Benefit Sanctions and Anti-Depressant Prescribing: The Mental Health Impact of Social Security Reforms

This blog is based on an article in the Journal of Social Policy. Click here to access the article.

An important and highly contested issue relates to the ‘efficacy and ethicality’ of conditionality within contemporary welfare states. Across social security systems internationally, recent decades have seen a growth in the specification of work-related behavioural requirements for claimants of out-of-work benefits, which are enforced through both claimant monitoring and benefit sanctions. A central issue within this debate relates to evidence on the impacts of such financial penalties, regarding both labour market and wider effects. In this empirical research, I consider mental health impacts specifically, through an investigation of the relationship between benefit sanctions and antidepressant prescribing in the UK.

The explicit aim of sanctions policy is to increase re-entry into work for unemployed individuals, an outcome that policymakers assume will lead to a range of wider benefits for both the individual and the state. Existing evidence on labour market impacts, however, is mixed; whilst sanctions appear to improve employment re-entry for some claimants in the short-term, many stop claiming without finding work whilst there are longer-term negative impacts in terms of wages and job stability. Evidence relating to wider impacts, furthermore, is almost universally negative, where sanctions have been linked with financial hardship, homelessness and food bank usage.

A growing issue of concern relates to the mental health impacts on claimants of both the threat and imposition of benefit sanctions. In order to build upon the limited empirical research in this area, this investigation adopts a quantitative approach and considers the period of Coalition government (2010-15) in the UK, which oversaw significant changes in sanctions policy. With regards sanctions imposed on Jobseekers Allowance (JSA) claimants, for example, nearly a quarter (24%) received at least one sanction during this period, whilst rates were historically high and varied dramatically through time. Following the implementation of the Welfare Reform Act 2012, furthermore, the minimum sanction period increased from 1 to 4 weeks and the maximum increased from 26 to 156 weeks.

Due to data availability, and similar to other UK quantitative studies into sanction impacts, this investigation is limited to analysing quarterly longitudinal data at the area-level of local authorities. The key finding is that, in the post-reform period, every 10 additional sanctions are associated with 4.57 additional antidepressant prescribing items, which translates to approximately one additional person receiving treatment. This finding is robust to a variety of different fixed effects model specifications that control for differences between local authorities, and is further supported by both a falsification test and a Granger-test for reverse causality.

Importantly, this finding indicates that sanctions are associated with adverse mental health impacts as well as wider impacts in terms of public expenditure. In their review of the UK sanctions regime, the National Audit Office (NAO) conclude that the total expenditure implications for the government as a result of sanctions are unknown. Savings to the government in terms of benefits not paid due to sanctions must be weighed against administrative costs and additional support for those affected. Though difficult to specify a precise monetary figure, this research indicates that an important cost is incurred by the additional antidepressant prescriptions that result from sanctions.

Given that the research is carried out at the local authority-level, the findings motivate further investigation using individual-level data. It is an important finding, nevertheless, that the scale and severity of sanctions during the period of analysis are sufficient to have observable impacts even at the area-level. Indeed, the findings stand in stark contrast to the official position of the Department for Work and Pensions (DWP), whose ministers and officials have previously claimed that individuals ‘welcome the jolt that a sanction can give them’ and refused to investigate the relationship between sanctions and mental health.

Recent policy developments, nevertheless, are indicative of a shift in attitude by the DWP. Since 2017, for example, JSA claimants already suffering from mental health problems have been deemed to represent a ‘vulnerable’ group, and are therefore now eligible for an immediate hardship payment following a sanction, which is paid at 80% of the JSA rate. Whilst this change is of course welcome in light of this research, the findings suggest that much greater consideration needs to be given to the mental health of all claimants subjected to the threat and imposition of sanctions, as opposed to the more limited number of people officially deemed as ‘vulnerable’.

Whilst the research considers a specific period in the development of JSA sanctions policy, the findings are of ongoing relevance with regards the contemporary social security system. Punitive financial penalties, for example, form a core part of the new Universal Credit (UC), which replaces six means-tested benefits including JSA. It has recently been announced that the DWP will end the harshest three-year sanctions of UC claimants, though half-year sanctions are still in place whilst sanctioned claimants are now required to repay hardship payments. Considered more broadly, furthermore, the findings contribute to the ongoing debate regarding the ‘efficacy and ethicality’ of conditionality. In light of the mixed evidence regarding labour market impacts, and the consistently negative wider impacts observed in empirical research, it would appear difficult for any normative viewpoint to support sanctions policy in its current form.

About the author

Evan Williams is a doctoral candidate at the University of Glasgow.



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