Select Committee on Work and Pensions Written Evidence

Memorandum submitted by the Revolving Doors Agency after the publication of the Welfare Reform Green Paper

  1.  Revolving Doors Agency is an independent, award-winning charity with over 10 years' experience of developing, testing and promoting innovative ways of working with people caught up in the damaging cycle of crisis, crime and mental illness. All of our clients have mental health problems and have been arrested or imprisoned, but most also present with a wide range of problems, such as homelessness, substance misuse and histories of abuse and institutionalisation. We are the United Kingdom's only national charity exclusively devoted to working with this client group.

  99% of our clients are unemployed.1

  2.  One area of our work is the development of practical `Link Worker schemes' based in police stations, courts and prisons, which offer a needs-led service combining assertive outreach with the provision of emotional support and practical help. We assist our clients to gain access to services such as housing, primary health care, welfare benefits, and drug and alcohol rehabilitation services.


  3.  This written submission is based on learning from our existing research and practice. Enclosed is a copy of "Snakes and Ladders",[231] which details the findings from our Link Worker Schemes in 2003. The relevant pages sections are referred to in brackets throughout.

  4.  The Welfare Reform green paper[232] notes that "the scale of the challenge is typically more concentrated in some of the poorest and most disadvantaged areas, and among people who often face other disadvantages, such as low skills". Revolving Doors Agency offers a particular expertise in relation to this challenge since all of the individuals with whom we work not only fall into this bracket but are also isolated from their communities and from services.

  5.  Our submission is intended only as a précis of a far more comprehensive response to the green paper, which will be based on extensive consultation with service users and practitioners.


  6.  We draw attention to the following:

    —  we agree that it is too readily assumed that claimants of incapacity benefit are simply unable or unwilling to work: this does not reflect our experience and with the right support many benefits claimants could conceivably work (pp 39-40);

    —  a benefit which supports individuals who are unable to support themselves due to illness or disability can play an important function in stabilising the lives of individuals with mental health problems; the current incapacity benefit system could be reformed with a view to performing this function more effectively and in doing so better support people into work in the long-term;

    —  the green paper refers to the reforms to the tax and benefit policies since 1997 which "have ensured that work pays": this does not accurately reflect the position as we have found it and more needs to be done (pp. 39-40);

    —  the availability of part-time and intermittent work deserves particular attention since for some individuals with mental health problems this is often the most manageable option;

    —  effective referral routes for individuals coming out of residential settings, such as psychiatric facilities or prison, and the avoidance of delay should be priority areas for any reform of the current system.


  7.  Any demarcation between those who are able to work and those who are not will always lead to a grey area at the boundary. The necessary implication, therefore, is that any dual benefit system must rest on the principles of flexibility and expert discretion. This cannot be overemphasised.

  8.  Our submission focuses on the following:

    —  the viability of a dual benefit system for individuals with mental health problems in light of the DWP's aim to help more people into work and support those who can't work as part of building a fair and inclusive society;

    —  the wider implications on reducing re-offending;

    —  what balancing rights with responsibilities means for our client group.


  9.  The relevance of mental health. The green paper notes that nearly 40% of claimants of incapacity benefit have a mental health condition, many of which will be variable and manageable. Success in addressing the support needs of sufferers is therefore crucial in meeting the target to reduce the number of claimants of incapacity benefit by one million.

  10.  Supporting individuals with mental health needs. Mental health service provision is currently patchy and generally ill-equipped to deal with, what the green paper rightly refers to as, "conditions [which] can vary widely and be complex and challenging". This is frequently exacerbated by cases of multiple needs and in practice what is required is:

    —  effective referral pathways into local mental health services where these are available;

    —  thorough training for personal advisers in mental health issues;

    —  joined-up working and seamless transitions between services ranging from criminal justice, and drugs and alcohol, to housing and health.

  11.  Functional capacity and personality disorder. Whilst we agree that the Personal Capability Assessment (PCA) should focus on functional capacity, this throws new emphasis on many mental health conditions. Of very special concern, not least due to its prevalence, is personality disorder, which affects thinking, feelings, interpersonal relationships and impulse control—all of which are highly relevant to the question of suitability for employment, as recognised by the National Institute for Mental Health in England[233]. Amongst our client group, one third has a formal diagnosis and a further third is assessed by Link Workers as having personality issues (pp 53-54). This lack of formal diagnoses does not reflect a lack of severity; rather, it underlines the poverty of mental health service provision[234] and that personality disorder is not easily susceptible to management by medication, since it is not attributed to a specific biological cause. This example demonstrates the crucial importance of a good understanding of mental health conditions amongst personal advisers.

  12.  Expert review. We welcome the proposal to review the mental health component of the medical assessment. However, we strongly recommend that the views of frontline mental health practitioners and, where possible, service users, are solicited as part of this review given the negative experiences that our clients have had of psychiatric services.


  13.  There is a danger that individuals who can only work part-time or intermittently will fall into a gap in a dual benefit system. They are not unable to work but nor may they be able to undertake the proposed employment programme. In relation to the theme "balancing rights with responsibilities", while individuals have a responsibility to work if able, they also have a corollary right to support in accessing work which is appropriate to the level of responsibility they are assessed as having.


  14.  Any reform of incapacity benefit must ensure that individuals are not penalised financially by return to work, which requires a holistic assessment of their financial position eg if a recipient of a Freedom Pass giving free access to London transport between Zones 1—6 started work full-time and was required to fund his own transport, this would cost him an additional £41.00 per week. For some people, the continuation of certain concessions for a limited period at the beginning of employment may reduce the danger of a cliff-edge in income that would deter their move into employment. Also, any complexity or delay leading to a temporary reduction in income (even if it can later be claimed back) means that individuals may not move into work.

