Jumping Through Hoops - Disability Employment Australiadisabilityemployment.org.au/static/items/Jumping_Through_Hoops.pdf · :Understanding the Downshifting Phenomenon in Australia

JUMPING THROUGH

HOOPS: not my choice

OCTOBER 2007

T h i s r e p o r t w a s c o m m i s s i o n e d b y t h e N e w S o u t h W a l e s N u r s e s ’ A s s o c i a t i o n

authors Christie Breakspear is a former academic who currently runs her own business in workplace relations and mediation. In recent years, Christie has also been part of a number of research projects, including From Juggling to Managing: the Evolution of Work and Family Policies in Three Australian Organisations (UNSW); Getting a Life :Understanding the Downshifting Phenomenon in Australia (with Dr Clive Hamilton) and Baby Boomers and Retirement (the Australia Institute).Christie has degrees in Arts, Education, Industrial Relations and M Commerce (Hons). Kerry O’Neill is a Professional Officer at the NSW Nurses’ Association. Kerry has completed a number of degrees including BA (Hons) Industrial Relations and Human Resource Management and Masters in Health Sciences. Prior to taking up her current role at the Association, Kerry spent 20 years working in mental health services.

acknowledgements We would like to thank very sincerely the twenty two mental health professionals who so generously gave their time to be interviewed for this research. We would also like to thank the Advisory Group for their assistance and expert advice on this research. They provided us with the guidance to ensure that the research was accurate, rigorous and current. The members were:

• Ms Kate Adams, Manager Professional Services, NSWNA • Dr Mairwen Jones, Senior Lecturer In Psychology, Co-Chair Mental Health

Research Group, Faculty of Health Sciences, University of Sydney • Mr Bill Koffman, Clinical Nurse Consultant, ACT & NSW Consultation Liaison

Mental Health Nurses Association • Ms Leonie Manns, Quality Assurance Coordinator, The Richmond Fellowship • Mr Michael Raper, President National Welfare Rights Network of Australia • Mr Gerard Thomas, Policy & Media Officer, Welfare Rights Centre

copyright © 2007 NSW Nurses Association PO Box 40, Camperdown, 1450 43 Australia Street, Camperdown, 2050 http://www.nswnurses.asn.au [email protected] ISBN: 0-978-1-921326-01-1 ISNB: 0-978-1-921326-02-8 1. mental health 2. welfare 3. NSW Nurses Association 3. Christie Breakspear Layout: Angela Garvey This publication may be downloaded for use in private study, research, criticism and review. Permission is granted for librarians to download a single copy to be made available to library users. The publication may not be reproduced in any other form without permission of the copyright owner.

TABLE OF CONTENTS

E X E C U T I V E S U M M A R Y ............................................................................ 3

RESEARCH METHOD...................................................................................... 4

FINDINGS ........................................................................................................ 4

CONCLUSION ................................................................................................ 8

I N T R O D U C T I O N .......................................................................................... 9

RESEARCH METHOD.................................................................................... 10

L E G I S L A T I V E C O N T E X T ......................................................................... 14

WORKCHOICES ........................................................................................... 14

WELFARE TO WORK..................................................................................... 19

LEGISLATIVE INTERSECT ............................................................................... 21

F I N D I N G S ..................................................................................................... 26

HEIGHTENED ANXIETY OF CLIENTS............................................................. 26

LACK OF EMPLOYMENT SUPPORT ............................................................. 56

IMPACT ON MENTAL HEALTH PROFESSIONALS........................................ 67

B I B L I O G R A P H Y ......................................................................................... 82

A P P E N D I X 1 ................................................................................................ 90

A P P E N D I X 2 ................................................................................................ 92

A P P E N D I X 3 ................................................................................................ 95

jumping through hoops 2

I have a client who’s a torture victim from

overseas. He’s young, traumatised, without

any family support.…….

He’s totally confused, caught up in the

system without understanding it….

He has so many needs, but Centrelink wants

him to go through their process, jump

through all these hoops…


EXECUTIVE SUMMARY

It’s a wonderful thing to get people back to work,

but the Government has to consider social justice

principles in this process. To blame the individual

is not just unreasonable, it’s cruel. I think we’ve

developed a cruel system with this current Job

Capacity Assessments (JCA)

Director, SESIAHS, 7 years

ince the enactment of WorkChoices and Welfare to Work

legislation, the New South Wales Nurses’ Association (NSWNA)

has received an increasing number of reports from their

members about the adverse effects of these laws, specifically in regard

to how they affect people with mental illnesses who are receiving

income support.

In addition, many mental health professionals are reporting negative

impacts on their workload, the way they do their job and their sense of

personal well-being. Because of this anecdotal evidence, the NSWNA

commissioned research to investigate these claims.

S


The report presents the experiences and opinions of twenty-two mental

health professionals whose clients have been affected by the recent

industrial relations and social security legislation.

Research Method The researchers employed qualitative methodology. Because the

researchers sought to investigate, explain and analyse the impact of

new legislation on mental health professionals and their clients, semi-

structured in-depth interviews were selected as the most appropriate

data collection method.

These qualitative methods allowed the mental health professionals’

stories to be told as well as the stories of their clients and the

researchers to understand and explain their different experiences.

Unlike quantitative methodologies which are concerned with the

frequency of various occurrences, qualitative methods ‘seek to

describe, decode, translate and otherwise come to terms with the

meaning of certain more or less naturally occurring phenomena in the

social world’ (Van Maanen, 1983:9).

The interviewees were employed in hospitals, community health

centres and in non-government organisations (NGOs). Their job titles

included clinical psychologists, occupational therapists, psychiatrists,

clinical nurse consultants, social workers, policy officers, consumer

advocates and case mangers. The interviewees came from three

geographic regions in Sydney.

Findings Overall, we found that although the mental health professionals

interviewed reported a diverse range of experience a certain


commonality of experience was evident. When asked about the

recent industrial relations and welfare to work legislation, its impact on

them, their work and their clients, three main themes emerged during

every interview. These were:

• the heightened anxiety of their clients who were living with

mental illness

• the lack of employment support for their clients

• the negative impact on mental health professionals, notably

their increased workload and decreased well-being.

The heightened anxiety of clients with mental illness The twenty-two mental health professionals interviewed worked mainly

with clients who had mental illnesses and were receiving income

support. Across the sample, the proportion of clients with mental

illnesses ranged from 40 percent to 100 percent. The interviewees

related stories of their clients who in recent months were presenting in

highly emotional states. This included clients who were fearful and

anxious about changes, both actual and anticipated, to welfare to

work arrangements. When asked how they would describe their clients’

concerns, the interviewees nominated three specific factors that were

causing distress and anxiety in their clients. These were: changing

income support arrangements, the new job capacity assessment

procedures and the prospect of seeking and maintaining employment.

In the first few months after the welfare to work laws took effect on 1

July 2006, the interviewees reported they had noticed their clients with

a mental illness who were receiving income support had become very

anxious. Those receiving the Disability Support Pension (DSP) were

anxious that they would lose this pension and instead be placed on the

lower Newstart Allowance.


Another source of anxiety for clients was the requirement that they

participate in the new Job Capacity Assessment (JCA), a

comprehensive assessment of a person’s ability to work. The interviews

demonstrated that many mental health professionals were concerned

about the actual process of job capacity assessment and the way it

was applied to their clients. Typically, interviewees referred to the new

procedures as ‘punitive’, ‘all about compliance’, ‘penalty based’,

‘big-stick approach’. Further, they saw the JCA as involving ‘no support

or understanding of these clients’ who were required to ‘jump through

hoops’.

Of great concern for clients, too, was the prospect of seeking and

maintaining employment. Research has shown that mental illness such

as depression can have a significant impact on a jobseeker’s capacity

to find and maintain employment. Interviewees reported that their

clients faced significant barriers to finding and maintaining sustainable

work. Some of the barriers nominated were financial costs, the stigma

and burden of mental illness, the episodic nature of their mental

health, homelessness and lack of flexible employment. Such factors

meant that the prospect of seeking and maintaining employment

induced extreme concern and anxiety among these particular clients.

Lack of employment support The second theme that emerged in the interviews was the perceived

lack of adequate employment support for people with mental illnesses

who were receiving social security benefits. While most interviewees

acknowledged the existence of a variety of government support

services, programs and allowances, it was generally reported that

support was inadequate for their vulnerable clients, that is, those with

mental illnesses. Apart from poor mental health, this particular group of

people was also often homeless and demoralised. Many of the


interviewees believed that special intervention, preferably one-on-one,

was critical to match the requisite level of assistance with the individual

needs of the jobseeker. Too often, this level of support was not

available.

Impact on mental health professionals When the mental health professionals were asked whether they had

experienced any change to their jobs in recent months, there was

widespread agreement that they found their work had become more

demanding and challenging. While the interviewees nominated a

range of factors that had impacted on their jobs and the way they

worked, there were three main effects that were repeatedly

mentioned. These were: a heavier, more complex workload; having to

liaise with Centrelink for clients, and having to spend more time

analysing legislative changes, explaining and re-assuring clients about

these changes.

In addition, a proportion of the mental health professionals reported

that their own sense of personal well-being had been adversely

affected as they grappled with the Government’s new policies. They

most commonly reported feeling greater levels of stress and frustration

arising from new job demands, anxious clients and a lack of resources.

Not all the mental health professionals interviewed considered that

there had been a notable effect on their health and well-being since

the implementation of new policies and procedures. Some indicated

that their jobs had always been stressful, that change was inevitable

and demands incessant. Further, they considered the new

requirements were ‘just all part of the job’ and therefore it was not

unreasonable or unrealistic that they should deal with them. This, after

all, was what mental health professionals did.


Conclusion The report concludes with some observations on the effects of the

recent legislative changes in industrial relations and welfare to work.


INTRODUCTION

ince the enactment of the new industrial relations and welfare to

work legislation, the New South Wales Nurses’ Association

(NSWNA) has been receiving an increasing number of reports

from their members of the adverse effects of these laws, specifically on

people with mental illnesses who are receiving income support.

Anecdotal evidence from mental health professionals suggests that this

particular group of individuals is experiencing increasing levels of stress

and anxiety. NSWNA members are further reporting that new Federal

Government policies and procedures in this area are causing

widespread confusion and apprehension among many income

support recipients, particularly those who have mental health

problems. As a consequence, many mental health professionals are

reporting a negative impact on their workload, the way they do their

job and their sense of personal well-being. Because of this anecdotal

evidence, the NSWNA commissioned research to investigate these

claims. The claims are examined in the context of recent industrial

relations and welfare legislation - the Workplace Relations Amendment

Act (WorkChoices) Act, 2005 and the Employment and Workplace

Relations Amendment (Welfare to Work) and Other Measures Act, 2005

(Chapter 1).

S


The report is structured as follows. Firstly, the research methodology is

explained. Then, in order to establish a broad context, the next section

discusses the relevant legislation, WorkChoices and Welfare to Work,

and how they interact. The following three sections document the key

findings of the research. The report concludes with some observations

and suggests that further research is necessary to understand the full

and ongoing implications of such radical reforms.

RESEARCH METHOD The information used in this study was generated by in-depth interviews

with twenty-two mental health professionals (15 female, 7 male). The

interviewees were variously employed in hospitals, community health

centres and in non-government organisations (NGOs). Their job titles

included clinical psychologists, occupational therapists, psychiatrists,

clinical nurse consultants, social workers, policy officers, consumer

advocates and case mangers. The accumulative total number of

clients that the participants were working with was over 800.

As such, this research encompasses the experiences of not only

mental health professionals, but also that of their clients.

The twenty-two interviewees came from three geographic regions in

Sydney, including the Northern Sydney and Central Coast Area Health

Service (NSCCAHS) extending from North Sydney to Central Coast, the

South Eastern Sydney and Illawara Area Health Service (SESIAHS)

suburbs extending from Sydney to Shoalhaven, the Sydney South West

Area Health Service (SSWAHS) extending from Balmain to Bowral. There

were also three interviewees from rural and regional NSW.

The interviews were conducted individually and lasted between 60

and 90 minutes. The researchers developed a set of 20 interview


questions (see Appendix 1) which guided the discussion between the

researcher and interviewee. The questions related to six broad areas

including: background information of interviewee, their knowledge of

the legislation, the perceived effect of the legislation, description of

their clients, job capacity assessment of their clients and employment

support for their clients.

