Select Committee on Work and Pensions Written Evidence

Memorandum submitted by The Sainsbury Centre for Mental Health after the publication of the Welfare Reform Green Paper


  The Sainsbury Centre for Mental Health (SCMH) broadly welcomes both the Government's green paper on welfare reform and this additional opportunity to contribute to the Committee's inquiry into disability benefits.

  SCMH is an independent charity working for a better quality of life for people with severe mental health problems. Much of our work focuses on employment—on tackling worklessness among people with mental health problems. This response focuses on issues facing people who are on incapacity benefits because of mental health problems.


    —    Many of the principles of A new deal for welfare are welcome. It could help many people with mental health problems to overcome the current disincentives to work.

    —    The unintended consequences of the system can, however, cause problems. Fair and consistent application, with good information and advice, are vital.

    —    Pathways to Work should be rolled out in its current form—too much extra conditionality could undermine the success of the scheme.

    —    The new two-tier benefit could lead to people with severe and enduring mental health conditions being labelled unemployable and facing a bigger benefits trap than they face today.

    —    The Personal Capability Assessment needs to be reformed and applied appropriately to people with mental health conditions.

    —    Incentives for GPs to provide employment support are a welcome idea.

    —    The Government can do a great deal to help create "mentally healthy" workplaces.

    —    People with mental health problems should explicitly be included in the proposed city regeneration schemes.


  A new deal for welfare identifies many of the fundamental problems with the current system of incapacity benefits and its implementation. It recognises that too many people are `written off' when they start receiving incapacity benefits, that they "trap" people in dependency for too long and that many people find volunteering or training puts their benefits at risk.

  Many of the problems with the current system are to do with the unintended consequences of its operation rather than the system itself (SCMH 2005a). Others are to do with the regulations. A report written by SCMH for the Social Enterprise Partnership listed the seven disincentives to work for those on benefits for mental health problems. They included:

    —    Taking on work, training or voluntary work can trigger a medical review, putting not just IB but DLA at risk;

    —    Fear of a drop in income when starting work caused by delays in receiving tax credits, low wages, reduced Housing Benefit and the risk of losing DLA;

    —    Lack of opportunity for part-time work: most people can take no more than four hours of Permitted Work a week without their benefits being reduced; and

    —    A lack of knowledge of the Linking Rules (that reduce the risk of losing future benefits if employment does not work out) and general lack of independent advice (Seebohm and Scott 2004).

  The reformed system will need to address these very practical issues as well as changing the rules themselves. It is not just what is implemented but how it is implemented that will determine the success or failure of the new system. In particular there will need to be:

    —    Fair and consistent application of the system's rules and processes.

    —    Clear information about how the system works.

    —    Tailored, independent and timely advice to claimants.


  Pathways to Work has been a tremendous success. It is important that the factors that have made it work to date are retained under the new system. While we accept that there needs to be a level of conditionality to get people who have given up hope to start thinking seriously about work, the present levels of conditionality are sufficient to get people moving and at the same time be perceived as supportive. Increasing the level of conditionality beyond this (for example by requiring people to undergo psychological therapy to keep their benefits) could have damaging effects on people's motivation and may backfire by focusing their attention on their eligibility for the enhanced benefit rather than on actually getting a job.

  The green paper suggests that the new condition management programmes will be delivered entirely by the private and voluntary sectors. This is another departure from the Pathways to Work pilots, which are based on a highly successful partnership between Jobcentre Plus and the NHS at local level. The pilots involve the private and voluntary sectors but quality control and clinical governance remain appropriately with the NHS and Jobcentre Plus. We do not believe that the private and voluntary sectors alone have the skills or the capacity to deliver volume services on the scale that will be necessary. The risk is that only large national and regional organisations will be able to participate, leaving smaller community organisations, which can reach the most marginalised groups in society, out of the picture.

  The way the impact of Pathways to Work is measured is also important. If success is determined by the number of people found work, the temptation will be only to work with those who have moderate disabilities and need little help. A broader measure of "distance travelled" by the individual would ensure those who need more intensive support are given a good service as well.


