Removing Financial Support For Anxiety and ADHD Raises Serious Equality and Human Rights Concerns

Written by Andrew Jones

Disclaimer: This article is for informational, educational and editorial purposes only and does not constitute legal, medical, welfare-benefits or financial advice. Eligibility for Personal Independence Payment (PIP) is determined according to an individual’s functional difficulties and the applicable legislation, rather than diagnosis alone. Anxiety disorders and ADHD vary considerably between individuals, and not every person with either condition will meet the legal definition of disability or qualify for PIP. Anyone affected by proposed welfare reform should seek appropriate advice from a qualified welfare-rights adviser, solicitor, healthcare professional or relevant support organisation.

When “Support Instead of Money” Risks Oversimplifying Disability

The debate surrounding disability benefits has intensified following comments and policy proposals from Helen Whately, Shadow Secretary of State for Work and Pensions, concerning people claiming sickness and disability benefits for conditions including anxiety, depression and Attention Deficit Hyperactivity Disorder (ADHD).

Whately and the Conservative Party have argued that some people with conditions such as anxiety and ADHD should receive greater assistance towards employment instead of being placed on a path towards what has been described as a “lifetime of benefits rather than work”.

There is nothing inherently wrong with offering better treatment, occupational support, reasonable adjustments, rehabilitation or assistance into employment.

Indeed, many disabled people desperately want better healthcare, greater employment opportunities and more meaningful support.

The difficulty arises when therapy or employment support is presented as a replacement for financial disability support, rather than something that can operate alongside it.

PIP is not an unemployment benefit.

A person can work and receive PIP, because the purpose of PIP is to help people who experience additional difficulties with everyday living or mobility as a result of long-term illness or disability.

Eligibility is based primarily upon how a person’s condition affects their ability to carry out particular activities, not simply whether they are employed or unemployed.

Removing financial support on the assumption that therapy will automatically make somebody capable of working therefore risks misunderstanding both disability and the purpose of PIP.

What Is Anxiety?

Everyone experiences anxiety occasionally.

Feeling nervous before an examination, job interview, medical appointment or unfamiliar event is part of ordinary human experience.

An anxiety disorder, however, can be very different.

Anxiety disorders can involve persistent or excessive fear and worry that is difficult to control and which significantly interferes with everyday life.

Symptoms can include:

Persistent or excessive worrying;
Difficulty concentrating;
Sleep problems;
Restlessness;
Irritability;
Fatigue;
Muscle tension;
Dizziness;
Heart palpitations;
Panic attacks;
Digestive problems;
Avoidance behaviours; and
Difficulty managing ordinary everyday situations.

Anxiety can become profoundly disabling.

For somebody experiencing severe anxiety, an activity that another person considers straightforward, travelling alone, entering an unfamiliar building, speaking to strangers, answering a telephone call, attending an appointment or navigating a crowded environment, can become extremely difficult.

The fact that anxiety is invisible does not mean that its impact is insignificant.

Anxiety Sometimes Needs to Be Addressed at Its Core

Therapy can be extremely beneficial.

Cognitive Behavioural Therapy (CBT), counselling, guided self-help and other psychological interventions have helped many people develop coping strategies and manage symptoms.

However, therapy does not work for everybody, and therapy alone cannot necessarily address the underlying cause of someone’s anxiety.

Treatment needs to consider the individual.

Anxiety can be associated with or aggravated by circumstances such as:

Trauma;
Bereavement;
Domestic abuse;
Bullying;
Discrimination;
Chronic illness;
Financial insecurity;
Housing problems;
Workplace problems;
Social isolation;
Disability;
Family difficulties; and
Other mental-health conditions.

Where anxiety has an identifiable underlying cause, simply offering someone a limited number of therapy sessions may not resolve the circumstances that are continuing to cause distress.