While guided by the questions, interviews were open ended and

interviewees were encouraged to elaborate on their experiences. The

researchers often asked additional questions and sought clarification

of information. However, to ensure consistency of interview material, all

interviewees were asked all 20 questions.

Most of the interviews were conducted in person, except for three

people living in rural/regional areas who were interviewed over the

telephone. All interviewees gave permission for the interviews to be

taped. To ensure accuracy, the researchers took notes during the

interviews and transcribed them after completion. The interviews were

then closely analysed and themes arising from them were recorded. As

much as possible, the researchers tried to use the exact words of the

interviewees in the report. This enabled them to tell their own stories in

their own way and in their own words. The opportunity to relate their

experiences was the main reason the mental health professionals

agreed to be interviewed. All interviewees were assured of

confidentiality and were given different names to preserve their

anonymity.

The mental health professionals interviewed were selected by the

Snowball Sampling method. This method, frequently used in research

requiring small numbers of participants for intensive interviewing, is

described as follows.


A method whereby interview subjects for a study are obtained

from subjects already interviewed from that study. Those subjects

first contacted are asked to name acquaintances, who are then

approached, interviewed, and asked for additional names. In this

way a sufficient number of subjects can be accumulated to give

a study adequate power (Medical Dictionary Search Engine,

2004).

Initially, the interviewees were identified by the NSWNA, but then by

referral from those already interviewed. The disadvantage of this

method is that a biased sample may be chosen. Efforts were therefore

made to ensure that participants were diverse in location, gender, job

and type of ‘story’. Some basic data are shown in Appendix 2.

Qualitative methods only, specifically interviews, were used to collect

and analyse data for this study. These qualitative methods allowed the

mental health professionals’ stories to be told and the researchers to

understand and explain their different experiences. Unlike quantitative

methodologies, which are concerned with the frequency of various

occurrences, qualitative methods ‘seek to describe, decode, translate

and otherwise come to terms with the meaning of certain more or less

naturally occurring phenomena in the social world (Van Maanen,

1983:9).

Because the researchers sought to investigate, explain and analyse the

impact of the new legislation on mental health professionals and their

clients, in-depth interviews were selected as the most appropriate data

collection method. Although interviewing is often claimed to be ‘the

best method’ of gathering information, its complexity can sometimes

be under-estimated. It is a time consuming method where the

researcher is invariably saturated with information whose accuracy


can be questioned because of its often subjective nature. Certainly, all

interviewers are vulnerable to the subconscious bias of information

provided by those interviewed. The researchers acknowledge that in

this study, all sources are biased and that there is no such thing as

flawless, objective research. In an attempt to overcome the problem of

bias, the researchers sought to check interview material with co-

researchers, Advisory Group members and the interviewees

themselves.

Another criticism sometimes levelled at qualitative research of this

nature is that it is not possible to generalise from a relatively small

number of cases. This criticism is understood and acknowledged. As

already explained, the researchers would like to emphasise that the

study is not concerned with gathering facts and figures or with

analysing the ‘where’ and ‘when’ of events. Rather it attempts to

understand and explain the twenty-two mental health professionals’

different experiences of the recent legislative changes on their

particular clients.


LEGISLATIVE CONTEXT

It is not a bad thing for people to work, but the

problem is that the work is not meaningful. What’s

being offered to my clients is temporary, casual or

part-time work. It is not always about capacity, as

people with a mental illness will fluctuate (in their

capacity to work). People need to be encouraged

to work, not forced. The Government needs to

consider a recovery based approach – you get

better long- term outcomes

Psychiatrist, non-NSW based, 16 years

WORKCHOICES he new WorkChoices laws, the Workplace Relations (Work

Choices) Amendent Act 2005, became fully operational on 27

March 2006. These laws fundamentally change how industrial

relations have been regulated in Australia for the last century. Up until

now, the AustraIian Industrial Relations Commission (AIRC) played a

significant role in the regulation of the employment relationship, as well

as recognising the role of trade unions and collective bargaining

T


(Creighton & Stewart, 2000). However, with the passing of the

WorkChoices legislation, the role of the AIRC is diminished to the point

where it ‘no longer possesses the power to hold test cases to declare or

modify industry standard conditions of employment like maternity

leave, redundancy pay or superannuation’ (McCallum, 2006; 2). In

other words, the WorkChoices laws abolish compulsory conciliation

and arbitration, which has been the basis of federal labour law for over

100 years.

Essentially, the WorkChoices laws include:

- the placing of individual workplace agreements (AWAs) above

collective agreements

- a reduction of issues which awards and agreements can cover

- increased capacity to dismiss employees

- a reduction of union access to workplaces

- strengthening of potential for insecure employment through

extended probationary periods

- improved capacity of employers to use contractors.

Historically, the Commission had been responsible for the protection of

lower paid workers under the award system (Watson, 2003). The advent

of WorkChoices means that those protections are now removed and

workers are left to negotiate their working conditions with their

employer at the enterprise level. Further, the legislation restricts the

capacity of trade unions to bargain with employers on behalf of their

members (Ellem, Baird, Cooper & Lansbury, 2005). There is only a role

for trade unions to bargain if ‘the employer agrees to bargain for, and

to enter into a collective agreement with a trade union’ (McCallum,

2006).


Traditionally, the role of labour law has been to regulate the

employment relationship and to ‘counteract the inequality of

bargaining power which is inherent in the employment relationship’

(Kahn-Freund, 1972; 8). It was also the purpose of labour law to

manage the power of organised labour such as trade unions. The

Coalition Government claimed trade unions possessed too much

power and the WorkChoices legislation would remedy the imbalance.

Consequently, the Federal Government included prohibited content in

the WorkChoices laws in order to limit the power of trade unions.

Examples of prohibited content include trade union training leave,

staffing levels, minimum and maximum hours for part-time employees

and trade union representation (McCallum, 2006; Sarina & Riley, 2006).

Further, the WorkChoices legislation reduces the number of allowable

matters in awards. Formerly, the award system protected workers

across an industry and set standards that ensured employees under the

award enjoyed the same minimum standards. Critics of the legislation

are concerned that the erosion of the award system will have a

detrimental effect on the working conditions of employees and on the

broader society. A recent report tabled by seventeen of Australia’s

leading academic researchers, states that:

the proposed changes will do nothing to address labour and skill

shortages or the productivity slowdown. They will, however,

damage the fabric of Australian society by encouraging poorly-

paid jobs with irregular hours and little security, worsening work-

family balance (University of Sydney, 2005; 4).

One of the most controversial aspects of the WorkChoices legislation is

the change to unfair dismissal laws. In organisations with fewer than 100

employees, employees are no longer able to seek redress from an


independent tribunal where they have been unfairly dismissed.

According to McCallum (2006:3):

a majority of employees have lost their right to be protected from

harsh, unjust or unreasonable employer behaviour that leads to

termination.

Further, the idea that employees can be dismissed for operational

reasons is contentious and potentially exploitative. Operational reasons

are broadly defined as ‘reasons of an economic, technological,

structural or similar nature relating to the employer’s undertaking,

establishment, service or business’ (Howe & Murray, 2006: 2).

There continues to be much debate about how this legislation is

interpreted and what it means for employers, trade unions and

employees. According to employers, arrangements under

WorkChoices provide flexibility and choice. The Federal Government

concurs, maintaining that it is a ‘simpler, fairer, national workplace

relations system for Australia’ (Australian Government, 2005). According

to trade unions, however, WorkChoices will be used to drive down

wages and conditions. Other critics of the legislation contend that

WorkChoices has both diminished the rights of employees and

elevated managerial prerogative to new heights over and above fair

outcomes (McCallum, 2006).

While the full impact of WorkChoices is still unfolding, it is evident that

the laws are very detailed, complex and ‘unintelligible to all but

experts’ (Creighton, 2005 as cited in Riley & Sarina, 2005; 343). In an

effort to clarify and simplify, and perhaps popularise, the Federal

Government recently launched (May, 2007) a series of industrial

relations advertisements which did not even include the term


WorkChoices. According to market research, this is a term that has

negative connotations and one that the Government now prefers not

to use. Instead the Federal Government has set up a ‘Workplace Info

Line’.

Another recent alteration was the Government’s introduction of the

‘fairness test’, legislated at the end of May, 2007. This amendment is

designed to ensure that workers earning less than $75,000 are

compensated if their workplace abolishes penalty rates or other award

conditions. It has been argued, however, that under the new ‘fairness

test’, it is unclear how ‘fair compensation’ for the loss of penalty rates

will be measured, Furthermore, once the decisions are made by

bureaucrats, they are unreviewable and secret (MCCallum R, cited in

Horin A, 2007:33). Another challenge is that employees wanting to

challenge a compensation ruling would have to apply to the High

Court, a very daunting and costly exercise indeed.

Critics of the WorkChoices legislation argue that the impetus for the

changes to Australia’s industrial relations system is an ideological one

(McCallum, 2006). The Howard Government resurrected ideology

when it legislated to give the power in industrial relations to employers.

This destroyed the delicate historical balance of protecting workers’

rights and employers’ rights. Under WorkChoices, new rules give

employers the power to introduce individual contracts under which

employees potentially lose penalty rates, overtime and public holidays

without compensation. Under WorkChoices, employees are no longer

protected from unfair dismissal or allowed to bargain collectively.

Further, the laws ensure the diminishing role and importance of the

union movement in public life. And finally, as Professor McCallum

states, ‘the levers of choice are exclusively in the hands of the

employers’ (McCallum, 2006).


WELFARE TO WORK

I think (paid) work is very very beneficial to clients.

It’s very highly valued, if you don’t work, you don’t

exist……..I’ve never come across any bludgers. If

you ask clients what they want in life they say I’d

like to get married, have kids and have a job.

Case Manager/RN, NSCCAHS, 10 years

The Federal Government’s Welfare to Work: Employment and

Workplace Relations Amendment (Welfare to Work) and Other

Measures Act 2005, came into effect on 1 July 2006. Arguably, it is the

most radical reform of Australia’s income support system since the

Social Security Act 1947. Ideologically, it marks a departure from the

longstanding acceptance of the government’s role in mediating

imbalances in the market and protecting the disadvantaged. Instead,

the emphasis is on individual agency and individual responsibility for

developing individual talents and social capital by way of participation

in the paid workforce (Jayasuriya, 2001).

In theory, the welfare to work laws stress the role and actions of the

individual over the protective role of the state. In practice, the aim of

the legislation is to encourage single parents, disabled and older

workers off pensions and into self-reliance through employment (Gray

and Collins, 2006:83). To achieve this aim the Howard Government’s

approach is to rely heavily on the ‘big-stick’ aspect of encouragement

(Carney, 2006:31).

The legislation has made significant changes in income support

arrangements. The four main groups targeted in the welfare to work

policy are people with disabilities, single parents, the long-term


unemployed, and mature-aged jobless people. However, because the

Government decided to exempt most existing welfare recipients from

its 1 July 2006 welfare to work reforms, their effects will mainly be felt by

new claimants for sole parent and disability payments, along with

those people covered by phased impact arrangements (Carney,

2007).

The Federal Government believes that encouraging parents into work is

the best way to help children and families. While welfare agencies and

other groups support this aim, there is concern that the reforms will

result in many single parents (and people with disabilities) being placed

on lower payments until they secure employment.

As mentioned, the main aim of Welfare to Work is to move more

people into work and reduce their reliance on pensions and

unemployment payments. While projections vary, the Australian

Council of Social Services (ACOSS) estimates that 30,000 sole parents

and 20,000 disability claimants will be affected by the changes each

year (Davidson, 2006:12).

Other critics have contended that under the welfare to work changes,

income support recipients with mental illnesses are disproportionately

affected and are at particular risk. Risks include reduced income,

penalties for breaches or non-compliance with all of these having a

detrimental impact on the persons’ well-being (Cowling, 2005; King,

Waghorn, Lloyd et al, 2006). In broad terms, the changes have been

condemned as a narrow ‘work-forcing’ and disciplinary approach to

welfare reform, in order to drive more people off welfare into whatever

jobs, of whatever quality, which the labour market can create for them

(Carney, 2007:10).


