Mental health: the DSP or unemployment benefits?

The government has decided against enforcing stricter criteria for the eligibility of the disability support pension, opting instead for tax breaks to entice people back into the workforce. But the problem of our dependence on welfare remains and its association with mental health problems deserves greater exploration.

Forty years ago fewer than in one in thirty working-age adults relied on welfare payments as their main source of income. The figure today is one in six. In particular, the proportion of the population on the disability support pension, DSP, has doubled since 1981.

In this month’s Medical Journal of Australia, Professor of Psychiatry, Ian Hickie, reiterates the message that mental health remains the neglected arm of health care in Australia. He notes that, at 8 per cent of the health budget, mental health expenditure accounts for around half the OECD average. One of the key targets in the report is to double the work participation for people on the DSP.

In the past 20 years the proportion of people on the DSP claiming a mental health problem has nearly doubled to around a quarter of all recipients. A third of recipients cite musculoskeletal problems. Anyone working in mental health will know that a significant proportion of people with chronic musculoskeletal pain, most commonly back pain, are likely to be suffering from a mental disorder. They are termed as being not “psychologically minded”, meaning they prefer seeing their problems in physical terms rather than face the prospect of a stigmatising mental illness. Their psychological anguish is represented through a physical ailment.

As a result, the proportion of people on DSP with a mental disorder is probably closer to 40 per cent.

While this appears consistent with a corresponding rise in mental health problems in the same period, this is not necessarily the case.

An important but perhaps neglected player in this debate is the medical doctor. They are the ones with the power to determine if someone will meet the criteria for disability. However, doctor’s groups have played little or no part in the discussion on welfare.

The bureaucratic procedure to determine if someone is eligible for the DSP is an arduous form. A doctor’s day is already filled with a mountain of regulation and red tape and another form is not taken too kindly. Furthermore, doctors are concerned with treating medical illness, not bureaucratic definitions of disability. Activities outside this realm are generally viewed as low priority.

Meanwhile, patients who are on the margin of receiving the DSP or the Newstart allowance will often ask to receive the DSP. The DSP is more generous than the unemployment benefit and there is little mutual obligation.

The sick role, however, comes with an obligation to seek and comply with treatment. The patient’s compliance with treatment is the priority for a doctor and other matters will often take second place. There are many times when giving-in to a patient’s wishes elsewhere can ensure their compliance with medication. The DSP is often one such compromise.

It should be noted there is a significant grey area when determining those who qualify for which payment. There should be no suggestion of corruption at any point.

The flipside is that 90 per cent of those who start receiving the DSP never return to the workforce. This is not a fact well known to professionals determining disability. All of my colleagues working in mental health had no idea and were flabbergasted when they heard the figure.

So for many people on the margins of DSP eligibility, there is considerable incentive to remain sick. This lack of incentive to take a more active role in society can strip them of meaning in their lives and perpetuate what may have started as mild mental illness.

A feedback loop of disability, welfare and worsening mental health is created. This is a hidden factor straining both Australia’s mental health and welfare systems. They are operating in a kind of pathological symbiosis.

Two thirds of Australia’s tax revenue is spent fulfilling welfare requirements. The disability pension is the fastest rising arm of this huge burden. Disability and mental health are inextricably linked and the rise in DSP has occurred at the same time as the growth in mental illness.

Without creating greater awareness on the part of the treating doctors about the implications of starting a DSP and a better system of transferring patients to unemployment benefits, the current system is harming those it seeks to help.