Zoe Hazel last worked more than 10 years ago, in the customer service department of an insurance company where the stress of constant monitoring and sales-driven targets contributed to her downward spiral into a deep mental health crisis.
Now, after years battling with severe anxiety, depression and borderline personality disorder, the 34-year-old from Kent has put her life on a more stable footing and wants to work. But she is terrified that if she says so, she could lose the benefits she relies on to pay rent and be forced to compete with better-qualified candidates for a job she might fail to hold down.
“I’m panicking just thinking about it,” she said. “I have no interest in staying on benefits for the rest of my life, I come from a very work-driven family . . . But I couldn’t start a job tomorrow. I can’t say whether I’m going to fail — I will only know if I try. I can’t take that risk.”
UK ministers say people like Hazel are those they most want to help, through reforms to a welfare system that has left some 3.5mn working-age adults trapped on health-related benefits with neither the financial incentive nor the practical support they need to enter work.
People who have spent a long time out of the workforce while in receipt of sickness and disability benefits have proved very unlikely to return. But with the bill for health-related welfare set to reach £100bn a year by the end of the decade, the government sees it as essential to reverse this trend — especially for young people near the start of their careers.
“The country can’t afford the level of resources, but we also can’t afford the waste of people’s talent that represents,” employment minister Alison McGovern told the FT earlier this month.
Plans due to be set out in a green paper by work and pensions secretary Liz Kendall this week will tackle two problems that have led rising numbers to claim health-related benefits, and fewer to come off them.
One is the perverse set of incentives built into the current system. The UK is one of the least generous countries in the world for people receiving basic unemployment benefits — which are worth less than 40 per cent of average earnings, and conditional on intensive job hunting.
People assessed as being too sick to work, or look for work, receive a much higher rate of support through incapacity benefits, which have no strings attached. At present, those who “pass” this test are rarely reassessed to see if their condition has improved or even contacted by Jobcentre officials.
In theory, someone in Hazel’s position could start work without losing her benefit entitlement, according to Anna Stevenson, a senior welfare benefits specialist at the charity Turn2us. But in practice, even being in a low hours, low stress role could be taken as proof of recovery by an assessor.

“People are terrified of getting a brown envelope saying ‘your benefits are being reassessed’ . . . There is a big trust issue,” Stevenson said.
This exacerbates a second set of problems: unlike jobless benefits claimants, who must meet regularly with work coaches, people receiving incapacity benefits who want to work get virtually no support to do so.
Officials say the government’s reforms will focus on measures to improve the help on offer and encourage long-term benefits claimants to engage with the system — without imposing punitive conditions.
But intense pressure on the UK’s public finances means ministers are also intent on making big short-term cuts in welfare spending — and will have limited resources to step up support.
Labour officials say ministers are looking at cutting up to £6bn from the annual cost of personal independent payments — the main disability benefit — by the end of the decade. On top of this, deep cuts to incapacity benefit could fund a smaller uplift in the basic rate of jobless benefit — lessening the current skewed incentives, but hitting some people hard.
“I use the benefits to get to a quality of life other people take for granted,” said Alicia Cartwright, who has brought up two children while managing bipolar disorder.
She was working more than 50 hours a week in a care home when she was first hospitalised. Since then, she has kept working in part-time admin jobs from her home in Preston — but found that every attempt to return to full-time work prompted a dangerous relapse.
Charities and think-tanks fear the reforms will further damage trust in the system, without breaking down the barriers to work that Cartwright and many others face — long waits for treatment, the need to rebuild skills and confidence, and a lack of local employers offering flexible or remote work.
“Slashing the incomes of people in this situation will fail to deliver sustainable savings,” said Tom Pollard, head of social policy at the New Economics Foundation. He also does shifts as a mental health social worker and has heard that calls to the NHS crisis line are flowing in from people worried they are about to lose their benefits.
Cutting personal independence payments, which are not means-tested and are supposed to reflect the extra costs of living with a health condition, would be especially controversial.
PIP was “that solid thing you can rely on — it really helps when your life is up and down and all over the place”, said Cartwright, who cannot drive because of her bipolar disorder, and uses the money to pay for taxis when she cannot cope with public transport, and convenience food when she cannot cook.
There is widespread support, however, for the goal of supporting people into work that would boost their mental health, as well as their income.
But Stevenson at Turn2us warned against “an assumption that if you take money off people, that gets them into work”, adding that the real issue was a lack of flexible jobs.
Hazel is dubious that a government promise of “tailored and personalised” support from work coaches, announced last week, will amount to more than help with a CV and interview preparation. “If you’ve been out of work for a decade there’s a lot more you need,” she said. “I don’t have the qualifications, the experience employers are looking for.”
Cartwright meanwhile worries that benefits cuts will force her to overwork, at the risk of triggering a major relapse. “If they decide what I can do on a good day is what I can do every day, I’ll lose a huge chunk of income,” she said. “I’m a good worker when I’m working. I can’t do too much of it.”
Data visualisation by Amy Borrett