APPENDIX 11
Memorandum submitted by the Mental After
Care Association (MACA) (EDP 17)
SUMMARY OF
EVIDENCE
1. It would be quite wrong to assume that
incapacity benefit represents a hiding place for significant numbers
of false claimants. This is especially true of people with mental
health problems, who can take a long time to develop the confidence
to start thinking about working again, and may have been damaged
by poor workplace experiences in the past. In addition, people
with mental health problems can experience significant fluctuations
in their capacity. The benefits system needs to be flexible enough
to allow for this.
2. The serious worry of some mental health
clients about losing benefits must not be underestimated. The
incapacity benefit system needs more security (in terms of fallback
arrangements) to encourage people out of it.
3. JobCentres lean more heavily towards
helping more able people, rather than more "difficult"
ones. Jobs suggested to the latter will be very basic, low-paid
work, regardless of the person's real ability and skills. People
with enduring mental health problems can therefore receive a less
good service.
4. JobCentres should be much more proactive
in networking and linking directly with (a) disabled groups and
people with special needs where, through a process of association
and learning, they will become more able to help service users
back into work, and (b) specialist independent and voluntary service
provider training organisations that can provide employment training
and support.
5. There may be some merit in reconsidering
whether resources spent on paying the private sector to deliver
employment services for people with disabilities would not be
better spent on increasing the numbers of, and disability training
of, Disability Employment Advisers and other staff within Job
Centres.
6. There is a widespread belief among many
employers that people with mental health problems are incapable
of working productively. We would advocate that resources are
committed to tackling employers' doubts in a pragmatic way. Assurances
could include, for example, written confirmation that if a person
with a mental health problem requires specialist support at work
then a local mental health service provider will immediately provide
it. A financial incentive might be subsidising a person with a
disability at work by paying for all their training needs. What
should not be forgotten in all this is that it is ten times harder
(and more expensive) to get people with a disability back to work
than to support them while they are in employment.
FULL EVIDENCE
1. Do the high numbers claiming incapacity
benefit represent hidden unemployment?
1.1 Yes—but it would be quite wrong
to assume that incapacity benefit represents a hiding place for
significant numbers of false claimants. This is especially true
of people with mental health problems, who can take a long time
to develop the confidence to start thinking about working again,
and may have been damaged by poor workplace experiences in the
past. In addition, people with mental health problems can experience
significant fluctuations in their capacity. The benefits system
needs to be flexible enough to allow for this.
1.2 The serious worry of some mental health
clients about losing benefits must not be underestimated. The
incapacity benefit system needs more security (in terms of fallback
arrangements) to encourage people out of it. They must believe
there is a guaranteed benefits safety net if they try to get work
and fail. The Job Seekers' Allowance is not seen as a "reliable"
benefit by many of our clients, or a "move-on" from
incapacity benefit.
1.3 Our own experience, working with mental
health service users who wish at some point to regain employment,
is that in general the chances of re-employment for people on
incapacity benefit are broadly similar, regardless of how long
they have been claiming the benefit. Some 10% might be in a position
to seek employment; another 10% require short-term support before
being ready; the remaining 80% require medium to long-term treatment,
support, motivational guidance and training.
2. What is or should be the role of JobCentre
Plus? Are they doing enough actively to engage people with disabilities
in finding suitable work? Are initiatives such as WorkStep successful?
2.1 Our experience is that JobCentres lean
more heavily towards helping more able people, rather than more
"difficult" ones, and that jobs suggested to the latter
will be very basic, low-paid work, regardless of the person's
real ability and skills. People with enduring mental health problems
can therefore receive a less good service.
2.2 JobCentres are not doing enough to link
people with mental health problems with the more intensive range
of services and support that is available to help prepare them
for work. These include mental health and drug and alcohol misuse
services. One MACA project manager who has run an employment training
scheme for some years has suggested that he cannot recall either
himself, or any other local service provider, ever being approached
by anyone from his local Jobcentre. Any relationship between the
service provider and the JobCentre has come from him and his staff.
An additional problem is in the high turnover of JobCentre staff,
resulting in a lack of continuity and difficulty in maintaining
a mutually beneficial relationship.
2.3 He cites two case studies. In the first,
where his approach had resulted in established lines of communication,
one client on incapacity benefit was permitted to return to college
full-time whilst remaining on the benefit. This was arranged as
part of his recovery programme and, after discussion, resulted
in the agreement of the JobCentre. In the past this would not
have been permitted under benefit rules. However the Disability
Employment Advisor (DEA) and their manager have now been moved
elsewhere and the established link broken.