Therapy may provide coping strategies.
It cannot make poverty disappear.
It cannot automatically remove trauma.
It cannot cure every chronic illness.
It cannot guarantee an accessible workplace.
It cannot remove discrimination.
It cannot provide secure housing.
And it cannot guarantee that somebody’s symptoms will disappear.

Some people may benefit from psychological therapy. Others may require medication. Some may require specialist mental-health intervention. Others may need a combination of treatment, financial security, occupational support and reasonable adjustments.

Treatment should therefore be individualised rather than imposed as a condition for removing financial support.

What Is ADHD?

ADHD is also frequently misunderstood within the disability-benefits debate.

Importantly, Attention Deficit Hyperactivity Disorder is a neurodevelopmental condition, rather than simply a mental-health condition.

ADHD affects how the brain develops and functions and can involve difficulties with attention, concentration, executive functioning, organisation, impulse control and hyperactivity.

People with ADHD may experience difficulties including:

Becoming easily distracted;
Forgetfulness;
Difficulty organising time;
Difficulty following instructions;
Difficulty completing tasks;
Losing important belongings;
Restlessness;
Impulsive decision-making;
Difficulty regulating attention;
Poor working memory;
Difficulty prioritising tasks; and
Becoming overwhelmed by complex demands.

Symptoms generally begin during childhood, although some people are not diagnosed until adulthood.

ADHD can affect employment, education, relationships, financial management and ordinary everyday activities.

It also exists across a very wide spectrum of functional impact.

One person with ADHD may work full-time with relatively minor adjustments.

Another may experience substantial executive-function difficulties, coexisting anxiety or depression, sensory difficulties or serious problems managing everyday tasks.

These individuals should not be treated as though their experiences are identical merely because their diagnostic label is the same.

Therapy Cannot Simply “Cure” ADHD

Talking therapy can help some people with ADHD, particularly with coping strategies, emotional regulation, organisation and associated mental-health problems.

But ADHD is not something that can simply be talked away.

Management may include:

Medication;
Psychological therapy;
Behavioural strategies;
Occupational support;
Workplace adjustments;
Educational adjustments;
Organisational assistance;
Structured routines; and
Environmental changes.

For some people, therapy may be transformative. For others, improvement may be limited.

Some require medication.
Some require continuing occupational support.
Some require workplace adjustments.
Some experience several conditions simultaneously and require multidisciplinary treatment.
And some will continue to experience substantial disability even after receiving appropriate treatment.

Offering somebody a course of therapy therefore cannot automatically eliminate the functional consequences of a neurodevelopmental disability.

A humane welfare system must recognise those differences.

Disability Is About Functional Impact, Not Political Labels

One of the biggest concerns surrounding references to “mild anxiety” or “mild ADHD” is the question of who decides what constitutes a mild disability.

Two people can have exactly the same diagnosis and experience completely different levels of impairment.

Someone diagnosed with anxiety may be able to work, travel and socialise relatively easily.

Another person with the same diagnosis may experience severe panic attacks, agoraphobia or overwhelming distress when attempting unfamiliar journeys or interacting with other people.

The same principle applies to ADHD.

One person might need occasional organisational support.

Another may struggle substantially with memory, planning, time management, communication and completing everyday tasks.

PIP assessments are intended to consider functional impact.

That principle is important.

Disability benefits should not be determined by politicians deciding that a particular diagnostic label is inherently too minor to deserve assistance.

The relevant question should be:

How does this condition affect this individual person’s ability to carry out daily living and mobility activities?

The Equality Act 2010

Disability is a protected characteristic under the Equality Act 2010.

Under Section 6 of the Act, a person is generally regarded as disabled where they have a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities.

This does not mean that every person diagnosed with anxiety or ADHD automatically meets the legal definition of disability.

However, people with either condition can be disabled under the Equality Act where the statutory requirements are satisfied.

The effects of the condition therefore matter.

Government departments also have responsibilities under the Public Sector Equality Duty.

