House of Commons - Social Security - Appendices to the Minutes of Evidence

Select Committee on Social Security Appendices to the Minutes of Evidence

APPENDIX 11

Memorandum by MIND (NATIONAL ASSOCIATION FOR MENTAL HEALTH)

Summary

Mind welcomes some of the objectives behind the single work-focused gateway, for example to improve people's prospects of working, simplify access to the welfare system and provide information about services. However we are very concerned about the overriding emphasis on work in combination with the compulsory nature of the interview, especially for people who are claiming benefits on the basis of incapacity for work.

Mind believes that people who are eligible for incapacity related benefits should be given every opportunity to receive advice about work prospects on a voluntary basis. We are not opposed to people having to give face-to-face evidence in support of their benefits claim but we do not believe that people should be given the impression that they are expected to work when that would be inappropriate or even damaging. Many people with a mental illness diagnosis will feel pressurised and intimidated and this may be very detrimental to their mental health. If work-focused interviews are to become a requirement within the claiming process it must be recognised that some people will need support to cope with them and others to be exempted.

The pilots, and any eventual national scheme, need to be clear about the purpose of the interviews and communicate this effectively to claimants. The personal advisers (and in the case of awareness training, "registration and orientation" staff) will need to have:

— knowledge relating to employment; specialist agencies providing employment support, the range of benefits and how they interact, and the impact of work-related activities on benefit entitlement.

Design and evaluation of the pilots and training of personal advisers should involve disabled people including people who experience mental distress, and those with experience of claiming benefits. Evaluation of the pilots should give weight to the views of claimants, their experience of the process and satisfaction with the outcome.

Introduction

1. Mind is the leading mental health charity in England and Wales. We work for a better life for people diagnosed, labelled or treated as mentally ill and campaign for their right to lead an active and valued life in the community. Through the experiences of individual Mindlink and Diverse Minds members, and those contacting our national and local information, advice and advocacy services, we are acutely aware of the importance of benefits and benefit regulations in people's lives.

Concerns about the Single Work-focused Gateway

2. People who experience mental distress face many barriers to education, training and employment, as set out in Mind's evidence to the Department for Education and Employment's Inquiry into Opportunities for Disabled People. Mind believes that barriers to people's participation in employment should be removed and has no wish to see people who experience mental distress "written off" in employment terms. In principle, personal advisers could bring a much-needed individual approach provided that they had appropriate training, qualifications, qualities and resources. Mind therefore welcomes the intention to improve people's prospects of working, simplify access to the welfare system and provide information about services. However we have serious concerns about the single work-focused gateway as the means to this.

3. In particular we are concerned about the overriding emphasis on work in combination with the compulsory nature of the interview. We are not opposed to people having to give face-to face evidence in support of their benefits claim. However, whatever the reassurances that no one will be compelled to take up work or training, making a work-focused interview part of the claims process gives the message that people are expected to work, irrespective of how inappropriate or damaging that would be.

4. The following effects can be expected:

— people with mental health problems may feel under pressure to explain and justify their incapacity to the adviser—distressing in itself—and then have to repeat this when they have the personal capability assessment (all work test—itself an ordeal);

— claimants may be steered into ill-advised courses of action if the adviser does not understand their needs, or if they think that the advice they are given has to be followed.

5. Mind believes that people who are eligible for incapacity related benefits should be given every opportunity to receive advice about work prospects, but on a voluntary basis. This should allow them to access advice and support on employment issues at the time when it would be most helpful to them, rather than at a prescribed time. If work-focused interviews are to become a requirement within the claiming process and during benefit entitlement it must be recognised that some people will need support to cope with them and others to be exempted. Access to advocacy is essential—people should be encouraged to bring someone with them to the interview if that would enable them to participate or to understand and retain what has been said.

Help needed to get a Job or Improve Work Prospects

6. If more people who experience mental distress are to be enabled to work the measures that are needed include job creation; employment support services; advice and support targeting employers; greater flexibility in relation to earnings and benefits; strengthened civil rights; and advice and support for self- employment, cooperatives and small businesses.

7. Much of this goes beyond the individual level. Indeed there are factors the individual cannot influence for example:

— reluctance of employers to hire (whether because of the nature of the impairment and their beliefs about it or lack of access to advice on how to make adjustments, break in work record, or lack of recent experience or qualifications);

— uncertainty of their health.

8. However there are forms of assistance that can be offered to people who are looking to re-enter the world of work after time away because of mental health problems:

— exploration of aspirations and ambitions;

— careers guidance;

— opportunities to try work without risking benefit entitlement;

— re-building confidence;

— emotional support;

— help in thinking through and/or asking for workplace adjustments;

— support in developing personal strategies to avoid recurrence of mental health problems;

— benefits advice including "better off" calculations;

— support and advice for self-employment.

9. Some form of brokerage or advocacy vis a vis employers—where an agency finds the job, makes the introduction and recommends the prospective employee - may be an important part of successful re-entry to employment. People need the chance to try things out safely, and not lose security of benefit income before they are confident of their employment. The longer linking rule introduced in October 1998 is very helpful in this respect. Other measures are needed to enable those people to reach their potential who cannot commit to regular employment because of their fluctuating health.

10. To the extent that these functions are beyond the scope of the personal advisers conducting gateway interviews, links to other agencies and programmes that can give the time and expertise are essential to the gateway's success.

Characteristics of the Pilots

Personal advisers

11. Critical to the success of the pilots therefore are the quality of the personal advisers and the quality of the options to which they can guide clients. Personal advisers will need:

— good disability and distress awareness to maximise the chance of a productive interview that is sensitive to the claimant's needs;

— knowledge of the local labour market, employment and education/training opportunities, career routes;

— knowledge of specialist agencies that could offer the kind of longer term support that mental health service users are likely to need;

— knowledge of the range of benefits and how they interact;

— knowledge of the impact of work-related activities on benefit entitlement.