LEGISLATIVE INTERSECT

With WorkChoices there’s an increased focus on

the individual. With Welfare to Work the main

feature is the movement away from a supportive

regime to one of compliance

Senior Policy Officer, SSWAHS, 4 years

This was the way one interviewee summed up what the new legislation,

WorkChoices and Welfare to Work, meant to them. The comment

echoed the opinions of many of the interviewees who considered the

notions of individual responsibility and mutual obligation were now

paramount. One critic warned that the new laws were ‘creating a

system that is coercive and which could contribute to the emergence

of a working poor’ (Boucher, 2007:5). This section examines the way the

two pieces of legislation interact.

In 2005, the then Federal Minister for Employment and Workplace

Relations, Kevin Andrews, stated his support for the proposed changes

to welfare:

This bill will respond to our twin challenges: the imperatives to

increase participation for these groups and reduce their level and

incidence of welfare dependence (Andrews, 2005).

For the Government, the notion of lessening the incidence of welfare

dependence was an appealing one, both financially and

ideologically. As one critic pointed out:

one of the important implications of adopting the jobs-first policy

setting is that it lessens the load borne by social security as an

instrument of social protection, and shifts that burden to the lower

reaches of the job market by bringing downward pressure on


minimum wages through shoring up jobs of marginal viability

(Karger, 2006).

By encouraging the deregulation of workplaces and allowing market

forces a greater role in setting the price of labour, the WorkChoices

legislation has facilitated the coercion of the weakest workers into

marginalised jobs.

The Government, in its support of WorkChoices, argued that lower

wages would create jobs for unemployed and other disadvantaged

people whom businesses might not otherwise be prepared to employ.

Indeed, Minister Andrews’ rationale for the changes emphasised the

importance of ensuring that disabled people have access to the

benefits associated with paid employment. However, as O’Brien et al

(2005:306) point out, there has been no evidence presented to support

the assumption that employers are eager to employ individuals with

disabilities.

Clearly, WorkChoices and Welfare to Work legislation intersect. As one

commentator observed:

The changes to the industrial relations framework under

WorkChoices will specifically affect those moving from welfare to

work. Changes to the compliance system will essentially compel

people moving from welfare to work to accept jobs that might be

below award conditions. Under the Welfare to Work legislation,

and consistent with a ‘work first’ approach, income support

recipients who do not accept a ‘suitable’ job will have their

payment suspended for 8 weeks. However, a ‘suitable’ job no

longer has to meet the relevant award and only has to meet the

[fair pay standard (Smith, 2006:7).

In other words, the welfare to work reforms create the environment in


which market forces are able to set the terms and conditions of work.

At the same time, the rights of income support recipients are

weakened as they are coerced into compliance. For example, if

employees leave jobs because they are unhappy with pay and

conditions, their access to unemployment benefits is reduced because

they have ‘voluntarily separated’. At the same time, the government

has admitted that job seekers must accept the first available job in

order to stay on benefits, even if the job has sub-award wages and

conditions (Seccombe, 2005).

Further, the WorkChoices legislation makes it difficult for people with

limited or no bargaining power, people with mental illness for example,

to negotiate fair and reasonable working conditions. In essence, these

two pieces of legislation enable the government to create an

environment in which many already vulnerable individuals are

condemned to an even more difficult and impoverished existence. As

another academic surmised:

WorkChoices really brings to an end what was left of functional

welfare through industrial policy, rendering the welfare to work

reforms much more draconian than otherwise would have been

the case (Carney, 2007:6)

Essentially, WorkChoices has made it easier for employers to offer

reduced employment conditions and to negotiate these conditions

with employees on an individual basis through AWAs. In tandem with

this, welfare to work legislation has made it more difficult for a person

currently on Newstart Allowance or Parenting Payment to refuse to sign

an AWA. Since 1 July 2006, this decision has been regarded as a

‘serious participation failure’ incurring an 8 week no-payment penalty.

Under the new system, moving from welfare to work leaves no room to

negotiate with employers over wages or conditions (Archer, 2006:9).


The Government has used the term ‘compliance’ to refer to the system

of penalties designed to punish welfare recipients for infringements.

Those who are voluntarily unemployed, have been dismissed for

misconduct, have three participation failures in 12 months or refuse

what the legislation calls ‘suitable work’ will have a payment

suspension for eight weeks.

According to the Welfare Rights Centre, the Federal Government ‘has

withheld $27.2 million from the pockets of the most vulnerable

Australians’ (Rights Review, September 2007; 3) with the new penalty

system since July 2006. Recent research figures indicate that 15,509

people had their welfare payments suspended for eight weeks

between July 2006 and July 2007 (Peatling, 2007:4). To put this in

context, in the year before the new legislation kicked in, there were

6432 people penalised for not meeting requirements without a

‘reasonable excuse’. Welfare groups have concerns about the

negative impact of the narrow definition of ‘reasonable excuse’. For

example, reasonable grounds do not include refusing a job because it

pays below the award wage. Nor do they include refusing

employment because the work requires self-employment status

whereby a person must make their own superannuation contributions,

cover their own public liability and manage their own tax (WRC,

2006:8).

For the Government, the intention underpinning no payment periods is

to facilitate entry into the workforce. Boucher, a critic of this rationale,

argues that there are problems with this compliance approach. Firstly,

no payment periods impact disproportionately on disadvantaged

groups; secondly, the no payment periods are punitive provisions which

will have the opposite effect – they will further entrench unemployment

and will ultimately reduce the capacity of recipients to comply with


their activity requirements and third, the grounds for ‘serious

participation failures’ can operate in a coercive manner inconsistent

with the language of ‘choice’ which underpins the WorkChoices and

Welfare to Work legislation (Boucher, 2007:50-1).

With the interface between industrial relations and social security

compliance, the Government is well on the way to achieving a

reduction in the welfare budget and complete flexibility for employers.


FINDINGS

very mental health professional’s narrative is unique, but a

certain commonality of experience was evident in the accounts

of the interviewees. When asked about the recent industrial

relations and welfare to work legislation, its impact on them, their work

and their clients, interviewees reported a diverse range of experiences.

However, three main themes emerged during every interview. These

were:

• the heightened anxiety of their clients with mental illness

• the lack of employment support for their clients

• the impact on mental health professionals, notably their

increased workload and decreased well-being.

HEIGHTENED ANXIETY OF CLIENTS Under the new Welfare to Work reforms people with mental illness who

are on income support are a particularly vulnerable group. The mental

health professionals interviewed indicated that anywhere from 40 -100

percent of their clients had mental health problems. They further

reported that many of their clients had a mental illness, which was

undiagnosed, sometimes unrecognised. Other clients denied that

anything was wrong with them and had never sought treatment.

E


Not only is this particular group of

clients very vulnerable under the new

welfare to work changes, but they are

particularly challenging for mental

health professionals and job capacity

assessors to deal with because they so

vehemently deny their condition. Their

denial of illness means they have no

record of treatment or medical

evidence.

Another vulnerable group includes

those particular individuals who have

severe episodic psychiatric illnesses,

such as schizophrenia. Previously, these

people would have qualified for the

DSP, but from 1 July 2006 many have

been placed on the Newstart

Allowance. Under the former system, this

group would most likely have been on

the DSP with the provision they could

choose to work when they were not

symptomatic. However, on Newstart

Allowance there is no such provision,

instead, people are required to seek

and undertake work.

According to welfare groups, these

requirements create significant

difficulties for people with mental

ANTONELLA

Antonella is very intelligent, articulate and informed. She studies social security legislation every day, is obsessive with detail and makes sure the welfare agency staff have got the story clear, and in exact order. Antonella drops into the agency regularly to provide updates and is determined that Centrelink is just trying to out manoeuvre her, but that she’s one step ahead. She has to be, because, at the heart of the matter is a complex set of arguments that go deep into the past where obscure Centrelink offences provide all the causal links. Antonella refuses to go to a job capacity assessment as she sees things differently. She believes there is nothing wrong with her; she is just unemployed and everything would be all right if Centrelink would just leave her alone. She repeatedly complains that Centrelink should ‘stop harassing me, it’s no one else’s business’.


illnesses including, worsening their

medical condition because of

pressure to look for and accept work;

the need to disclose their medical

condition to their Job Network

agency to avoid the imposition of

onerous job seeking requirements;

and erosion of the person’s capacity

to self-manage their illness by

identifying when they can and

cannot work (Coad et al, 2006:7). In

addition to these problems, there is

the reality of the paucity of employers

who provide flexible work

arrangements to people with episodic

illnesses.

Mental illnesses such as depression

and anxiety cost Australian

workplaces approximately 3.5 billion

dollars per year (Butterworth, Crosier &

Rodgers, 2004). The costs have been

attributed to absenteeism and

reduced productivity (Butterworth et

al, 2004). The relationship between

mental health, work and welfare is

complex and under researched. It has

been demonstrated that ‘45% of sole

parents had a diagnosed mental

health condition over a 12 month

period’ (Coad et al, 2006; 6). Further,

ADEN

Aden claimed Newstart Allowance after release from involuntary in-patient treatment in a psychiatric hospital for schizophrenia. He provided a medical certificate attesting to the diagnosis, and a treating doctor’s report, which explained his history, the diagnosis and ongoing treatment – all of which made his vulnerable mental state very clear. When Aden was sent a JCA appointment notice, he got a friend to ring Centrelink to advise that he was too ill to attend and that he urgently needed income support. His friend was told that until our client attended the JCA, no payments could be made. Aden was fortunate in having a supporting, articulate friend who was able to advocate for him, but often this is not the case for people with schizophrenia. However, forced referral to a JCA may have served only to alienate a young man whose most immediate need was stable income support.


85% of people with a psychotic illness such as schizophrenia are on DSP

and they receive these payments because their mental illness hinders

their ability to participate in the paid workforce (Butterworth, 2003). As

already discussed, under the new welfare to work regime both of these

groups of people are expected to demonstrate to Centrelink why they

are unable to participate in the paid workforce. For some clients,

having to demonstrate this is neither practicable nor possible. Another

case study showed the frustration of a client with a mental illness trying

to deal with Centrelink:

I have a young client who’d been working part-time for a few months,

but Centrelink kept pressuring her to find full-time work. I don’t know

whether this would even be possible for her because she was severely

depressed, taking anti-depressants, was self-harming and had been

sexually assaulted. So she wasn’t in great shape to find and keep a full-

time job. But it was the pressure from Centrelink that got to her, so that

in the end she threw up her hands, refused to go near Centrelink and

decided it was easier to earn money as a sex worker. She reckons it’s

too stressful trying to deal with Centrelink and easier to support herself

this way despite a recent diagnosis of HIV positive. She’s 22

.

Social Worker/Counsellor, SSWAHS, 7 years

The association between poor mental health and income support

recipients has been attributed to a number of factors. Some of these

include financial hardship, social isolation, trauma both physical and

psychological, and relationship difficulties such as divorce (Butterworth,

Crosier & Rodgers, 2003; Butterworth, Fairweather, Anstey & Windsor,

2006). It has been suggested that the consequences of being on

income support, including poverty, lack of self esteem and uncertainty


can either cause mental health problems or exacerbate them -

particularly depression and anxiety. Interviewees reported this was the

case with a number of their clients. For example:

Some of my clients have experienced acute distress after their

interaction about employment with Centrelink, a real increase in

anxiety levels. Some clients find the correspondence difficult to

understand and feel pressured to work when they ‘get the letter’ - this

causes them to feel more worried and anxious. My clients are reluctant

to challenge Centrelink, they feel they have to comply, even though

they find it very difficult to go to work. They also feel confused about all

the changes and do not know where to start. This means that their

mental health deteriorates, but they are too afraid to challenge their

job agency or Centrelink.

(Psychiatrist, non NSW based 16 years)

and

There’s a sense not of government caring for but of government

watching clients …very threatening for those with a paranoid illness or

anxiety problem. It makes them worse. So I suspect that some people

might even avoid going on any sort of government support because of

the intrusion.