  The decision to introduce two levels of the new ESA benefit could have major ramifications for people with mental health problems. The risk is that those on the higher level will be labelled unemployable and they will face the same or more disincentives to work as current IB claimants.

  In the right circumstances and with the right support almost anyone who wants to work is employable. The green paper states that the higher level group will be "eligible for help and support as and when they want it". They need to be encouraged and given the message that they can work again with the right support and not excluded from any of the support of Pathways to Work nor exempted from the requirement to attend work-focused interviews unless they are too ill at the time. The Social Exclusion Unit (2004) detailed the kind of support people with severe mental health problems need to get into work.

  It is important that the Government maintains its pledge that the "severity of the impact" of a condition rather than the severity of the diagnosis that determines which level of benefit a person receives.

  Protecting the benefit entitlements of people who return to work matters especially to people with severe and enduring mental health problems because of the fluctuating nature of their conditions. The present Linking Rules are too often not well understood or implemented (SCMH 2005). Improvements to the system will be necessary to give people the confidence to step out into employment knowing they will not have to reapply for ESA (especially where it has been paid at the higher level) if it does not work out.


  Reforming the PCA process is a vital change to the current system. Inappropriately timed medical assessments and the widespread perception that the PCA does not fairly assess mental health problems, make this a major barrier to seeking work. The review of the PCA should encompass the content of the PCA itself, the circumstances in which a PCA takes place and the time taken to arrange a PCA (given the pledge to put new claimants on JSA for up to 12 weeks until this has been completed).


  The Government's pledge to reward primary care providers who take steps to support people to keep or return to work is very welcome. The Quality and Outcomes Framework of the new GP contract allows practices to be given incentives for certain activities. While the most recently published QOF excludes incentives for helping people in this way, we believe an appropriately structured incentive (for example to provide employment advice or condition management programmes through a person's GP surgery) would be helpful. Incentives to "get people off benefits" or to reduce the number of sick notes they produce are not appropriate.


  We welcome the Government's aim to create healthy workplaces and improve occupational health support. This is an important issue for many. We know that:

    —    Employers are reluctant to employ people with a history of mental health problems.

    —    Many workplaces do not know how to help staff with mental health problems, at considerable cost in terms of sickness absence and staff turnover.

  Creating mentally healthy workplaces can be assisted by:

    —    Investing further in efforts to tackle stigma and discrimination at work, for example through the Shift programme;

    —    The public sector (and the NHS in particular) taking a lead in offering staff support for their mental wellbeing and positively employing people with mental health problems;

    —    The creation of a "wellbeing workplaces" scheme to accredit employers on their support for staff mental health (SCMH 2006);

    —    Raising awareness of the business case for a mentally healthy workplace (eg in terms of staff retention and productivity) and how management practices can reduce stresss;

    —    The provision of timely intervention, including case management and CBT for those who do not recover and return to work as expected (Seymour and Grove 2005).


  The green paper describes the Government's aim of addressing the cycles of deprivation and low employment by improving the skills of the "most disadvantaged" groups in urban areas. People with severe and enduring mental health problems should be actively included in these initiatives. Experience of voluntary and community initiatives with Black men and women with mental health problems shows that practical support and confidence-building can help them to pursue their ambitions in life (SCMH 2005b).

  People with mental health problems should not be assumed to be seeking entry-level work. Many will have become unwell while in higher education or professional employment (Rinaldi et al2006). A return to education or training may be an important step to getting and sustaining a worthwhile job. Help must be tailored to the individual and the kind of work they are able to do and would like to do: not just to getting any work.


  Rinaldi M et al 2006 "Not just stacking shelves" in A Life in the Day, Vol 10 Issue 1, February 2006.

  SCMH 2005a Benefits and work for people with mental health problems, Briefing paper 27. London: SCMH

  SCMH 2005b Together We Will Change. London: SCMH.

  SCMH 2006 The Future of Mental Health: A Vision for 2015. London: SCMH.

  Seebohm P and Scott J 2004 Addressing Disincentives to Work. London: Social Enterprise Partnership GB.

  Seymour L and Grove B 2005 Workplace interventions for people with common mental health problems. London: BOHRF.

  Social Exclusion Unit 2004, Social Exclusion and Mental Health. London: ODPM.


February 2006

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