Public authorities must have due regard to the need to:

Eliminate unlawful discrimination;
Advance equality of opportunity between people who share a protected characteristic and those who do not; and
Foster good relations between different groups.

Any major welfare reform disproportionately affecting disabled people would therefore require careful consideration of its equality impact.

Would Excluding Anxiety or ADHD From PIP Breach Human Rights Law?

This question requires legal caution.

It would be inaccurate to state that any restriction upon PIP eligibility would automatically breach the Human Rights Act 1998.

However, a blanket policy excluding people because they have a particular disability or diagnostic label could potentially raise significant equality and human-rights questions.

One relevant provision is Article 14 of the European Convention on Human Rights, incorporated into UK law through the Human Rights Act 1998.

Article 14 protects against discrimination in the enjoyment of other Convention rights.

Social-security and disability-benefit disputes have previously raised arguments involving Article 14 together with Article 1 of Protocol No.1, which protects the peaceful enjoyment of possessions.

Whether any future reform would actually violate human-rights legislation would depend upon matters including:

The precise wording of the law;
Who was affected;
Whether different groups were treated differently;
The purpose of the policy;
Whether the Government could objectively justify the difference in treatment; and
Whether the measures were proportionate.

The legally safer position is therefore this:

A blanket exclusion of people because they have anxiety or ADHD would not automatically constitute a proven breach of the Human Rights Act, but it could create serious equality and human-rights concerns and could potentially be susceptible to legal challenge.

The UN Convention on the Rights of Persons with Disabilities

The debate also extends beyond domestic UK law.

The United Kingdom is a State Party to the United Nations Convention on the Rights of Persons with Disabilities (CRPD).

Article 5 concerns equality and non-discrimination.

Article 28 recognises the rights of disabled people in relation to an adequate standard of living and social protection.

The CRPD promotes an approach to disability which recognises that disability is not merely about a person’s medical diagnosis.

People can also be disabled by environmental, institutional, financial and social barriers.

This matters enormously when discussing welfare reform.

Someone may have the ability and desire to work but nevertheless face barriers including inaccessible workplaces, discrimination, inflexible employment practices, unsuitable transport, inadequate healthcare or insufficient reasonable adjustments.

Governments are entitled to review welfare spending and eligibility criteria.

However, reforms affecting disabled people should be evidence-led, proportionate and developed with proper consideration of equality, dignity and the lived experiences of disabled people.

Andy Burnham, the PIP Review and Calls to Exclude Anxiety and ADHD

The debate has now become particularly significant for Andy Burnham and his Government, which faces decisions over the future direction of Personal Independence Payment and the wider welfare system.

Recent reports, including coverage by WalesOnline, have highlighted calls for PIP reform under the Burnham Government that could result in people with conditions such as anxiety and ADHD being excluded or subjected to substantially tighter eligibility requirements.

However, an important distinction must be made.

The specific political call to remove eligibility for what has been characterised as lower-level or “mild” anxiety, depression and ADHD claims has come from Helen Whately, Shadow Secretary of State for Work and Pensions, and the Conservative Party.

It should therefore not be reported as though Andy Burnham himself has announced that people with anxiety or ADHD will automatically be excluded from PIP.

Instead, the significance for Burnham is that his Government now faces the political question of what direction PIP reform will take and whether condition-based restrictions will be rejected or incorporated into future policy.

That distinction is important.

There is a considerable difference between:

“Andy Burnham has proposed excluding anxiety and ADHD from PIP.”

and:

“Andy Burnham’s Government is facing calls to reform PIP in a way that could exclude or restrict claims involving anxiety and ADHD.”

The latter more accurately reflects the debate.

It is also precisely why disabled people, advocates, charities and human-rights campaigners should pay close attention to how future reforms are designed.

The Danger of Excluding Entire Conditions

A welfare system based upon blanket diagnostic exclusions would risk producing deeply unfair outcomes.

Imagine two people diagnosed with anxiety.

