Mental illnesses are not an ‘ideal type’ of disability for disability income support: Perceptions of policymakers in Australia and Canada

Abstract

Aim: This article aims to explore how policymakers conceptualise a person suitable for disability income support (DIS) and how this compares across two settings – Australia and Canada. Methods: A constructivist grounded theory approach was used; 45 policymakers in Australia and Canada were interviewed between March 2012 and September 2013. All policymakers are or were influential in the design or assessment of DIS. Results: Results found that the policymakers in both jurisdictions define a suitable person as having as an ‘ideal type’ of disability with five features – visibility, diagnostic proof, permanency, recognition as a medical illness and perceived as externally caused. Many of the policymakers described how mental illnesses are not an ‘ideal type’ of disability for DIS by juxtaposing the features of mental illnesses against physical illnesses. As such, mental illnesses were labelled imperfect disabilities and physical illnesses as ‘ideal type’ for DIS. Conclusions: The rise of DIS recipients has divided the once protected ‘deserving’ category of the disabled into more (‘ideal type’ of disability) and less deserving (imperfect disability). Such conceptualisations are important because these categories can influence the allocation of welfare resources.

Gatekeeping disability income support: A conceptual model

“…Informants spoke about five characteristics that created an ideal type of disability: visible, clear proof, permanent, easily recognizable as a medical illness, and externally caused. Given the complexity of this concept, I explore it further in a separate article (McAllister, ).…”

“…Another policy implication is that disability income support policy‐makers need to recognize the broad spectrum of disabilities. Disability income support programmes were designed with “boxes to be checked” (Lightman, Vick, Herd, & Mitchell, ) and arguably more for identifying physical illnesses—ones that are visible, provide diagnostic proof and at least, in theory, are more permanent in nature—than mental illnesses (McAllister, ) and some episodic somatic illnesses (Lightman et al, ; Stapleton & Tweedle, ; Vick & Lightman, ). The conceptual model illustrates the tension between having a binary programme like disability income support and a nonbinary category of illnesses like many mental illnesses.…”

“…Gatekeepers want to ensure that disability income support flows to recipients who are still considered disabled over a long period of time. However, this certainty is not always possible with many mental illnesses due to their fluctuating nature and invisibility of symptoms (Gewurtz et al, ; McAllister, ). As such, the shift from a medical model to a capacity (Jongbloed, ) may not be as important as shifting from a policy designed to identify persons with physical illness to a gate that better captures the nuances of mental illnesses and other episodic disabilities.…”

“…Others focus more on who makes that decision or instead describing (and often comparing) the different assessment processes (Council of Europe, ; de Boer, Brenninkmeijer, & Zuidam, ; Geiger, Garthwaite, Warren, & Bambra, ). Geiger et al () provide a classification of assessments, but the inclusion of the nuances of the definition of disability (which can create inequalities between certain types of disabilities (McAllister, )) or in‐depth details about the assessments most notably—who conducts them (Stone, )—is needed. The OECD has published many reports on disability income support, but these tend to focus on the growing size of disability income support programmes and provide high‐level comparisons (OECD, , , , ).…”

Changes in access to Australian disability support benefits during a period of social welfare reform

“…International studies suggest that where medical opinion on appropriate treatment options for a given condition differs, disability benefit applicants ability to demonstrate that their condition is fully treated may vary according to the experience, training and expertise of the assessing medical practitioner (McAllister & Leeder, 2018). People with psychosocial disabilities may find it more difficult to access benefits under policy regimes that place greater weight on provision of biomedical information to support decision making (McAllister, 2019). Increasing the administrative burden on applicants, through new practices such as requiring applicants to collate and present primary medical evidence, may have a disproportionate impact on people with cognitive, intellectual or psychological conditions (Hong, 2019; Moynihan, Herd, & Harvey, 2014).…”