Conceptualising the social in mental health and work capability: implications of medicalised framing in the UK welfare system

TY - JOUR

T1 - Conceptualising the social in mental health and work capability: implications of medicalised framing in the UK welfare system

AU - Irvine, Annie Louise

AU - Haggar, Tianne Jazmin

PY - 2023/3/13

Y1 - 2023/3/13

N2 - Purpose: This paper asks whether the separation of mental health from its wider social context during the UK benefits assessment processes is a contributing factor to widely recognised systemic difficulties, including intrinsically damaging effects and relatively ineffective welfare-to-work outcomes. Methods: Drawing on multiple sources of evidence, we ask whether placing mental health—specifically a biomedical conceptualisation of mental illness or condition as a discrete agent—at the core of the benefits eligibility assessment process presents obstacles to (i) accurately understanding a claimant’s lived experience of distress (ii) meaningfully establishing the specific ways it affects their capacity for work, and (iii) identifying the multifaceted range of barriers (and related support needs) that a person may have in relation to moving into employment. Results: We suggest that a more holistic assessment of work capacity, a different kind of conversation that considers not only the (fluctuating) effects of psychological distress but also the range of personal, social and economic circumstances that affect a person’s capacity to gain and sustain employment, would offer a less distressing and ultimately more productive approach to understanding work capability. Conclusion: Such a shift would reduce the need to focus on a state of medicalised incapacity and open up space in encounters for more a more empowering focus on capacity, capabilities, aspirations, and what types of work are (or might be) possible, given the right kinds of contextualised and personalised support.

AB - Purpose: This paper asks whether the separation of mental health from its wider social context during the UK benefits assessment processes is a contributing factor to widely recognised systemic difficulties, including intrinsically damaging effects and relatively ineffective welfare-to-work outcomes. Methods: Drawing on multiple sources of evidence, we ask whether placing mental health—specifically a biomedical conceptualisation of mental illness or condition as a discrete agent—at the core of the benefits eligibility assessment process presents obstacles to (i) accurately understanding a claimant’s lived experience of distress (ii) meaningfully establishing the specific ways it affects their capacity for work, and (iii) identifying the multifaceted range of barriers (and related support needs) that a person may have in relation to moving into employment. Results: We suggest that a more holistic assessment of work capacity, a different kind of conversation that considers not only the (fluctuating) effects of psychological distress but also the range of personal, social and economic circumstances that affect a person’s capacity to gain and sustain employment, would offer a less distressing and ultimately more productive approach to understanding work capability. Conclusion: Such a shift would reduce the need to focus on a state of medicalised incapacity and open up space in encounters for more a more empowering focus on capacity, capabilities, aspirations, and what types of work are (or might be) possible, given the right kinds of contextualised and personalised support.

KW - Mental Health

KW - Distress

KW - Entification

KW - Medicalisation

KW - Welfare

KW - Unemployment

KW - SDG 3 - Good Health and Well-being

U2 - 10.1007/s00127-023-02449-5

DO - 10.1007/s00127-023-02449-5

M3 - Article

SN - 0933-7954

JO - Social psychiatry and psychiatric epidemiology

JF - Social psychiatry and psychiatric epidemiology

ER -