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ESA changes may increase "self harm and even suicide" amongst women, warn Scottish Directors of Public Health

Changes to guidance on who qualifies for ESA first revealed in February by Benefits and Work “will potentially increase mental distress, self harm and even suicide” amongst women according to the Scottish Directors of Public Health.

Back in February Benefits and Work warned that that a new ESA scoring system deliberately makes it harder for women to qualify for the support group than for men.

For example, a man with a diagnosis of depression and a history of deliberate self-harm who is unemployed – generally the case for ESA claimants – will be eligible for the support group, according to the guidance.

But a woman in the same situation will not be eligible for the support group. Instead, she will have to also show that an additional factor – such as being homeless or divorced –applies to her.

Our article caused such concern to the Scottish Directors of Public Health that they have now issued a statement calling for a review and warning that the changes could be responsible for deaths amongst women claimants.

Doctors issuing the statement criticise the reasoning on which the guidance is based, explaining:

“The new guidance is proposing a very basic screening tool that seeks to predict who is at highest risk of suicide or other problems. However, this is highly problematic and not nearly sensitive enough. It is much more likely to discriminate against women. Due to a number of complex and interacting factors there is a higher incidence of self-harm amongst females than males, whilst the incidence of suicide is higher in males.”

The doctors go on to warn that:

This change to the criteria is a further blow to disadvantaged individuals, especially women, with mental health problems as it will potentially increase mental distress, self harm and even suicide; as well as increasing pressure on GP’s trying to support our most vulnerable patients.”

The full statement of the Scottish Directors of Public Health is set out below.

Changes To Employment Support Allowance Will Discriminate Against Women - Statement From Scottish Directors Of Public Health

The Directors of Public Health in Scotland warn that a new scoring system to decide if claimants with mental health issues can get Employment Support Allowance because of a risk of harm to themselves or someone else will discriminate against women.

The DWP have advised that four criteria should be taken into account when assessing 'substantial risk for claimants with a mental function problem, particularly in relation to self-harm and suicide risk''.

The criteria state that men and women should be assessed differently -

  • one indicative “substantial risk” criterion and one high risk diagnosis and either: male and one personal factor or: female and two personal factors
  • or one high risk diagnosis and either: male, personal factor A and one other personal factor or: female, personal factor A and two other personal factors

The new guidance is proposing a very basic screening tool that seeks to predict who is at highest risk of suicide or other problems. However, this is highly problematic and not nearly sensitive enough. It is much more likely to discriminate against women. Due to a number of complex and interacting factors there is a higher incidence of self-harm amongst females than males, whilst the incidence of suicide is higher in males[1].

Loss of income and stigma through sanctioning or changes in benefits is a very large risk factor in precipitating mental health problems and suicide and the very fact that people are having their income changed creates a risk.

There are two major concerns about this updated guidance; first of all it discriminates against women with mental health conditions and at risk of suicide and/or self-harm.

And secondly it puts further pressure on GPs and health professionals when they are providing evidence to support patients claiming ESA as they will need to include additional information about their female patients.

The Directors of Public Health (DPH) in Scotland are calling for these new criteria to be reviewed to prevent the risk of women with mental health problems being unable to claim this benefit and the resulting risk of poverty for them and their families.

Dr Linda de Caestecker, DPH in Greater Glasgow and Clyde[2] said “These changes are very concerning and will discriminate against women and people with mental health problems.”

Dr Alison McCallum, DPH in NHS Lothian and chair of DPH in Scotland added “These changes place an added burden on women and people with mental health problems to prove their exceptional level of need. This is unfair, bureaucratic and unhelpful to people who should expect our support. Our experience to date indicates that that harm is likely to result from these changes”.

An Edinburgh GP commented, “The welfare benefit changes have been damaging to the health and wellbeing of a significant number of very vulnerable individuals. This has increased the workload of GP’s trying to improve our patient’s health. This change to the criteria is a further blow to disadvantaged individuals, especially women, with mental health problems as it will potentially increase mental distress, self harm and even suicide; as well as increasing pressure on GP’s trying to support our most vulnerable patients.”

For further information;

Dr Alison McCallum, Chair, Directors of Public Health in Scotland

NHS Lothian, 2-4 Waterloo Place, Edinburgh, EH1 3EG

Tel: 0131 465 5813

26 March 2015

 


[1] Prevention of suicide and self-harm: Research briefing. NHS Health Scotland 2014

[2] Dr Linda de Caestecker is the DPH lead in Scotland for vulnerable women

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