(Case Manager/RN, NSCCAHS, 10 years)

The concept of self-determination is very important to people with a

mental illness in facilitating their recovery (Tse & Yeats, 2006). Having

control over their life and work is an inherent aspect of this. Neither

WorkChoices nor the welfare reforms adequately considers this

concept, and are actually more likely to result in the person feeling


demoralised (Butterworth et al, 2006). There was considerable

evidence of clients with mental illness feeling generally powerless,

demoralised and victimised. For example:

There’s a feeling of failure and uncertainty among many of my clients,

a sense that the Government is checking on them. People aren’t

confident about their income support anymore. There’s a deliberate

government policy change, it’s all about work, not welfare

(Case Worker, Sydney SESIAHS, 9 years)

and

Recently I’ve seen an increased anxiety among clients about having

their pension taken away from them….. Even though people are

motivated to work there’s a lot of disincentives eg Centrelink ringing

them up, having to notify them all the time. A lot of them just feel like

giving up, that there’s no point; they think no-one will ever employ

them…that sort of thing


With the new welfare to work requirements, I was getting clients starting

to really act out, saying things like:

‘am I going to be able to stay here’ (rehabilitation centre)

‘I don’t have the ability to work’

‘what am I going to do, how am I going to live’

(RN, Sydney SESIAHS, 5 years)

The interviews for this research were conducted barely 12 months after

the Welfare to Work legislation took effect on 1 July 2006. Although it


was early days, many of the interviewees considered the new

legislation was beginning to have an impact on both their clients and

on the way they, themselves, approached their work. Overwhelmingly,

they reported negative effects, particularly in relation to heightened

levels of anxiety, distress and uncertainty among their client base.

As stated previously the mental health professionals interviewed dealt

primarily with clients with mental illnesses who were receiving income

support. The proportion of their clients who had a mental illness ranged

from 40 percent to 100 percent across the sample. The majority of

interviewees related stories of their clients presenting in highly

emotional states, including being fearful and anxious about changes,

both actual and anticipated, to welfare to work arrangements. When

asked how they would describe their clients’ concerns, the

interviewees nominated three specific factors that were causing

distress and anxiety in their clients. These were:

• changing income support arrangements,

• the new job capacity assessment procedures and

• the prospect of seeking and maintaining employment.

Changes to income support

In the first few months after the Welfare to Work laws took effect, the

interviewees reported that their clients with mental illness and on

income support had become very anxious. Those on DSP were anxious

that they would lose this pension and instead be placed on the lower

Newstart Allowance.

The Newstart Allowance is an income support payment for adults who

are unemployed. A person may qualify for Newstart Allowance if they

are at least 21 years old, have lived in Australia for more than 2 years,


are unemployed, are capable of undertaking work, are available for

and actively seeking work or undertaking an activity to improve their

employment prospects and either satisfy activity test requirements or

are exempted from these (Job Capacity Assessment Service Provider

Guidelines, 2006:18).

The Disability Support Pension (DSP) is an income support payment for

people with long-term disabilities or medical conditions that keep them

from working (Job Capacity Assessment Service Provider Guidelines,

2006:19). Since 1 July 2006, the criteria for the DSP have become more

stringent. People with disabilities who apply for income support after

June 2006 and who are assessed as having a ‘partial capacity to work’

– defined as a capacity to work between 15 to 29 hours per week

without on-going support in the open labour market - will no longer be

able to claim the DSP (Cowling, 2005:3). Estimates indicate that 81,000

people with disability will be put on lower payments, mainly Newstart

Allowance (ACOSS, 2006). Those without work will receive $46 per week

less than the pension and those who study full time will receive up to

$166 per week less. If they get a job for 15 hours a week at the

minimum wage, their weekly disposable income will be $99 less than if

they were on DSP (ACOSS, 2006).

The number of people with disabilities who will be affected under the

new welfare to work arrangements is significant. It is estimated that

those individuals who currently qualify for DSP but who will shift to full or

part-rate Newstart Allowance over the next three years (2006-9) is

approximately 75, 700 (Department of Employment and Workplace

Relations, 2005).


As the following quotes show, clients expressed great concern about

both real and anticipated changes in their pensions. Interviewees

reported:

Clients are calling us more frequently, anxious about being moved off

their pension (to Newstart Allowance). If so, it could mean a drop of

$46 a week for them. There’s never been such a dramatic change to

the system.

(Policy Officer, SESIAHS, 4 years)

When the (Welfare to Work) legislation first came in, I had a lot of my

clients ringing me up really concerned that if they didn’t get work

they’d have their pension taken away. So I had to do a lot of re-

assuring, explaining that it didn’t apply to them.


I’m definitely seeing a lot more anxiety among clients; lots of them are

ringing up very anxious about losing payments. Many of them don’t

understand why they have to go through JCA and are anxious about it

having an effect on their payment

(Education/Liaison Officer, SESIAHS, 8 years)

My clients became more stressed, anxious and some got very angry.

They got angry because they couldn’t understand why the

Government would not let them do the program (rehabilitation

program) then think about getting a job. The pressure was on to get a

job, regardless.

(Registered Nurse, SESIAHS, 5 years)


Clients are having to meet a lot more requirements. I feel I have to

know a lot more about Centrelink – the rules and regulations. It has

made me more aware and conscious that there may be issues with

Centrelink. Clients seem unclear about the changes and are stressed.

Some of our clients are homeless, so they never get their mail and are

breached and not even aware until they try to get money. Then they

become angry and frustrated.

One of my clients was on DSP because she has schizophrenia and she

got a job – the environment she was working in was not very stable- the

boss would sack people if they did not turn up, She did not tell

Centrelink about her job it was only casual. Centrelink found out and

she was worried, I am not sure if her DSP was cut off – there is not much

concern for their safety net if getting a job can mean people on DSP

payments can be cut.

(Social Worker/Case Manager, SESIAHS, 18 months)

Even though DSP is not subject to activity test requirements or the

penalties that apply for failure to seek and maintain employment,

interviewees reported that their DSP clients were still very anxious about

potential changes to their income support. Interviewees indicated their

clients were confused too, about the nature of these changes, as were

they themselves sometimes.

As with any reform, there was a proportion of clients who were fearful

of change in general. Others were specifically concerned about the

prospect of having to deal with Centrelink and having to undertake

courses or rehabilitation programs as part of being re-assessed for


employment. Interviewees reported that these new requirements not

only increased their clients’ stress and anxiety levels, but in many cases,

exacerbated their mental illnesses.

Many of my clients are panicky about the possibility of being taken off

DSP. They’ve never worked, usually because of mental illness. The

changes are really affecting them, making them worse, it’s just makes

no sense.

(Community Mental Health Nurse, SSWAHS, 16 years)

My understanding of Welfare to Work is the reciprocity requirements.

My clients are happy with that, but they do get very anxious about

their pensions being threatened. Quite bizarre really because many of

them have a major mental illness and no-one in the world would take

away their pensions, but they still get very anxious about it.


I feel people are being enforced by Centrelink to get off pensions

without any consideration of what their actual needs are. My clients

think this and are so anxious about all the hoops they will have to jump

through just to keep their pensions (DSP)

(Occupational Therapist (OT), SESIAHS, 10 years)

Interviewees also reported clients’ apprehension about what they

perceived as the Government intruding into their lives. Clients

expressed great suspicion and anxiety at having to go through new

bureaucratic processes, for example being asked questions by

Centrelink about their financial affairs, their health and capacity to


work. While many of these clients would remain unaffected by the

Government’s reforms, it was their anticipation of these possibilities that

caused anxiety.

Interviewees reported that their clients’ perception of greater

Government intrusion into their lives was a real source of frustration and

worry for them. Most commonly clients perceived Centrelink as a kind

of ‘big brother’ who asked questions, sent letters, tested, assessed and

‘made them jump through hoops’.

I have a client who’s a torture victim from overseas. He’s young,

traumatised, without any family support. They’ve put him in some place

way out of the city and expect him to find his way to Centrelink, pay his

train fares, understand the expectations. He’s totally confused, caught

up in the system without understanding it….he has so many needs, but

Centrelink wants him to go through their process, jump through all

these hoops…

(Social Worker/Counsellor, SSWAHS, 7 years)

Other interviewees recounted the fear and confusion many of their

clients felt about being interviewed by Centrelink staff. In particular,

clients with mental health problems were totally overwhelmed by

Centrelink’s questions, requirements and demands. This was particularly

so for those clients trying to qualify for DSP under the new rules.

Over the last 12 months, I’ve noticed my clients are more worried and

anxious. They are more afraid of seeking assistance from the

Government – one woman I am seeing at the moment would rather be


a sex worker than see Centrelink. She

works on the streets and I am worried

about her

(Community Nurse, SSWAHS, 2 years)

The new system seems to be stricter and

the Government thinks that everybody

can work, but this is not true. The

Government seems to make decisions

without any consultation. It’s not as easy

as they think.

(RN, SESIAHS, 5 years)

Centrelink does not recognise that

some of our clients do not have insight

or acknowledge their mental illness or

mental health issues – and they do not

have the capacity to work. So they are

breached.

(Social Worker/Case Manager, SESIAHS,

18 months)

New Job Capacity Assessment

Some of my clients report that job

capacity assessors do not tell them who

they are or what their qualifications are.

Some of my clients are sometimes not even aware they are having a

job capacity assessment – they think they are just attending a meeting.

The problem with the current system is that a person receives only one

THERESE

We recently had a client who was on Newstart and had been in hospital with a mental illness for five months. Since she came out of hospital six months ago she hasn’t received any payment. We’re advocating for her to get back payment, but so far they’ve only given her payment for six weeks. It’s difficult for her to contest this, really overwhelming for her. So we’re trying to do it for her. We actually have to go down to Centrelink with her because she gets so confused. She’ll say yes to anything. We’re contesting that she is capable of work. She has medical evidence to support this. She’s been put back on the Newstart incapacitated allowance which means she doesn’t have to look for work for 3 months. I hope that she will go back to work at some stage. Manager, Crisis Accommodation, 4 years


assessment and a decision is made. This is a major problem as quite

often it takes more than one interview to assess a person’s capacity to

work. The new system is complex, people do not know where to start or

who to talk to.

Centrelink staff and job agencies need more training in mental health

and how to assist people to get back into work. Health care

professionals should also be given training on how Centrelink works and

the changes, like JCAs. It is not easy for health professionals to speak to

Centrelink

(Psychiatrist, non NSW based, 16 years)

The new Job Capacity Assessment (JCA) is a comprehensive

assessment of a person’s ability to work. The assessment involves

identification of barriers to a person’s employment and any

interventions that may be required to help them overcome these

barriers (Job Capacity Assessment Service Provider Guidelines,

2006:15). The barriers include both physical and psychological

disability, homelessness and addiction. The Government is focusing on

employment as the remedy to solving issues such as homelessness,

affordable housing (public & private) and substance abuse.

The issue of capacity is not as straightforward as the Federal

Government claims. Peter Dutton the Minister for Revenue and

Assistant Treasurer argued that ‘the community feels it is a fair principle

that people are asked to work in keeping with their abilities and

capacity’ (Dutton, 2005:5). This is a simplistic approach to a complex

situation, as capacity is not just about an individual’s disability but also

the local labour market (Cowling, 2005). As Cowling (2005:12) further


points out, there are numerous factors that impact on a person’s

capacity to work such as hours of work, flexible working conditions,

proximity to public transport and access to affordable childcare.

One mental health professional interviewed explained that most of his

clients had been failures in the school system and had come from

homes where their parents either abused or neglected them. Because

of these factors, he considered it unlikely that these clients would ever

be work ready. He contended the whole notion of being assessed for a

job was inappropriate and irrelevant for most of his young clients. He

stated:

My clients need parents, the kind of parents that most kids have.

They’ve never had this, they’ve never been able to negotiate all the

milestones. They’ve been disengaged from school, neglected or

abused by their parents. These are not kids who are going to find a job.


The situation is even more problematic for those people with mental

health problems who may regularly require a reduction in hours due to

the episodic nature of their condition. Furthermore, it is not always

possible to predict when this work flexibility will be required. Even more

challenging for people with disabilities, is that under the new welfare

arrangements the definition of ‘work’ has been changed so that in

order to receive the DSP an individual’s disability needs to be such that

it prevents them from working 15 hours per week, as opposed to the

earlier test of 30 hours per week. The new test only applies to new

applicants for the DSP, hence the long transition associated with the

process of implementation (O’Brien et al, 2005:315).


