy and tell us, “If you’ve nothing to hide, you have nothing to fear.”
What is the Conservative Government afraid we’ll discover?
Perhaps now is the time to demand a full inquiry into the practical results of the work capability assessment regime…
An inquiry to be followed by criminal prosecutions.
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