The mental health impact of recession and welfare reform in England between 2008 and 2013

Abstract

Abstract. Background: Welfare benefit policies have important implications for public health. They aim to reduce the risk of poverty, promote employment for people who can work, and help maintain the livelihood of people who are not able to work due to unemployment, disability or old age. They may help reduce the economic and health consequences of recessions, however the 2008 recession and subsequent rise in government debt has also led to welfare reforms that reduce access to and adequacy of welfare benefits. This thesis uses the recent recession and subsequent welfare reforms in the UK as natural experiments to investigate the relationship between recession, welfare benefit policies and mental health. Study design: I use routine administrative and survey data for England and systematic review methods to investigate the impact of the recession on mental health and the impact of welfare benefit reforms on mental health and employment. Study 1 reflects on the methodological challenges of investigating natural policy experiments such as those outlined in this thesis. Study 2 investigates the impact of initial rises in unemployment during the recession on suicides, Study 3 investigates trends in self-reported mental health problems during and after the recession when welfare reforms were introduced. Study 4 investigates the mental health effects of a specific policy introduced from 2010 to use a new tougher assessment to reassess the eligibility of disability benefit claimants. Study 5 presents a systematic review of international evidence investigating the employment effects of changes to the eligibility and adequacy of out-of-work disability benefits. Study 6 investigates the employment effects of the disability benefit reassessment policy in England. Results: The onset of the 2008 recession in England and subsequent rise in unemployment was associated with a rise in suicides. The association between increases in unemployment and rises in suicides was stronger in the 2008 recession than it had been in the previous 1990s recession, suggesting that welfare policies may have been less effective at reducing the mental health impact of unemployment. The trend in suicides however continued to increase between 2010 and 2013 even after unemployment peaked and began to decline. The prevalence of reported mental health problems also increased from 2009. Whilst unemployment trends explained some of the initial increase in reported mental health problems, it did not explain the continued increase and widening of inequalities from 2010 to 2013. The policy introduced in 2010 to reassess the eligibility of disability benefit claimants was associated with adverse trends in mental health, including a further rise in suicides, self reported mental health problems and antidepressant prescribing. A systematic review of international evidence indicated that similar policies did not generally increase employment, but rather moved people from disability benefits onto other benefits. The disability benefit reassessment policy introduced in 2010 appears to have moved people with mental health problems from inactivity into unemployment, but there was no evidence that it had improved the employment chances of people out-of-work with mental or physical health problems. Conclusion: It is likely the 2008 recession had an adverse impact on mental health. This may have been greater than it would otherwise have been because of changes to the welfare system over recent decades. Welfare benefit reforms since the recession have then potentially exacerbated this situation, and may have led to further adverse trends in mental health that particularly affected the most disadvantaged groups. These welfare policies have not led to improved employment chances for people out-of-work with health problems, suggesting that the harms may outweigh any benefits. These policies have been associated with an increase in the numbers of people out-of-work with mental health problems potentially leading to greater reliance on welfare in the future.