More than a mental health issue:broadening the concept of ‘work capability’ through qualitative secondary analysis of claimant narratives

This article offers a perspective on the policy problem of rising mental-health-related economic inactivity and associated health and disability benefits claims in the UK. Rather than engage directly in debates about whether these health problems are ‘real’, or if and how health assessments should be reformed, we ask a more fundamental question about the way the problem of economic inactivity is being represented in policy. Drawing on Bacchi’s ‘what’s the problem represented to be?’ approach, we consider whether the important but increasingly dominant focus on mental ill health as the cause of inactivity is obscuring understanding of the broader set of factors that simultaneously constrain people’s capacity for work. Through secondary analysis of a large qualitative longitudinal dataset, we illustrate how a multiplicity of structural, economic, social and relational factors shape and constrain people’s capacity for work. Participants gave rich, nuanced and complex accounts of their capacity for work, which revealed that mental distress is just one dimension. However, placed within a welfare system that takes a narrowly medicalised approach to assessing work capacity, coupled with a punitive regime of conditionality and sanctions for those not meeting this criteria, people’s difficulties retaining and regaining work were not comprehensively acknowledged, and mental distress inevitably became the primary lens through which their difficulties were bureaucratically legitimised and responded to. Throughout the analysis, we emphasise that people’s distress is real, genuine and often severe, but it is rarely the whole story of what is blocking their pathway to fulfilling, sustainable employment.