There was very little indication that the Government was recognising

the needs of these particular clients, let alone trying to accommodate

them with flexible arrangements. According to interviewees:

There seem to be more barriers for my clients to get through before

they can get work. Some of them have the kind of illness where they

can’t work consistently, often this precludes them from even turning up

to job interviews. Increasingly, too, the problem of disclosure and

employment information is really worrying people more and more.

I think the current JCA should have a separate category for those with

a psychiatric disability so that they can be assessed by people trained

in mental health and sensitive to their particular needs. ..It’s really a

specialist field, but this is not happening.

(Consumer Advocate, SSWAHS, 7 years)

There’s also a problem with the Newstart requirements where they

have to apply for 10 jobs. If my clients with mental illness are going

through a manic phase they scrub up quite well at an interview, get

the job, but then can’t or don’t turn up. Even if they do (turn up) they

often present a danger to other employees. The government has a

duty of care to potential employers.

(Case Worker, SESIAHS, 9 years)

Clients are experiencing more stress and are disorganised – they don’t

know about the changes in rules. What they need is guidance and

support. The breaching is disastrous – you can be cut off for eight

weeks for not attending a JCA – their payments can be reinstated and

their money controlled by a charity. I don’t know what charities have


been set up for this, but all I know is that clients are more stressed and

they are presenting with a lot more issues with Centrelink.


The new system (JCA) is not transparent, it doubles the service provision

and it’s inefficient. Clients often have to do another JCA for no

understandable reason.

(Clinical Nurse Specialist, SSWAHS, 6 years)

Under the new system, JCAs are conducted by assessors employed by

Centreliink, Health Services Australia, Commonwealth Rehabilitation

Services (CRS) and by 15 non-government organisations contracted by

the Department of Human Services. JCAs may be doctors or other

allied health professionals. Currently, over fifty percent of job capacity

assessors are psychologists (575); others include registered

occupational therapists (269), accredited rehabilitation counsellors

(191), social workers (162), registered nurses (77), registered

physiotherapists (65), accredited exercise physiologists (61) and

registered medical practitioners (43) (Department of Human Services –

Job Capacity Assessments, Hansard Written Question on Notice HS33,

31 October 2006). Assessors are not required to have a mental health

background or to have work experience in that setting.

Recently, some welfare groups dealing with clients who have mental

health problems have reported a high degree of client dissatisfaction

with JCA findings and recommendations. Reasons for poor quality

assessments related to a lack of medical evidence; lack of expertise

and experience of some assessors (NSW Welfare Rights Centre, 2007).


Clearly, if people with mental illnesses are to maintain stable income

support and be fairly and accurately assessed for work, it is essential

that Centrelink staff and other assessors understand both the

prevalence and nature of mental illness and the effect it has on a

person’s capacity to work. However, evidence is emerging that too

many job capacity assessors lack the appropriate qualifications, skills

and experience to accurately assess the group of clients with mental

health problems. Welfare groups argue that the assessors do not

always have a mental health background relevant to clients’ illness,

condition or disability and therefore lack the specialist skills required to

make informed and accurate assessments (Cowling, 2005; WRC, 2006,

ACOSS, 2006).

The Welfare Rights Centre summed up their experience of dealing with

clients with mental illness who were facing job capacity assessment:

Too many people are having their mental illness exacerbated by

inappropriate and undesirable activity demands and the imposition of

harsh ‘participation failure’ penalties when they should not be on

activity tested payments in the first place (Rights Review, 2007:12)

The Welfare Rights Centre is further concerned about the way new

‘activity testing’ is applied to people with a mental illness:

Many of our clients who have a mental illness or who have a long-term

and debilitating psychiatric disability, may acknowledge nothing more

to our caseworkers than temporary anxiety caused by Centrelink’s

treatment, or they may fail to recognise that they are ill at all. Such

clients may present to Centrelink (and our service) as eccentric,

aggressive, neurotic or paranoid but without psychiatric evidence

many clients with severe psychiatric disabilities face a future of

unstable income support due to problems satisfying Social Security


activity tests and obligations regarding when and how to notify

Centrelink of changed circumstances (WRCb, 2006:8).

Finally, the WRC is particularly concerned about the potential impact

of JCAs on people with serious psychiatric disabilities:

…the guidelines are prompting an excessive number of referrals, and

these referrals are creating hardship for clients and producing ill-

advised decisions as to entitlements (Rights Review, 2006:6)

As the pool of people subject to job-seeking requirements increases,

the Welfare Rights Centre has recommended that the Federal

Government develop training programs to raise the awareness of

mental health issues among Centrelink and Job Network staff involved

in the activity testing of social security recipients.

Many of the interviewees echoed the welfare groups’ concerns. They

too expressed a desire to see better training for job capacity assessors

enabling them to more sensitively and knowledgeably deal with clients

with mental illness.

The new system is more stressful – clients have to have an assessment

before they can get payments and there are delays in being put on

payments. It depends on who you speak to at Centrelink to what

information you are given. I had a client with a serious undiagnosed

mental illness who was paranoid and delusional. She got breached

because she did not attend a JCA. She needed extra support, so I had

to go to the assessment. If I hadn’t been with her she would not have

got her payment.



Centrelink asks the wrong questions of my clients, they don’t have the

expertise. Lots of enquires about a person’s mobility, can they move

from their bedroom to kitchen. Completely irrelevant. My clients’

problems are they think the food in the kitchen is poisoned, and that

someone is out to get them – that sort of thing. There are no boxes to

tick on their forms about this.

(Clinical Psychologist, SESIAHS, 7 years)

Lots of clients can’t talk to Centrelink about anything. Centrelink staff

has adopted a ‘work first’ approach. Clients feel this inflexibility


My understanding of the new system is that everyone who applies for

income support must now have a job capacity assessment

administered by people outsourced by Centrelink. Some of the people

administering aren’t necessarily qualified in mental health area. This

means there’s no standard, the quality of the service is very variable.

It’s very much up to the individual assessor, so there are no checks and

balances.

(Senior Policy Officer, SSWAHS, 4 years)

There was considerable evidence from the interviews that the mental

health professionals were concerned about both the actual process of

job capacity assessment and the way it was applied to their clients.

Typically, interviewees referred to the new regime as ‘punitive’, ‘all

about compliance’, ‘penalty based’, ‘big-stick approach’, ‘no support

or understanding of these clients’ needs’.


In essence, much of the interviewees’ negativity was associated with

the compliance model underpinning the new assessment procedures.

Interviewees were not critical of the Government’s aim to place more

people into work, but were apprehensive about the process being

used to achieve this objective. They were also concerned about the

appropriateness of the job for the client, some commenting that the

Government seemed to have a ‘work first’ approach and that any job

would do.

There’s no doubt that these new rules are causing so much stress.

Clients are ringing up more frequently, anxious and crying about what

will happen to them under the new rules. They spend so much time

ruminating over the new assessment procedures.

I don’t think there is anything wrong with getting people into work who

have been on welfare, but the type of work has to be meaningful and

match their skills…The Government is not looking at the best interests of

people on welfare, but just providing the state with a cheap labour

force.


From what I know of the new system (JCA) is that it’s making clients feel

more stressed and concerned when they have to go to Centrelink for a

JCA. The new system seems harsher; it is not focused on helping a

person, it seems punitive.



The current system is not improving people’s economic or social

participation – people are feeling an increase in stress, due to reporting

conditions.


Many of the interviewees commented that the new system was flawed

in that it further marginalised and inappropriately penalised their most

vulnerable clients. They considered the majority of their clients did not

need to be coerced into finding work, most of them would have liked

to work and be part of society, but because of their mental health

problems this was not always possible. Some of their comments were:

I think people should be encouraged, not coerced into work. I don’t

think people should be forced to work, but there are people who lose

hope without work. That’s my concern. If some government decided

on a strategy to encourage people to sensitively get off the DSP and

into employment, I’d encourage this. But not the way they’re doing it

now.

My clients aren’t coping too well with the new system; it hasn’t been

sold very well. Clients are worried they are going to be worse off. They

feel things they were used to eg living skills centres, health services,

work programs are going to be cut too. Also worried their income will

be reduced.


My problem with the new system (JCA) is that it seems to be based on

the premise that the average person with a disability is trying to rip off

the system. I just don’t think that’s true. I think the average person in the


system is very honest and their work ethic is just as high as everyone

else in the population. But this new system seems to be punitive, about

catching people out….It’s a very small percentage of people who are

doing the wrong thing, but they get all the publicity.

(Case Worker/RN, NSCCAHS, 10 years)

Some of the requirements that Centrelink puts on my (young) clients

exacerbate their mental health issues….Many of their lives are chaotic

…they’ve been thrown out of home, are disengaged with school, have

no adult support, usually no job and lack the skills and experience to

get one. They need proper parenting!


Another concern with the JCAs is the emerging trend for Centrelink not

to accept clients’ medical evidence requesting exemption from

activity testing. According to recent research, Centrelink will no longer

accept more than two 13 week exemptions without an automatic

referral to a JCA. For this particular group of clients having to go

through the activity test process, frequently results in the cancellation

of income support for 8 weeks (Rights Review, 2007:13).

As the quotes below show, the issue of Centrelink not accepting

medical certificates was becoming increasingly common in the

experience of the mental health professionals interviewed:

Previously clients would have a treating practitioner report but now

(under new system) these reports are not seen as sufficient. There is no

integration of treating health professionals into these assessments. And

it seems that the job capacity assessors do not have experience with

mental health. I now have to contact a senior person at Centrelink and


speak to them directly with my patient’s consent and sort out the

process. My clients find the system complex. They feel they have fewer

choices, that they are jeopardising their payments if they question the

assessment process.


One change I’ve observed is we’re getting clients returning over and

over, trying to put in a medical certificate for JCA. I don’t understand

why the medical evidence is not being accepted, though. I’ve seen

some clients with mental illness put in a medical certificate to

Centrelink and be refused. This didn’t happen before this new system.


It’s dangerous when the treating psychiatrist’s advice is ignored by

Centrelink.


This current job assessment system is incompetent because it does not

guarantee the integrity of the process………..expert medical opinion is

ignored by Centrelink.

(Director, SESIAHS, 7 years)

Under the Government’s previous system of assessing people’s

capacity to work, experienced Centrelink staff were often able to

repeatedly grant activity test exemption to clients where deemed

appropriate. For the group with episodic mental illness, when it was

clear there was little or no capacity to seek or maintain work,

Centrelink was able to exercise its discretion. With the new ‘work first’


agenda, this practice is no longer feasible. Interviewees recounted

incidents of clients with mental illness being subjected inappropriately

to activity testing. Invariably, these were their most vulnerable clients

who often had little insight into the nature of their illness and often

denied they were even ill.

Time and again, interviewees expressed deep concern for their most

vulnerable clients in the new ‘work-first’ regime:

It’s so concerning because some of these people who are going to be

assessed to work 30 hours per week, have never worked that in their

lives. In the past Centrelink used to give an exemption to particular

clients, but now they have to go for a job capacity assessment.


The Welfare to Work changes mean more people are being

challenged by Centrelink…… In the past Centrelink generally

accepted medical opinions, but JCA has changed all this.


I think it’s changed now and Centrelink doesn’t put much value on a

doctor’s or psychologist’s report saying their client can’t work at all.

There’s no trust, it’s almost as if Centrelink thinks we are doing

something to trick them about the (mental) health of our clients

because we say they can’t work, Many of my clients are not working,

so they need help from Centrelink. But Centrelink puts conditions on

them that they can’t meet….

