Mental ill health treatment is not a problem that can be solved on a individual effort or by personal lifestyle changes. It needs a collective effort to return the fruits of labor back into the hands of the laborer and out of the bellies and store-rooms of the few.
Disability and Capitalism
Under capitalism, people are forced to sell their labour-power in exchange for a wage which they can use to purchase what they need to live. As a result of this, capitalists are always seeking to reduce the labour-power they need to purchase (in an ill-fated attempt to increase profit) through increased mechanisation. These machines are designed to be as generalised as possible so that the largest number of people from the working class could operate them, without the expense of specialist training. As imperialism shifts manufacturing to poorer nations we see a rise in service industries which require a large amount of emotional labour, the additional labour of performing a particular emotion while working.
This means that those people whose bodies or behaviours exist beyond the design of the machinery, or who cannot do the emotional labour required, are either expensive or impossible to employ. In addition, capitalism demands more and more productivity: for workers to work faster which further excludes workers who cannot keep pace.
Thus there exists, in Britain, an ever expanding group of disabled people who are excluded from capitalist production and therefore are reliant on other means of survival. In a society where the worker is valued only through the wage, those who cannot earn are considered worthless to capitalist society.
Disability and Work
We see this focus on whether or not a person can “work” at the core of Britain’s disability benefits. In Britain, there are broadly two types of disability benefit. One is intended for the extra costs of disability, and the other directly relates to whether the state thinks you should be working.
The money awarded for the extra costs of disability is inadequate, because it is not enough to meet the costs of living in an ableist society. No amount of money would meet this cost because there is no individual solution to a systemic problem. The existence of the “extra costs of disability” benefit is a tacit acknowledgement of the hostility of society to disabled people, a hostility that is only increasing.
When considering disability benefits, the state categorises people in several ways. Firstly, by their age. People can be a “child” (under 16), a “qualifying young person” (16-19, in education), “working age” (under state pension age, which is different depending on when you were born, but today is 66) or “over state pension age”.
If you are of working age then you are expected to work or look for work. If you cannot work due to sickness or disability then you are required to submit evidence of this, for example, a sick note. After an indeterminate period of submitting sick notes (supposed to be 28 days but often longer), the assessment process begins. This is the Work Capability Assessment (WCA), carried out by a private company, Maximus, which is functionally the state acting as a gatekeeper to disability benefits. Because the DWP is concerned with keeping out “fraudulent” claims, the assessments err on the side of caution (huge percentages of mandatory reconsiderations and appeals are successful). Before the pandemic, these assessments consisted of forms, evidence from doctors and, for some people, a face-to-face assessment.
The outcome of the WCA is that you are sorted into one of three more categories. Fit for Work, which means you must look for work (aside from the necessity under capitalism of selling your labour power, your other benefits may stop if you do not look for work). Limited Capability for Work, where you also do not get any more money, and where you must attend “work-focussed interviews” or be required to take part in “work preparation”. These activities, for the reasons explored in the first section, have never been shown to do anything to help people find work. The final category is Limited Capability for Work Related Activity, also known as the “support group” which is a deeply insulting misnomer. If you are in this group, you will receive more money. You are not required to do anything to look for work and you are exempt from the benefit cap.
Disability Benefits and the Pandemic
Against this backdrop, the pandemic. All face-to-face assessments are currently suspended, with no date for this to return. As of the date of this article, assessments are carried out on paper and by telephone.
This has detrimental effects on claims for both types of disability benefit. There are more poor decisions to be challenged, more disabled people excluded from the process itself because they are unable to make or participate fully in telephone calls, and the recent reintroduction of a negative determination if you fail to participate. The DWP thinks that there are no valid reasons for not taking or making a telephone call. Neurodivergent, non-speaking people, or people with depression or anxiety are much more likely to be unable to participate (not least because the history of assessment is, itself, traumatic). This is consistent with the DWP’s move towards online benefit claims; Universal Credit is only available to claim online which creates a significant delay to accessing benefits to which you are entitled or, in some cases, making claiming at all completely impossible.
There is also a concern amongst welfare rights advisors that the reason for the documented fewer claims for disability benefits and the fewer challenges to DWP decisions is because access to advice has been so limited during the pandemic. One of the core functions of advice services is help with filling claim forms – with advice centres closed, this help is simply not available.
The effects of the pandemic are particularly noticeable in the Work Capability Assessment. It is not possible to get a “Fit for Work” or “Limited Capability for Work” determination without a face-to-face assessment and as explained earlier, these are not happening. The DWP has repeatedly said that only a “Limited Capability for Work Related Activity” outcome can be recommended by assessors on the basis of the claim form and telephone assessment. The result of this is that large numbers of disabled people are left in limbo with no outcome decision. Even when a face-to-face assessment happens, this is no guarantee of a correct outcome as the assessments themselves are fundamentally flawed. People are known to have been determined “Fit for Work” at their assessment and then, at tribunal, been moved to the Limited Capability for Work Related Activity category.
The government claims that the reason for this decision is that the money awarded in the “Fit for Work” or “Limited Capability for Work” categories is the same. However, there are several practical issues with this approach which result in additional hardship. The first is that under Universal Credit you are not treated as having “Limited Capability for Work” while waiting for the assessment. The DWP have also recently reintroduced conditionality (that you must look for work in order to receive your benefit) which means that in theory, while waiting for your assessments you would have to look for work or be sanctioned for not doing so.
The second problem is that under Employment and Support Allowance (ESA), whilst you are treated as having Limited Capability for Work while waiting for your assessment on the contribution-based form of the benefit, you are limited to 365 days of benefit before you must have a determination. What welfare rights advisors are starting to see is an increasing number of people whose contributory-ESA runs out before they have had an assessment, and therefore many people are being forced to claim Universal Credit (which we understand to be a worse benefit for many reasons, not least that you may then be forced to look for work). This also disproportionately affects people who do not have an immigration status that allows them to claim public funds; Universal Credit is a public fund whereas contribution-based ESA is not.
Thus there exists, in Britain, an ever expanding group of disabled people who are excluded from capitalist production and therefore are reliant on other means of survival. In a society where the worker is valued only through the wage, those who cannot earn are considered worthless to capitalist society. There is no easily accessible alternative means of subsidence: the system of disability benefits in Britain is dehumanising and humiliating and exists to reinforce this ideology. The government’s response to the pandemic has been a methodical eugenics campaign against disabled people. The violence of structural ableism is seen again here, as people are denied the money they desperately need to live.
There is no possibility of reforming these systems beyond ending wage labour and that must remain our focus. There must be a disabled peoples’ inquiry into all aspects of this pandemic response and we must expose these decisions for what they are: eugenics.