Person A experiences occasional periods of worry but continues working, travelling and carrying out daily activities independently.

Person B experiences severe panic attacks, cannot undertake unfamiliar journeys without support, experiences overwhelming psychological distress around other people and struggles with ordinary daily activities.

They share a diagnosis.

They do not share the same disability experience.

The same applies to ADHD.

If eligibility were restricted simply because politicians had decided that ADHD or anxiety were no longer sufficiently serious conditions, the welfare system could fail to recognise people with profound functional impairment.

The principle should remain:

Assess the person, not simply the diagnosis.

Therapy and Financial Support Are Not Mutually Exclusive

Perhaps the greatest weakness in the “support instead of money” argument is the assumption that these things must be alternatives.

They do not.

A person can receive therapy and financial disability support.
A person can receive medication and PIP.
A person can work and receive PIP.
A person can receive employment support and reasonable adjustments.
A person can require financial assistance while actively trying to improve their circumstances.

Indeed, financial security may sometimes make treatment and rehabilitation more achievable.

Someone worrying constantly about heating bills, food, transport costs or the additional costs associated with disability may find it considerably harder to concentrate on therapy, recovery or returning to employment.

Removing financial support does not automatically make somebody healthier.

Sometimes it simply makes them poorer.

Supporting Employment Should Not Mean Punishing Disability

There should not have to be a choice between employment and disability support.

Many disabled people work.

Many desperately want to work.

Others could work if employers made appropriate adjustments, healthcare was accessible, waiting lists were shorter, transport was suitable and flexible or remote employment opportunities were available.

Some people may be capable of working part-time but not full-time.

Others may experience fluctuating conditions that make conventional employment difficult.

A progressive welfare policy should therefore ask:

“What barriers are preventing this individual from participating fully in society?”

The answer may involve therapy.

It may involve medication.
It may involve rehabilitation.
It may involve workplace adjustments.
It may involve flexible employment.
It may involve education.
It may involve better access to healthcare.
And it may also involve financial disability support.

These measures are not mutually exclusive.

Young People Should Be Given Opportunity, Not Blamed for Their Disability

There is merit in wanting young people to have opportunities rather than being abandoned by inadequate healthcare, education or employment systems.

Nobody should unnecessarily be written off.

But language suggesting that young disabled people are being allowed to fall into a “lifetime of benefits” can also create a damaging narrative.

It risks implying that the person is the problem.

Perhaps the better question is why so many young people with anxiety, ADHD and other conditions struggle to access timely diagnosis, treatment, reasonable adjustments, suitable education and secure employment in the first place.

If somebody has spent years waiting for mental-health support or an ADHD assessment, removing financial support will not fix the healthcare system.

If an employer refuses reasonable adjustments, removing PIP will not make that workplace accessible.

If someone cannot safely undertake a journey because of overwhelming psychological distress, simply telling them to work will not remove that impairment.

Government policy must address these barriers at their source.

Conclusion

There is nothing wrong with wanting disabled people to have opportunities to work.

Employment can bring financial independence, purpose, social connection and confidence.

But employment support should never be based upon the assumption that invisible disabilities are somehow less legitimate than physical ones.

Anxiety can profoundly restrict someone’s ability to function independently.

ADHD is a genuine neurodevelopmental condition whose effects can extend throughout a person’s lifetime.

Therapy can help enormously, but it is neither a guaranteed cure nor an appropriate replacement for every form of disability support.

The debate surrounding Helen Whately’s proposals and the future direction of PIP under Andy Burnham’s Government should therefore be approached with considerable caution.

Any future reform should concentrate upon individual functional need, accessible healthcare, reasonable adjustments, removing barriers to employment, equality and human rights.

People should not be excluded from disability support merely because politicians regard the name of their condition as insufficiently serious.

A compassionate society can encourage employment while protecting disabled people.

The two objectives should complement one another.

They should never require disabled people to surrender the financial support that enables them to participate in society in the first place.