People with mental health problems are still being wrongly assessed by a “severely flawed” system intended to find whether they are entitled to state help, according to a doctor who was charged with improving so-called “fit-for-work” tests.
The doctor, who did not want to be named, was employed by Maximus, the US company that took over the government’s controversial scheme to determine whether claimants are entitled to employment and support allowance in March 2015. He said that despite improvements to the system, some were still “falling through the net”.
The doctor, who now works in the NHS having left the company last year after more than a year as an assessor, alleged there were a series of problems at the heart of the scheme. These include unreasonable targets leading to poor quality assessments; not enough specialists in mental health; and tests that are too subjective and often skewed against the claimant.
As a result, the tests, which were introduced by the Department of Work and Pensions (DWP), were not fit for purpose, the doctor said.
“There may be cases where a person was seriously unwell, but within the criteria in the assessment, I would have to classify them as well,” the doctor, who has psychiatric training said.
Maximus is under severe pressure after a damning report by the National Audit Office in January found it performing worse than its much-criticised predecessor, Atos, in key areas. Auditors found that one in 10 of its reports on disability claimants were below standard, that the average cost of assessments has risen and the company is struggling to retain staff.
The doctor, who trained and worked in psychiatry for four years before becoming a disability assessor, first worked for Atos before going on to work for Maximus.
One issue, they said, were targets that meant the average face-to-face time with a claimant was just 30 minutes. “Working in clinical psychiatry, an assessment of a new patient would take 45-50 minutes, with 10 minutes for dictating notes,” they said.
“The target set by Maximus was six tests a day at 65 minutes each. Around 30 minutes for assessment, 30 for writing up. The argument was you might get an easy case that would take 35/40 minutes and a difficult one that would take longer. But there were times when you had five difficult cases in a row. You get pushed into doing difficult cases fast. I would stay late most evenings and had to skimp on quality at times.”
The DWP said that the scheme had been improved following consultation with mental health experts and charities.
The doctor acknowledged improvements to the scheme, saying that, following a spate of stories about claimants killing themselves, there was a shift in emphasis to allow protection of claimants who were believed to be at risk of harm if they were found fit for work.
However, echoing criticism of the work capability assessments that has been made by mental health groups, medical professionals, user groups and a parliamentary committee, the doctor said he believed those with mental health problems were still being failed by the scheme.
“You need people with psychiatric training. I worked in mental health for three years and I still struggled. If someone tells you they are severely depressed but there is no input from their GP and no psychiatrist, and no input from the mental health system, then the assessor is more likely to put down ‘fit for work’, because the assessor is basing their assessment more on the level of input they have rather than their clinical presentations,” the doctor said. He pointed out the majority of people who killed themselves who had mental health issues had not received a medical assessment.
“Some of the signs are subtle, if they have had depression, if they have had low mood or a lack of energy, looking at their body language. Their demeanour. You can assess how bad their mental state is but that’s very difficult if you have had no training,” he said.
Maximus said all staff had training in how to recognise how a person’s mental health impacted upon their ability to work. He said: “Our doctors, therapists and nurses are responsible for carrying out functional assessments, which are not clinical psychiatric assessments. While it is not our role to diagnose someone’s mental health, we know how important it is to understand it in the context of an individual’s functional capability.”
He said the company had more than doubled the number of mental health experts to help assessors.
“We continue to engage with mental health charities and organisations to support our training and understanding of people with mental health conditions who come to us for an assessment.”
A DWP spokesman said: “We are committed to ensuring people get the right support they need – a high quality and fair assessment is key to this. The work capability assessment has been strengthened following five independent reviews, and this includes the way mental health is assessed.”
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