(OT, SESIAHS, 10 years)


LINDA

Linda has had psoriasis and severe depression for over 12 months. She claimed Disability Support Pension as she has a serious disability and was unable to work and earn an income. However, she was given a zero impairment points rating on the grounds that her condition was not ‘treated and stabilised’. As she did not qualify for DSP, Linda was required to claim and was placed on Newstart Allowance. As a result of a mandatory Job Capacity Assessment she was required, as a term of her Activity Agreement, to attend the Commonwealth Rehabilitation Service for an occupational rehabilitation program. On appeal to an Authorised Review Officer in relation to the original DSP decision, the ARO upheld the Centrelink decision and added that, with treatment (whether or not it was actually available to her) Linda would be fine within two years. At the time of this decision, Linda had a detailed, lengthy medical report from her treating psychiatrist who had been treating her for over 12 months. The report indicated that Linda had severe psoriasis that extended all over her face and that she was being treated for severe depression. It further indicated that she was suicidal and had been admitted to a psychiatric hospital, that she had left after six months, but that she had only lasted a few weeks before being readmitted. The comprehensive report also explained that her depression was treatment resistant and that she had deteriorated recently due to both the effect of the psoriasis and to the anxiety arising from having to attend occupational rehabilitation. The report explained that Linda was on medication and was undergoing electro convulsive therapy along with diversional and psychological therapies. Despite this, she remains depressed, suffers excessive ruminations, struggles with suicidal thoughts on a daily basis and had recently overdosed on her anti-depressant drugs. The psychiatrist was very categorical in stating that Linda was not able to work or to engage in non-mental health based rehabilitation, was not capable of engaging in vocational rehabilitation and that the rehabilitation she was being required to undertake was inappropriate. He stated that with her treatment she was likely to remain significantly unstable for two years and clearly would be unable to work. He stated that he completely disagreed with Centrelink's assessments and that this was a mental illness with a high incidence of completed suicide.


Seeking and Maintaining Employment

As mentioned, research shows that mental illness such as depression

can have a significant impact on a jobseeker’s capacity to find and

maintain employment. It affects qualifications and skill levels; reduces

work experience and increases the likelihood of discrimination by

prospective employers. Its episodic characteristics, together with the

effects of medication, limit job prospects and impact on productivity

(Derr, Hill and Pavetti 2000).

Despite this evidence, the recent welfare to work arrangements fail to

take account of the needs of clients with mental illness as they attempt

to find and maintain jobs. This group of jobseekers faces significant

barriers to finding and maintaining sustainable work, for example

financial costs, the stigma and burden of mental illness, the episodic

nature of their mental health, and lack of flexible employment.

According to the interviewees, such factors meant that the prospect of

seeking and maintaining employment induced extreme concern and

anxiety in these particularly susceptible clients. Many of the

interviewees commented:

Recently I’ve had a few more clients dismissed from work because they

have a mental illness………There’s so much pressure on these people

now to keep a job when they are obviously unwell.


Recently, I’ve noticed a deterioration in the mental health of clients,

increased anxiety about work. They’ll say things to me like, they’re

going to make me look for work, I can’t leave the house, what am I


going to do? The biggest concerns for clients with mental illness are loss

of money and having to look for work.


Because many of my clients haven’t been in the workplace for a long

time, they get very anxious about it. Sometimes they’re suicidal about

the thought of having to prepare for work.

(Registered Nurse, Crisis Team, SSWAHS, 7 years)

July 1 2007, there’s a whole lot of single parents (45% have a diagnosed

mental illness) who have just been coping. Now there will be

interference from Centrelink and/or JCA (assessors). This will create a

whole lot of turmoil when these people have to come in and sign an

activity agreement (to do 15 hours a week work). They will be the first

group to have to do this. We’re getting calls from single parents very

anxious and confused about the changes.


Research has also shown that jobseekers with mental illnesses are less

likely to be able to meet activity requirements and therefore are

penalised and further marginalised by current policy settings (Parkinson

and Horn, 2006). Under welfare to work reforms, the Government has

introduced a system of penalties designed to punish welfare recipients

for infringements. Those who are voluntarily unemployed, have been

dismissed for misconduct, have three participation failures in 12 months

or refuse what the legislation calls ‘suitable work’ will have a payment

suspension for eight weeks.


Welfare agencies have expressed serious concerns about aspects of

the new system. Of particular concern is the immediate eight-week no

payment periods and the emergence of a larger pool of activity tested

recipients (WRC, 2006:9). The mental health professionals interviewed

echoed these concerns. One interviewee summed up the problem as:

There is a real collision between WorkChoices and Welfare to Work as

far as our clients are concerned. The Government is saying that if a

client doesn’t accept a suitable job offer (and they have a definition of

suitable job offer) then the client will lose payment for 8 weeks. A lot of

our clients are unskilled, so not in high demand for skilled jobs. But if

they don’t accept what’s thrown at them then they will be penalised.


Between 1 July 2006 and 30 June 2007, the first full year of operation of

Welfare to Work, there were 15,509 eight week no payment penalties

imposed whereas during the last full year of the previous system there

were 6,432 eight week no payment penalties. This increase of 9,077

represents a significant rise of 140%.

The Welfare Rights Centre has estimated the combined monetary

value of these penalties at $27m and has claimed that ‘this has come

out of the pockets of the most vulnerable Australians’ (‘Rights Review’

September 2007: 3).

Those interviewees who had experience of their clients being placed

on no payment periods were strongly critical of the new compliance

regime and its adverse effect on their clients:


If a person doesn’t actively engage in some sort of return to work

process then they get breached. I have serious concerns about people

with mental illness in this new system. These people are living with and

trying to work through complex issues. Perhaps the priority isn’t meeting

with a return to work officer…….but rather to ensure they have some

stable housing.

(Manager, Crisis Accommodation, SESIAHS, 4 years)

It’s really important to get people into work, but it’s not going to be

done with a bludgeon approach. We need people involved who are

mental health professionals to encourage people and certainly not

threaten to cut off their payments.


The Government’s belief that welfare to work transitions will increase

through this harsh compliance framework does not appear to be

supported by any substantive evidence. There is no question that the

Government is entitled to take reasonable measures to ensure that

income recipients are not rorting the welfare system. However, this new

compliance framework, like the previous system, is predicated on the

false assumption that the majority of income recipients are ‘bludgers’.


LACK OF EMPLOYMENT SUPPORT

My experience is none of these support services are particularly

effective. I’ve had one client doing the rounds with them for over 5

years…….they have no faith they’ll ever get a decent job.

Community Mental Health Nurse, SSWAHS, 16 years

The second theme that emerged from the interviews was participant’s

perception of a lack of employment support for people receiving

income support who had mental illnesses. While most interviewees

acknowledged the existence of a variety of government support

services, programs and allowances, it was generally perceived that

support was inadequate for those vulnerable Centrelink clients, that is,

those clients living with mental health problems. Apart from poor

mental health, this particular group of people was also often homeless

and demoralised. Many of the interviewees believed that special

intervention, ideally one-on-one, was critical to match the requisite

level of assistance with the individual needs of the jobseeker. Too often,

this level of support was not available. One interviewee described his

experience as follows:

There’s a group of people who are especially vulnerable under this

new system. These are the ones who have to get medical evidence

that they are not capable of 30 hours work a week. But often they

have mental illnesses that are undiagnosed and untreated, so this is the

real challenge. How do you deal with these clients who don’t have a

history of medical assessment. Part of the nature of their problem is that

they have no insight into the nature of their mental illness, even that

they are ill. These clients are extremely difficult to deal with; they’re

aggressive, seen as trouble-makers, often transient, easily stigmatised

which means they are locked out of support. This is an increasing


problem and it’s gotten worse under Welfare to Work. It’s brought them

more out into the open because the current system doesn’t deal

effectively with this group, they don’t fit into either category – being

exempted or deemed fit for work.


RUTH

Ruth had lived in Department of Housing accommodation with her daughter for many years. She was known to local mental health services, but did not have a diagnosed mental illness. She did not believe she had a mental illness and declined any assistance offered by the local mental health service. Ruth saw her GP regularly and they made sure she was safe and treated her with antipsychotics as she had a long history of paranoia and delusional ideas. She trusted her GP. Ruth was on Newstart and was breached because she did not comply with the new compliance regime. She tried to resolve the matter but became confused with the new system and this further exacerbated her paranoia. Ruth reported that Centrelink was not helpful because they kept telling her different things and she became confused and disorganised. Ruth was breached and did not receive payments for eight weeks. She did not pay her rent or bills and was evicted from her housing. Ruth came to our service because she was homeless and had no money to buy food. While she was here she was suspicious of us and refused to see the local mental health service and was reluctant to let us help her with Centrelink. She had no insight into her situation especially her need to see a mental health team. We did not make her as we wanted her to stay with us and trust us as we did not want her to remain homeless. While she was here we tried to help but she left before we could, she went out one day and never came back. No one knows what happened to her or if she was ever able to sort things out. It is likely that she is now homeless, whereas before these changes she had an income and housing.


The research on suicidality and demoralisation in regard to welfare

reform in Australia, found that poor mental health and suicidal

behaviour were common amongst income support recipients

(Butterworth et al, 2006). Butterworth et al’s study investigated

concepts such as hopelessness, worthlessness, suicidal ideation,

dissatisfaction with life and reported suicide attempts. It found that

‘welfare recipients are among the most psychologically vulnerable and

this needs to be considered when evaluating current welfare and

social policy’ (Butterworth et al, 2006; 654).

The evidence clearly points to the benefits of work for people with

mental illnesses (Honey, 2004; Marrone and Golowka,1999). However,

all too often, the interviewees reported that their clients were not

receiving the assistance they needed. As a result, many interviewees

feared their clients would be further marginalised and their sense of

helplessness reinforced. When questioned about their assessment of

employment support services for their clients, interviewees summed up

their experiences as:

I’m not impressed with Government support services for my clients.

These days I seem to waste my counselling sessions with clients

preparing them for Centrelink job assessments. They’re so stressed

about all the new requirements; they often don’t understand what they

have to do, so I have to go through it all with them before I can even

begin any therapy. It’s ridiculous.



They (support services) work for some. But not for those clients who’ve

been mentally ill for a long time.


With Job Network providers, I get mixed reports, it’s quite confusing. The

information I get from Centrelink is not clear and I think Centrelink is the

only one that can make a referral. The clients report that they have

difficulty with the job Networks. We use counsellors and support groups.

I refer to Psychiatric Rehabilitation Association (PRA) they are really

helpful. CRS are good but they are very busy.

The Personal Support Program is good but the problem is that if a

person misses an appointment with PSP they can be breached, this is

not helpful. Overall, these services are not very effective in increasing

people’s economic and social participation.


The purported aim of the Welfare to Work legislation is to promote

employment, including for those with disabilities and mental health

problems. In so doing, it is very important that both assessment

procedures and service delivery fully take into account the high

prevalence of mental illness among long term job seekers. Yet,

according to some critics, the current welfare to work model of

intervention and compliance pays insufficient attention to the

importance of responding to mental illness in parallel with assistance to

resolve other health and personal barriers and employment targeted

assistance (Horn and Jordan, 2006).


Many interviewees echoed these concerns, pointing to the

inadequacy and inappropriateness of current programs and services.

Others mentioned the long waiting times and shortages of both

government and non-government assistance programs. Typical

responses were:

There’s a shortage of support programs.

(Case Manager/R N, NSCCAHS, 10 years)

Centrelink and Job Network give useless help to the kind of clients we

get.


Programs need to be improved and expanded. Clients find it daunting

to work with all this bureaucracy.


CRS is under-funded. There’s a specialist unit in Parramatta but that’s

not much use to my clients.


More than two years ago, the Human Rights and Equal Opportunity

Commission (HREOC) recommended in their report Workability II:

Solutions (2005:66) that:


‘………..there be further investigation and implementation of measures

that address the recruitment and support needs of people with mental

illness………..’

This and other recommendations were based on the high number of

submissions to the Commission emphasising the prevalence of mental

illness in Australian society and the special needs of people with mental

illness. For example, it was recommended that flexibility at all stages of

the employment process is crucial in accommodating people with

episodic mental illnesses. Other research has identified the importance

of support in the workplace in helping people with mental illnesses

undertake paid employment (Tse & Yeats, 2002).

Welfare groups, too, attest to the inadequate level of support and

training for people with disabilities when trying to enter the workforce.

According to the Brotherhood of St Laurence (2006:4), training is often

interpreted by many employment services to mean short or refresher

courses in computer use or interview skills. This type of training is neither

relevant nor adequate for people who have not been in paid

employment for some years and who suffer from mental health

problems.

Interviewees were aware of various support services available to their

clients with mental illness, including the Commonwealth Rehabilitation

Service (CRS), TAFE, STEPS, Centrelink, Job Network, Sheltered

Workshops, Psychological Rehabilitation Association, NGOs and

charities. The interviewees repeatedly emphasised how important it

was to encourage their clients to work to their full capacity. While not

all their clients were capable of participating in paid employment,

those who were, needed significant and appropriate support.