  15.  For many individuals the regular benefit payment is one of their few sources of stability. They are therefore asked to gamble this stability with a chance at work with odds unknown. The financial incentives of work must be worth it. Many of our clients are not even capable of engaging in the balancing exercise that this requires which shows that for many individuals, ongoing support means one-to-one guidance about what is in their own interest. Trust in personal advisers is therefore paramount but given the aim is one million cut, it is not unreasonable for claimants to be wary that their current stability is under threat.

  16.  Multiple financial insecurities created by multiple benefits are a considerable exacerbating factor for the depression, anxiety and paranoia suffered by many of our clients. This may not only directly affect their assessed capacity to undertake work, but may encourage a deep-seated reluctance to do so.


  17.  The green paper refers to a system that is "relevant—it must reflect the needs of the local labour market". This requires joined-up assessments which take into account the individual's needs and skills and the needs and requirements of local employers. This is particularly important if a system of penalties is introduced for those engaging in an employment programme, since the key to success is matching individuals to employers who need them.

  18.  Employers also need support. In economic terms, it may appear riskier to employ an individual with chronic mental health problems than one without and this will also act as a disincentive. To counteract this, employers and fellow employees need a reliable network of support and education about mental health in the workplace.

  19.  Our experience suggests that incapacity is one of a number of barriers to someone's return to work. Particularly, statistics relating to the prison population[235] suggest a high overlap of people with mental and physical health problems and with a criminal record, which is a significant barrier to work. The Rehabilitation of Offenders Act 1974 should be reformed in accordance with Home Office recommendations[236] to achieve the right balance between managing the risks posed by ex-offenders and providing opportunities for them to reform and return to employment.

  We recommend undertaking research to establish the full effect of multiple barriers to work.

  20.  A note of caution should be lodged in relation to the reserved circumstances category of claimants. The individuals who fall into this category are likely to have problems as varying and diverse as those who are able to work in some capacity. One sub-group is likely to be made up of individuals who have led very traumatic lives and are subsequently damaged. Transfer into the reserved circumstances group should be a key point at which to identify such individuals and, in the spirit of joined-up working, refer them to mental health services and other agencies that are able to work with them.


  21.  As the green paper points out, GPs play a pivotal role. However, around 50% of prisoners are not registered with a GP[237] and similarly nor are 34% of our referrals (pp 41-45). Furthermore, GPs have acknowledged that they do not have enough time to explore complex mental health and multiple needs issues. The risk is that our clients will be further excluded from support if lack of access to primary care is not taken into full account.


  22.  The green paper proposes incentives for those who engage in work-related activities and penalties for those who do not if they are assessed as able. This approach fails to recognise that incentives and penalties do not work as mirror-images. It does not follow from the fact that a financial incentive may encourage an individual to pursue a course of action, that a financial penalty will have the same effect, particularly when gambling on stability. Furthermore, penalties should not be used to punish an individual for what are really manifestations of their mental health problem.


  23.  Failing the vulnerable. There is a risk that if the reformed system is defined by the target that it is designed to meet, the most vulnerable and needy individuals who are denied support in so many other areas, will also fall short of the barrier into the new Employment and Support Allowance. We welcome the positive proposals to support individuals into work but guard against a target-driven approach which will inevitably lead to the exclusion of the vulnerable. We particularly commend the approach of the Office of the Deputy Prime Minister in this regard and their commitment to "focus on the most disadvantaged and champion them as services are transformed across Government" by "using the experiences of the "bottom 10%" as a litmus-test of reform across Government"[238].

  24.  Increasing re-offending. The effect of setting an individual up to fail by implementing a system that does not take full account of the far-reaching effects of mental health conditions directs vulnerable individuals with psychiatric conditions into the criminal justice system and will drive up re-offending: when income is reduced the incentive is not always to work, but to commit crime. This is particularly acute in relation to individuals coming out of residential settings such as prisons and some psychiatric facilities.

  25.  Fraud and error. Incorporating the principles of flexibility and discretion inevitably incur greater risk of fraud and error. However, this can be minimised with appropriate safeguards and the necessity for flexibility and discretion as cornerstones of a dual benefit system far outweigh this increased risk.

  26.  The human face of the benefits system. A problem long-encountered by our clients is the inability to interact socially, which causes particular problems when it comes to communicating with frontline staff in charge of the benefits system (pp. 23-24). Therefore, this issue of reform must be looked at from both a systematic and an operational perspective.

231   N O'Shea, I Moran and S Bergin (2003) `Snakes and Ladders' London: Revolving Doors Agency. Back

232   Department for Work and Pensions (2006) `A new deal for welfare: Empowering people to work' London: DWP. Back

233   National Institute for Mental Health in England (2003) `Personality Disorder: No longer a diagnosis of exclusion' London: NIHM(E) Back

234   Revolving Doors Agency is shortly to publish a collection of case studies, at the request of the Home Office, which reflect our clients' experiences of mental health services. A copy will be available after publication on request. Back

235   Social Exclusion Unit (2002) `Reducing re-offending by ex-prisoners' London: ODPM; and Simon, F. and Corbett, C. `An evaluation of prison work and training' London: Home Office. Back

236   Home Office (2002) `Breaking the Circle: a report of the Review of the Rehabilitation of Offenders Act 1974' London: Home Office. Back

237   Social Exclusion Unit (2002) `Reducing re-offending by ex-prisoners' London: ODPM. Back

238   Office of the Deputy Prime Minister (2005) `Sustainable Communities: People, Places and Prosperity' London: ODPM. Back

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