Distress awareness

12. Personal advisers will need awareness of the impact of mental distress on capacity for work, and indeed capacity to be interviewed. However helpful the interview is intended to be it is likely to be perceived as a threat and pressure by many people. Those being interviewed who have a mental illness diagnosis may be at very different stages in relation to recovery or rehabilitation. Advisers should respect people's own strategies for getting or staying well, recognising that the things people do with their time—and their avoidance of doing other things—may be helping them to maintain a fragile state of relative well-being.

13. Explaining the origins and effects of a breakdown can be extremely distressing, stirring up powerful feelings and entailing a degree of personal exposure not normally expected in everyday transactions outside therapeutic settings or other medical interviews. As the personal adviser interview is not assessing incapacity for work (another stage in the process) advisers should accept people's account of the extent of their incapacity. They need to explore if appropriate what the person might be able to do and what support would make it possible, rather than probing or questioning the person's limitations.

14. People with mental health problems can have good days and bad days, something that is significant both for work prospects and the work-focused interview itself. Claimants may have their own strategies for regaining employment, and personal advisers need to acknowledge and work with that. They may have a clear idea of what kinds of work would be damaging to them. Some people will feel guilty or inadequate because they are not working and this can only be compounded by any implication that they are not trying hard enough. They may need support to retain or re-gain a sense of their long term employability without feeling harassed or pushed too soon into job search.

Other issues

15. Mental distress affects people of all walks of life. In a Mind survey about people's use of disability benefits we asked about education and employment. The types of education respondents were engaged in or wanted to access ranged from literacy classes to postgraduate studies, taking in a range of different vocational subjects. Personal advisers will need knowledge of the range of opportunities locally that are relevant to the individual's skills, experience and hopes.

16. There is a wide range of agencies and programmes providing supported training or employment geared to particular needs, although their coverage around the country is patchy. Personal advisers will need knowledge of the provision locally that they can access for their clients or tell them about.

17. The interview does have the potential to ensure that people are correctly informed about the range of benefits to which they may be entitled. Personal advisers need to have knowledge about eligibility for different benefits and how they interact with each other and with training and employment.

18. People who have been found incapable of work will be anxious about losing that status prematurely, for example if they undertake a work-related activity to improve their employability and are then deemed able to work. Personal advisers should be able to offer a level of protection to their clients. If someone takes up voluntary work, for example, following their interview this should not trigger an assessment of their capacity for work. People will feel harassed and insecure if their entitlement to benefit is constantly in question. Personal advisers will therefore need to know what the impact is of work related activity on benefit entitlement, including the rules on therapeutic work. Claimants must not follow the advice of a personal adviser only to find their benefits stopped or in jeopardy.

Registration and orientation staff

19. It appears that "registration and orientation" staff, responsible for the initial stage of the gateway process, will have discretion, and hence a great deal of responsibility in determining whether or not a claimant is to have their interview waived or deferred. Training and guidance is therefore very important to enable them to make these decisions fairly and sensitively. Consideration should be given as to how to establish this decision without making claimants go into details of their mental health difficulties at this administrative stage of the process.

Venue

20. The venues for interviews should be accessible to disabled people. Appointments should be offered in consultation with the individual so that as far as possible people can attend at a time they can manage, and home interviews can be offered or declined.

Training

21. People with experience of unemployment, claiming benefits, and disability including mental distress should be involved in the training of personal advisers and registration and orientation staff.

Advocacy

22. It should be an accepted and encouraged aspect of the interviews that people who wish to bring someone with them do so. Many people will not want this but for those who do it can be essential and enable them to get across what they want to say.

Call centre pilots

23. Mind welcomes extending the use of telephone access but this must not make it harder for people to access the system in other ways. Not everyone is comfortable with or able to use the telephone, or has ready access to one.

Evaluation of the Pilots

24. People with experience of unemployment, claiming benefits, and disability including mental distress should be involved in the design and evaluation of the pilots.

25. Evaluation should include qualitative research about the experience and give weight to claimants' views. How helpful did the interviewee perceive it to be, how satisfied were they, was there a difference between what anticipated and what happened? Did they find out anything they did not already know? Did it encourage them to try anything they would not have done otherwise? Or earlier than they would have otherwise? If so were they happy with the outcome? Were they satisfied with the adviser's awareness of issues for people with mental distress (or other disability access issues)?

26. Do they believe their prospects of working have improved? Were suggestions made that they felt were inappropriate, or irrelevant to their capabilities and interests? Did they feel under pressure to pursue them? Was their mental health affected (positively or negatively) by the interview? There should also be some assessment of the quality and range of vacancies or opportunities identified by advisers, and how well they match the experience and abilities of clients.

27. Evaluation should also address satisfaction with the registration and orientation stage and the use of discretion to waive or defer the interview. Did people feed they should not have had to have the interview?—before the interview?—and afterwards?

28. The longer term outcome should be addressed as well. If people took action as a result of their interview how did it work out in the longer term? Did people subsequently take up work or training, and was this related to the interview?

29. Personal advisers could also be asked about any barriers they perceive to their effectiveness, for example:

— cooperation from other agencies or sectors;

— lack of employment and training opportunities or support services to make them viable for a mentally distressed person;

— perceptions or beliefs of clients.

30. Other measurable outcomes will include numbers of people moving into jobs or training, referrals to other services, and benefit claims, but the qualitative data will be needed to interpret them. Assessment of the evaluation of the pilots needs to take account of the fact that participation in the early stages is voluntary. Findings from the evaluation of the personal adviser pilots in the new deal for disabled people must also inform the decisions on roll-out.



© Parliamentary copyright 1999	Prepared 27 July 1999