However, when asked about employment support programs and

government assistance schemes, many of the interviewees expressed

similar concerns to those expressed by the Brotherhood of St Laurence

and other welfare groups:

There are not enough programs to support these people into

employment. There are new barriers for people trying to get into

work…...they can only do limited courses of six months because of the

new work first rules. That sort of stuff is not going to help the kind of

clients we get here.


There are specialist mental health NGOs in the community that provide

housing support, employment support, help with income. The Welfare

Rights Centre provides help for people who have difficulties dealing

with Centrelink. CRS tries to get people with disabilities into

employment. But when people leave hospital, they often fall into a

vacuum, so not in touch with what’s available.


It’s disappointing for my clients when nothing comes of the job

assessment process and all those programs they have to go through.

There are letters from Centrelink saying clients are capable of 15 hours

work per week, when I don’t think they are. But my views aren’t

considered. Under the new system they have to go through another

three - four months of assessment, at taxpayers expense. In my

experience, they don’t ever end up getting jobs.

(Community Mental Health Nurse, SSWAHS, 16 years).


My clients want to get back to work, but they need support. They don’t

need Centrelink sending them letters every couple of weeks about

activity tests.


The interviewees explained that if their clients’ Centrelink assessment

indicated that they were not ready to participate in employment

assistance, they were usually referred to the Personal Support Program

(PSP). Alternatively, an additional assessment would be done to assess

any mental illness, permanent disability or incapacity which often led

to placement on the DSP and the option of participating in disability

open employment services. Interviewees nominated the Federal

Government’s PSP as the most effective program because of its range

of services including assessment, counselling, personal support, referral

and advocacy, practical support and transition. Another advantage

mentioned was the on-going nature of the service, which gave clients

up to two years assistance. Furthermore, the Federal Government

allocated an additional 29,000 places in the Personal Support Program

as part of the new Welfare to Work changes. Those interviewees who

had direct experience of the Personal Support Program, commented:

There are some good Government support services eg Personal

Support Program. Clients can go on it for up to two years, which is

good for them. The only problem is that there are long waiting lists.


There are some good support programs eg Personal Support Program

has some really useful programs. But it’s getting more difficult to get

people into work when they don’t put in the effort….this is because the


system is very onerous now. There’s a lot of pre-work and appointments

required of people. They feel like they’re being made to jump through

more hoops for no purpose. It’s a frustrating process.


However, there were some dissenting voices:

There are some job agencies, which are more helpful than others.

Some of my clients have been able to access computers and have

minimal training, but that is only a few. The Personal Support Scheme is

not necessarily helpful to some of my clients, but they have this

imposed upon them. They must see their Personal Support worker every

two weeks. Clients find this yet another appointment they need to

attend.


I think we’ve got a long way to go with providing assistance to people

with mental illness and on income support. It’s not producing the results

we hoped for. Economically, I think the clients are becoming worse off.

With social participation, we try to provide a consumer network, have

a meeting every month, encourage people to join clubs, get involved

in the community. But there’s still incredible stigmatisation because of

their mental illness.


PSP is a waste of money. There needs to be services provided to my

clients post-employment, this is when problems can arise for them. In


my experience the CRS comes closest to providing this necessary on-

going support.


A number of the interviewees were critical of their recent and

increasingly frequent, dealings with Centrelink. Some indicated they

often had to accompany particular clients who were not capable of

dealing with Centrelink by themselves. One rural mental health worker

stated:

In the last few months I’ve had to go down to Centrelink more and

more often with my clients. Partly it’s because they are so strung out,

convinced they won’t be able to get any money and therefore won’t

have anything to live on. But it seems to me the bureaucracy is getting

more complicated, I often can’t make any sense of what Centrelink

staff are saying to us. This situation is really adversely affecting clients

and their families.

(Clinical Nurse Consultant, Rural, 4 years)

Other interviewees indicated it was rare to find specialist Job Network

services for people with mental health issues. More than half the

interviewees commented that the Government’s generic job support

services (Job Network) were not effective in helping clients who had

mental health problems. These clients required specialist employment

assistance and assessment by specialist staff to help them prepare for,

find and retain jobs in the open labour market. A range of their

comments were:


I have a client who will be capable of doing a job eventually, but the

system says he has to lose his disability pension first. That’s ridiculous; he

needs it while he gets better and prepares himself for work. All very

gradual…there’s no-one in the system who seems qualified to

understand this.


Some people need non-conditional income security and the biggest

group needing this is clients with mental illness. They also need to deal

with bureaucrats who understand about mental illness, particularly the

episodic kind.

(Case Worker , SESIAHS, 9 years)

The most effective way of getting people with mental illness to

participate is to make it voluntary. Our current approach of coercion

won’t do it.


Centrelink’s job is to ensure that vulnerable people have income

support. But income is now less secure than it was because of

conditionality.


While acknowledging that a small proportion of their clients were

unlikely ever to be capable of paid work, all the mental health

professionals agreed that appropriate employment provided

enormous benefits for clients. Some of the benefits interviewees


reported were improved self-esteem, increased well-being, a sense of

purpose, independence and participation in society. Clearly, greater

levels of employment assistance, integrated and ongoing support are

required to ensure more clients with mental health problems can

overcome barriers and participate in the paid workforce. Most of the

interviewees considered that the current level of employment support

was inadequate to achieve this goal.

Their view was reinforced by one welfare commentator who stated:

The effectiveness of the current suite of employment programs at

working with these client groups (parents and people with

disabilities) is constrained by a lack of resources across the major

employment programs. Eligibility for Intensive Support

Customised Assistance (ISCA) in Job Network has been

tightened. No additional resources have been……provided to

the Work for the Dole program to work with these client groups

(Smith, 2006:9).

IMPACT ON MENTAL HEALTH PROFESSIONALS

The phenomenon of mental health professionals’ roles and

responsibilities being impacted by the Work Choices and Welfare to

Work reforms emerged as the third major theme identified in our

research.

When the twenty-two mental health professionals were asked whether

they had experienced any change to their jobs in the last 12-18

months, most acknowledged they found their work more demanding

and challenging. While the interviewees nominated a range of factors


that had impacted their jobs and the way they worked, there were

three main reasons that were repeatedly mentioned. These were;

• a heavier, more complex workload

• having to liaise with Centrelink for clients

• spending more time analysing legislative changes and re-

assuring clients.

In addition, a proportion of the mental health professionals reported

that their sense of personal well-being had been adversely affected as

they grappled with the Government’s new policies. They most

commonly reported feeling greater levels of stress and frustration

arising from new job demands, anxious clients and a lack of resources.

Not all the mental health professionals interviewed considered that

there had been an effect on their health and well-being since the

implementation of new policies and procedures. Some indicated their

jobs had always been stressful because of the nature of the work and

the clients they dealt with. Some interviewees commented they were

accustomed to adjusting to new legislative requirements and the

demands of the bureaucracy. Change was inevitable and on-going

indeed it was ‘all part of the job’ of mental health professionals.

Heavier, more complex casework load

The new laws have meant that I have had to be more flexible with my

appointments; I’ve had to change my hours of work and I’m doing a

lot more advocacy for my clients. I’ve also had to contact Centrelink a

lot more, and on one occasion, I had to visit their office. I do not speak

to junior staff at Centrelink – I only get results when I talk to a senior

person. I’ve had to be more vigilant in making sure my clients are able


to work, and are not being forced. Overall, I have to do more work,

chasing up more people.

(Psychiatrist, non NSW based,16 years)

Interviewees reported the new Government policies meant more

complex systems and more regulation for clients. For example, there

were now several types of Newstart Allowance, with different

conditions according to the age, health and parenting status of the

recipient. Mental health professionals reported they often had to help

their clients negotiate their way through these new procedures and

requirements.

I now feel I have to advocate a lot more. Before this new system, I

would not feel I had to attend Centrelink and could do all my

advocacy on the phone. This is not the case anymore. It’s more

important that someone goes with them (the client) – the system is

much more complex and confusing.

I feel more worried about clients and what will happen to them. I think

they are being punished for having a mental illness or being homeless. I

also feel like I, personally, have to know a lot more about Centrelink.


I’ve found that I have to spend more time trying to prove things and

get more support for clients; more time trying to advocate for them. A

lot more of my clients have become unwell because of the pressure

that’s put on them………..there’s constant pressure on them, letters

that are confusing for them.



Under the new system everything at work is more time-consuming,

intense and mandatory.

(Community Mental Health Nurse, SSWAHS, 16 years)

Welfare to work changes is a massive overhaul. Essentially biggest

change since the system started……..so more of my work is now

devoted to client advocacy rather than case work. Consequently, it’s

now a more stressful job.


It’s (the new legislation) made me prioritise employment and welfare

issues for clients.


What’s really sad is that Centrelink has lost specialist staff, disability

officers, who had expertise in dealing with clients with mental illness.

They did a tremendous job, but their positions have gone. It’s a shame

and makes it more frustrating for our clients (with mental illnesses) and

this in turn impacts on us.


I have noticed that my workload has increased because clients are

coming in asking for certificates more often and Centrelink want more

paper work. I find I am doing more welfare work, because we don’t


have any welfare workers I seem to be picking up more and more

work.

(Clinical Nurse Consultant, Rural, 1 year)

Having to report to Centrelink every 2 weeks and feeling fearful about

possible breaches, eg withholding income, severely impacts on the

mental health of clients. People are worrying unnecessarily sometimes

about these changes. They have made a big difference to our clients

and as a result we now have to manage them.


I think when clients are expected to negotiate with Centrelink, I get a

sense that they are overwhelmed which increases their anxiety – and

all adds to our workload.


It’s more and more difficult dealing with clients with behaviour

problems and mental illness. The front-line level is particularly difficult.

You have to recognise when clients should be referred.

(Case work Co-ordinator, SESIAHS, 9 years)

Liaising with Centrelink for clients

As discussed previously in this report the mental health professionals

interviewed reported a huge rise in their clients’ stress and anxiety levels

because they did not fully understand the new welfare system.

Frequently, as a direct consequence of this they found themselves

having to liaise with Centrelink on their clients’ behalf about


administrative procedures such as social

security debt, correct rate of payment,

no payment penalties and job capacity

assessments.

In the last few months there have been

big content changes. Welfare to Work is

lots of new content, plus dealing with

Centrelink has become more

complicated. It’s very rarely

straightforward now because of the

structural and cultural change. Clients’

matters appear more complicated.

Recently I’ve noticed a change in the

clients I see. There’s more fear and

anxiety, sometimes they’re open about

this, sometimes not. They particularly fear

having to deal with Centrelink. A lot of

clients with mental illness don’t disclose

(their condition) which can make it tough

to deal with Centrelink; difficult for us too,

so we tend to target people in Centrelink

who are more senior, more aware. All this

takes a lot of time ….and it’s getting

worse.

(Education/Liaison Officer, SESIAHS, 8

years)

VERA

Vera is in her late 50s and has schizoaffective disorder. She lives with her family and up until two years ago worked but relapsed at work and was terminated. Vera is now on the DSP. Prior to 1 July 2006 she was able to work casually when she was well and understood the system. Her husband is near retirement and was working. She did not tell Centrelink and was confused about all of the changes to Welfare to Work. Because of the changes she did not tell Centrelink how much money her husband earned and as a result was fined. She has become very anxious and needy, she rings me constantly and frequently attends the centre without an appointment. Before this she was independent and worked casually. She is now scared of Centrelink and I think they are making her ‘jump through hoops’. She cannot understand why she was fined. She did not mean to break the rules and this has impacted negatively on her mental health.


We have to be a lot more proactive in advocating for our clients with

Centrelink. Our clients don’t have a voice, they just cop it, so we have

to do it for them. All these new requirements are adding to our

workload.


Clients’ anxiety levels have increased around their Centrelink

payments. They get really worried about having to go in for interviews,

be assessed, so we spend a lot more time coaching them.


Recently there’s been a huge increase in raising issues with Centrelink

or DEWR. I spend much more of my time dealing with issues around

how people are coping with Welfare to Work and trying to find

solutions for people who don’t fit into the parameters which the policy

department has set for Centrelink to implement.


I am now having to spend an enormous amount of time liaising with

Centrelink on behalf of my clients – who have to be there with me. I

feel a lack of control in my job. Once I used to be able to refer these

clients on to other, specialist service. Now everything has to go through

Centrelink. It’s very frustrating and stressful.


