Navigating the welfare system and mental health: clinical and ethical reflections on disability assessments

Welfare assessments can harm the mental health of neurodivergent individuals and people with intellectual disabilities, yet this remains under-recognised in clinical practice. This article integrates three perspectives: media reporting on private profit in UK disability assessments; a clinical case of an autistic man whose deterioration was triggered by Personal Independence Payment and Universal Credit reassessment; and research on the experiences of people with learning disabilities. Common themes include fear, shame, loss of agency and reactivated trauma. Psychiatrists should view welfare systems as determinants of mental health, adopt trauma-informed, neurodiversity-aware approaches and support patients through advocacy and interdisciplinary collaboration.