2.4 In the second, another client on incapacity
benefit wanted to get a job. He contacted Jobcentre Plus to arrange
an appointment with the DEA. At the meeting he was referred on
to the New Deal 25+ representative who tried to persuade him to
join the New Deal 25+ programme. The client explained that he
had completed the previous New Deal programme and that it had
not resulted in him obtaining employment. When he asked what guarantee
of employment could they provide, there were none. Subsequently
the client declined New Deal 25+ and is currently seeking employment
on his own accord.
2.5 The client in question presents as being
of very low intelligence whereas in reality, despite some mild
learning difficulties, he is a very capable individual, keen and
committed to finding employment. It may be that because JobCentre
staff have little experience of working with people with different
"special needs" they consequently find it difficult
to identify those people who are more likely to be work ready.
We believe there is a substantial number of missed employment
opportunities resulting from a lack of understanding of mental
health issues by JobCentre staff.
2.6 From this, we would argue that JobCentres
should be much more proactive in networking and linking directly
with (a) disabled groups and people with special needs where,
through a process of association and learning, they will become
more able to help service users back into work, and (b) specialist
independent and voluntary service provider training organisations
(such as MACA) that can provide employment training and support
to help people with mental health problems attain their goal of
employment. In practice, this means DEAs and other JobCentre staff
mapping their local services and service user groups and taking
time to visit them and establish enduring relationships. Jobcentre
Plus may wish to consider placing specialist outreach workers
to work alongside statutory heath-care and specialist voluntary
employment agencies at grass roots level to develop their understanding
of the wide range of needs of disabled people in order for them
to assist people according to their individual needs.
2.7 We would also suggest that any Employment
Service contract with an independent employment agency should
have written into it a requirement to establish such networks.
Unless the process of effective networking begins, in order to
address the artificial barriers between themselves and other statutory
and voluntary agencies, Jobcentre Plus will fail to meet Government
objectives. Only through a process networking and co-working will
Jobcentre Plus and their preferred providers begin to understand
how to address the complex needs of people with disabilities,
special needs and other health problems. A successful example
of joined-up work involving many agencies is the Dependency To
Work (D2W) initiative in London, in which MACA provides the mental
health input.
3. The New Deal for Disabled people: have
the lessons been learnt from earlier pilots? How might it be made
more effective?
3.1 In our experience, earlier New Deal
programmes concentrated mainly on IT training courses. Quite a
few of our clients find IT isolating, and we believe there is
a need for more vocational training opportunities.
3.2 Some of our clients who are on incapacity
benefit are reluctant to join New Deal 25+ as they are afraid
they may not be able to fulfil the requirements of the scheme,
thus resulting in the potential loss of income and/or a change
in their benefits. Presentation of the New Deal to people with
disabilities need to emphasise the advantages of the scheme and
also the safeguards built into the system to ensure no financial
loss will be incurred.
3.3 Interviews with clients may not always
be as friendly and welcoming as they might. They may be compulsory,
but this means they should be even more sensitive to the difficulties
faced by people with disabilities, and in particular mental health
problems. The emphasis must be to stress that the client is not
on the scrapheap but that there are real opportunities for worthwhile
and fairly paid employment to aim for.
4. The role of the private sector in delivering
employment services for people with disabilities and health problems
4.1 The private sector (including the independent
and voluntary sector for this purpose) can, through its close
ties with other local organisations, sometimes access services
that the statutory sector cannot. But our experience suggests
that private contractors, like Job Centres themselves, can fail
to network to best effect with organisations that could help clients
with mental health problems get back into work. They may also
be too driven by financial considerations and targets, which tend
to favour focusing resources on placing "easier" clients.
4.2 There is a danger that some clients
with mental health problems are sent to contracted New Deal service
providers who may lack the depth of knowledge of problems faced
by this group of people. By the same token, we know, for example,
of a mental health voluntary sector organisation contracted to
provide a New Deal service that was inappropriately sent clients
with disabilities the organisation was not best placed to support
and help, such as a hearing impairment.
4.3 On balance, there may be some merit
in reconsidering whether resources spent on paying the private
sector to deliver employment services for people with disabilities
would not be better spent on increasing the numbers of, and disability
training of, Disability Employment Advisers and other staff within
Job Centres.
5. Are the needs of particular groups of
people with disabilities and health problems adequately catered
for? Should employment projects be more inclusive and adapt to
individual need rather than be aimed at people with specific disabilities?
5.1 We have already noted above that Job
Centres and other employment agencies may tend to concentrate
on placing "easier" clients. This can work to the disadvantage
of people with mental health problems, who may be considered "difficult"
even though they may have many skills and a good deal of work
experience. We have also noted that people with mental health
problems can often be offered only poorly paid an unattractive
work, ignoring their skills and past experience.
