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 employmenton 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
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 formtoo 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
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
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
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
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
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 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.