Increased time spent analysing impact of legislative changes and reassuring clients

Many interviewees reported they were still grappling with the welfare to

work reforms and their significance for clients. As with any change, this

was proving to be a very time consuming exercise, not helped by


having to simultaneously reassure clients. Some typical comments

were:

The main challenge is that we seem to be spending most of our

working time understanding and analysing the changes under welfare

to work, then we have to assess the impact of these changes.


The demands of families, restrictive nature of the Mental Health Act

and keeping up with the changes are big challenges in recent times.


It’s getting harder trying to support clients in relation to security of

income support. There’s less we can do, fewer people we can call on.

We used to have access to disability officers in Centrelink, but their

roles have been abolished .It’s all become much more complex for

our clients, which makes them much more anxious – and we have to

deal with that now.

(Director, SSWAHS, 7 years)

Welfare to Work is all about getting people off the DSP. It seems quite

punitive…putting responsibility back on to the individual (and the

family) to be a good citizen. That’s not easy to accept when you’re

dealing with such vulnerable clients.



There’s more bureaucracy, more questions from the top, more

expectations from the community. Clients don’t always get the service

they’re entitled to……all this has to be worked through with our clients.


I think the new legislation has made our organisation look really closely

at what it’s doing around welfare and work. …put it higher up our

agenda. We’re starting to hear a lot of anecdotal stuff from our

members. Things like: ‘it’s just not fair’, ‘ it’s a disincentive to work’,

‘people are afraid of losing their pension’

(Senior Policy Officer, SESIAHS, 12 months

Not having enough time in the day to get the job done and feeling

under-resourced; wanting to do the best for your clients but feeling

that is very challenging with limited time.


Detrimental effect on mental health professionals’ personal wellbeing

Some interviewees stated that the new industrial relations and welfare

to work climate had definitely negatively impacted on them. Typically,

they reported feeling pressure to do more to support and advocate for

their clients while, simultaneously, having to grapple with the changes

to the welfare system. Inevitably, these factors combined to have an

adverse effect on some interviewees’ personal sense of wellbeing.

Some examples included:


Now it’s more work, more pressure, so more stress. Things aren’t

happening to assist our clients, so this makes you feel very frustrated.


I feel I’m under pressure all the time. I’m met with suspicion. I feel angry,

frustrated, but mostly tired all the time.


I find that I am more irritable and extremely tired. I find the changes

very stressful. I have noticed an increase in my workload.

(Clinical Nurse Consultant, Rural, 1 year)

Perhaps because the new legislation is so recent, it was difficult for

some interviewees to directly attribute any deterioration in their health

and wellbeing to the changes. As mentioned, other interviewees

indicated their jobs had always been stressful and that this had not

changed over time.

Well, it’s all part of your job isn’t it? We’re working with vulnerable

people. Although, the one thing I have noticed with the recent

changes is that I don’t have as much time to spend with my clients

picking up clues, seeing how they’re doing with Centrelink. That makes

it all harder because I don’t have the chance to train my clients in how

to deal with Centrelink – it’s all more complex now too. That adds to it.



I’m OK, I’ve had years of experience. But I see the impact on my less

experienced colleagues. They’re really struggling with work overload.



OBSERVATIONS & CONCLUSIONS It’s a wonderful thing to get people back to work, but the Government has

to consider social justice principles in this process. To blame the individual

is not just unreasonable, it’s cruel. I think we’ve developed a cruel system

with this current JCA.

Director, SESIAHS, 7 years

his report presented the experiences of twenty-two mental health

professionals in regard to the way they and the clients they

manage have fared under the recently implemented industrial

relations and welfare to work legislation. Although participants

experience varied, three common themes emerged, namely, the

heightened anxiety of clients who had mental illnesses, as a result of

the changing income support arrangements, the new job capacity

assessment procedures and the prospect of seeking and maintaining

employment; the lack of employment support for clients; and the

impact on mental health professionals, notably their increased

workload and decreased wellbeing.

T


Nineteen of the interviewees came from the Sydney metropolitan area

and three from rural and regional areas of NSW. The predominance of

city participants reflects the difficulty the researchers experienced in

accessing people from non-metropolitan areas. It was not a matter of

physical distance being a barrier for research participation, but rather

that people from more remote areas were reluctant to participate in

the research. When questioned about the reasons for this they

indicated they were fearful of speaking out in case they jeopardised

their jobs or displeased their employers. Other organisations and

individuals approached stated they were supportive of recent

government initiatives and did not wish to participate in research

potentially critical of these policies. Many of the twenty-two individuals

who did agree to be interviewed stressed their need for anonymity.

One of the participants’ in the research stated ‘It is not a bad thing for

people to work…. People need to be encouraged to work, not forced.

…..’. This sentiment was expressed by all of our participants, and none

of them disputed the benefits of encouraging and supporting their

clients to participate in the work force. However, as this quote illustrates

it is the level of coercion that the Federal Government has placed

upon those already vulnerable, to meet the compliance regime that

has had a negative impact on some of the mental health professionals

and their clients. The consequence of not complying is having your

payment cancelled for eight weeks. The Federal Government has

already withheld $27.2 million from the pockets of the most vulnerable

Australians since July 2006 (Rights Review, September 2007; 3).

This report has identified and described some of the concerns mental

health professionals have about the reforms on the mental health of

their clients. Currently, Job Capacity Assessors do not consider the


reports and recommendations from treating teams such as case

managers and psychiatrists. As one of the participants stated; ‘the

current job assessment system is incompetent because it does not

guarantee the integrity of the process………..expert medical opinion is

ignored by Centrelink’. Ignoring medical evidence and making

inappropriate referrals to job agencies will not increase the social and

economic participation of people with a mental illness who are

receiving income support.

The issues for people with a mental illness are complex. These reforms

do not factor in the complexity of their needs and thereby enable

them to participate in the work force. This notion that, ‘any job will do’,

is not reasonable or practical. The participants identified that their

clients are experiencing an increase in their anxiety levels as a result of

these reforms.

The findings in this report reveal the human cost of these reforms. While

the Federal Government focuses on the quantitative data and

economic implications of these polices, we have chosen to investigate

the everyday experiences of mental health professionals and their

clients. After all, we are not just a configuration of facts and figures,

and the negative effect of these reforms on the lives of those already

marginalised and vulnerable cannot be ignored.

We recommend that the Federal Government review the current

reforms and:

1. Undertake qualitative research investigating the issues for people with a mental illness who are receiving income support

2. Collect data on the new compliance system to review its

effectiveness


3. Ensure the transparency of the reform process and the data are on the public record

4. Consult consumer groups and other stakeholders to identify the

issues for people with a mental illness who are receiving income support

5. Provide training in mental health for Job Capacity Assessors

6. Review the current system so that the reports of treating

clinicians are included

7. Review the Welfare to Work legislation, notably eight week no payment period


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APPENDIX 1

RESEARCH QUESTIONS Background information 1.What is your job title?

2. Where do you work? (organisation and location)

3. How long have you been in your current position?

4. What are your main job responsibilities/duties?

5. Broadly, what have been the main challenges of your job in the last 12-18 months?

Knowledge of legislation 6. What do you know about the recent new Australian laws in the areas of industrial relations and welfare? (Prompt: Workplace Relations (WorkChoices) Amendment Act 2005 and Welfare to Work and Other Measures Act 2005)

Effect of legislation 7. Although this legislation is very recent, do you think it has had any impact on (indicate which law is impacting):

(a) the way you do your job. Can you give me some examples? Extra responsibilities?

(b) the clients you see

8. In what ways, if any, have the legislative changes affected your personal wellbeing at work?

Details of clients 9. Approximately what proportion of your clients receiving income support would have a mental illness?

10. What kinds of mental illnesses do they commonly have?

11. In the last 12-18 months (ie since legislation enacted) have you noticed any change in the mental health of these particular clients?

12. If so, could you describe these changes?


Job Capacity Assessment of clients 13. How are the new job capacity assessment requirements different from the previous system?

14. What is your experience of the effect of these new assessment requirements on your clients?

15. Do you have any comment on the current system of job capacity assessment compared with the previous one?

16. The Federal government claims ‘Welfare to Work is getting record numbers of Australian men and women who have the capacity to work into jobs’. Isn’t that a good thing?

Assistance for clients 17. What assistance is available for your clients eg govt and other training programs, mental health services?

18. In your opinion, how effective is this assistance in increasing the economic and social participation of clients with mental illnesses?

19. Do your clients need more support from government and other groups? Examples?

Case study 20. Is there one of your clients on income support and with mental illness who stands out for you as being particularly vulnerable during the last 12-18 months? Without disclosing personal details and information, how would you describe their situation?


APPENDIX 2

LIST OF INTERVIEWEES Laura (F)

Case Worker, South Eastern Sydney Illawara Area Health Service (SESIAHS), 9 years

Marian (F)

Education/Liaison Officer, South Eastern Sydney Illawara Area Health Service (SESIAHS), 8 years

Robyn (F)

Community Mental Health Nurse, Sydney South West Area Health Service (SSWAHS), 16 years

Tom (M)

Policy Officer, South Eastern Sydney Illawara Area Health Service (SESIAHS), 4 years

Steven (M)

Case Manger/RN, Northern Sydney Central Coast Area Health Service (NSCCAHS), 10 years

Jane (F)

Director, South Eastern Sydney Illawara Area Health Service (SESIAHS), 7 years

Scott (M) Consumer Advocate, Sydney South West Area Health Service (SSWAHS), 7 years


Rebecca (F)

Senior Policy Officer, Mental Health, Sydney South West Area Health Service (SSWAHS), 4 years

Sara (F)

Occupational Therapist, South Eastern Sydney Illawara Area Health Service (SESIAHS), 10 years

Sigrid (F)

Clinical Psychologist, South Eastern Sydney Illawara Area Health Service (SESIAHS), 7 years

Christine (F)

Registered Nurse Crisis Team, Sydney South West Area Health Service (SSWAHS), 7 years

Senya (F)

Manager, Crisis Accommodation, South Eastern Sydney Illawara Area Health Service (SESIAHS), 4 years

Pauline (F)

Community Nurse, Mental Health, Sydney South West Area Health Service (SSWAHS), 6 years

Phillip (M)

Clinical Nurse Consultant, South Eastern Sydney Illawara Area Health Service (SESIAHS), 2 years

Angela (F)

Registered Nurse, South Eastern Sydney Illawara Area Health Service (SESIAHS), 5 years

Melanie (F)

Psychiatrist, non NSW based, 16 years


Alice (F)

Clinical Nurse Consultant, Sydney South West Area Health Service (SSWAHS), 9 years

Brad (M)

Social Worker/Counsellor, Sydney South West Area Health Service (SSWAHS), 7 years

Melissa (F)

Social Worker/Case Manager, South Eastern Sydney Illawara Area Health Service (SESIAHS), 18 months

Joe (M)

Clinical Nurse Consultant, Rural, 4 years

Alana (F)

Clinical Nurse Consultant, Rural, 1 year

James (M)

Clinical Nurse Specialist, Sydney South West Area Health Service (SSWAHS), 6 years


APPENDIX 3

INFORMATION SHEET The New South Wales Nurses’ Association is investigating the impact of the Welfare to Work and Work Choices legislation on mental health consumers and others. We would like to interview service providers such as case managers (both government & non-government), general practitioners (GPs) and mental health professionals.

The overall aims of the project are to:

Investigate whether the current reforms have had an adverse effect on the mental health of people receiving income support;

Identify the changes to the type of work and workload of services providers as a result the legislation.

As a participant you will only be required to meet with the researcher on one occasion. Depending on your preference, the interview will be conducted at the NSW Nurses’ Association or your workplace. No other person will be present during the interview. The interview will be taped and it is anticipated it will take approximately 60 to 90 minutes. You are free to withdraw from the project at any time.

Your confidentiality is assured. Under no circumstances will your name, address, workplace or phone number be published or shown to anyone apart from me or Kerry O’Neill. When documenting the findings your name or any other details will not be used. All information will be held in a locked filing cabinet.

If you would like more information or are interested in participating, please contact me, Christie Breakspear on [email protected] or 0417 069 026. You can also contact Kerry O’Neill Professional officer at the NSW Nurses Association on [email protected] or 8595 1234.


Documents

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