5.2 Employment projects should definitely
be fully inclusive to meet the needs of all people with a disability,
and adapt to individual need. They must focus on the needs of
the individual and not continue to segregate people according
to their disability "label" as has traditionally happened.
5.3 Many people have complex needs (for
example a mental health problem linked to a history of drug or
alcohol misuse, and perhaps a physical disability as well). No
standard service or single-speciality provider is going to be
able provide support into employment for this group—one
size does not fit all. That is where the networking and good co-working
between different agencies becomes so vital.
5.4 The arrangements need to be extremely
flexible to take into account the changing capacity of people
with mental health problems, who may be well one week and unwell
the next. Generally speaking, this places this group apart from
people with a physical or sensory disability.
6. The tax credit and benefits system: is
it too complex for the circumstances faced by people with disabilities?
Should it be reformed to reduce financial disincentives to find
work?
6.1 The tax credit and benefits system is
too complex for most people, whether they have a disability or
not, although it can be a particular maze for people with mental
health needs or a learning disability. (The Disability Living
Allowance form in particular can be a nightmare to complete.)
6.2 There is a need for a flexible benefits
system that meets disabled peoples' concerns for their long-term
employment prospects and supports them to sustain work in the
longer term. For some people with mental health problems it is
a significant achievement in itself simply to walk into a Job
Centre, given concerns about potential loss of benefits and worries
about taking up employment again. A "prescriptive" approach
to people with disabilities (for example, a £40 per week
subsidy for 12 months) does not allay their fears of unemployment
beyond that time unless they are secure in the knowledge that
the system responds quickly to any recurring health concerns.
If the job does not work out their claim form benefit must be
processed immediately and they must suffer no financial disadvantage
(eg a lower level of benefits than before). If they do not feel
assured about this, they will lack trust in the system and will
not move beyond "go".
6.3 The loosening of the rules regarding
"permitted work" is welcome and yet in our experience
only a few have taken this up. In one instance one of our clients
was charged Council Tax and rent as a result of his permitted
work income thus reducing the real term financial incentive. The
same local authority also levied "poll tax" arrears
against the client, reducing further the financial benefit from
his permitted work earnings. Word gets around, and whilst this
client is still working the disincentive is clear to others who
remain deterred from seeking work as a result. It is evident from
this that the benefits system needs to provide more incentives
to work, alongside with clear guidance to other relevant agencies
(for example local authorities) that those incentives are not
part of any means testing, and are exempt under the "rules".
6.4 In another instance, a client who has
worked and sustained employment under "permitted work"
for the past 14 months is now seeking to return to college to
refresh his skills en route to a return to employment as a graphic
designer. He saw his benefit stopped prior to last Christmas after
failing a "medical" coincidentally requested shortly
after he began "permitted work". He amassed £800
of benefit, rent and council tax arrears whilst his appeal was
put through, which eventually succeeded and his benefits were
reinstated. During the time his incapacity benefit was stopped
the client was encouraged to apply, and then prevented from claiming
Income Support because his "permitted work" earnings
were taken into account, cancelling out any entitlement to income
support.
7. How does discrimination hinder the employment
of people with disabilities?
7.1 There is still a widespread belief among
many employers that people with mental health problems are incapable
of working productively, or will take an inordinate amount of
sick leave. We should make no mistake in understanding that the
large majority of employers are in business to make a profit.
Social conscience may play a small part for some, but for people
with more complex needs, the situation is very different. We have
seen some improvement in attitudes over the years, and have supported
specific mental health campaigns aimed at employers (such as the
Department of Health's current Mind Out For Mental Health campaign).
There are also noble exceptions. But employers' general understanding
of mental health issues improves very slowly, and we do not believe
it is ever going to be wonderful.
7.2 Without long-term assurances and financial
incentives most employers are reluctant to take on the financial
risks and responsibility for certain types of disabled people.
Particular disabilities such as a mental illness, or a history
of substance misuse (where may have additional implications such
as a criminal record) create additional barriers.
7.3 We would therefore advocate that resources
are committed to tackling employers' doubts in a pragmatic way.
Assurances could include, for example, written confirmation that
if a person with a mental health problem requires specialist support
at work then a local mental health service provider will immediately
provide it. A financial incentive might be subsidising a person
with a disability at work by paying for all their training needs.
What should not be forgotten in all this is that it is ten times
harder (and more expensive) to get people with a disability back
to work than to support them while they are in employment.
Simon Lawton-Smith
Head of Public Affairs
6 January 2003
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