Memorandum submitted by Mind (DM 24)


About Mind


Mind is the leading mental health charity in England and Wales, working to create a better life for everyone with experience of mental distress by:

advancing the views, needs and ambitions of people with mental health problems

challenging discrimination and promoting inclusion

influencing policy through campaigning and education

inspiring the development of quality services which reflect expressed need and diversity

achieving equal rights through campaigning and education.





In April 2006 Mind responded to the Government's proposals for welfare reform. The response outlined areas of concern for people with mental health problems, particularly in relation to the reform of Incapacity Benefit (IB) which provides crucial financial support to people with mental health problems at a time when paid work is not an option.


Concerns raised by Mind in 2006 are borne out by issues emerging since the introduction of Employment and Support Allowance in October 2008. Main issues include: staff carrying out the assessments do not have adequate mental expertise; the assessment does not take account of the fluctuating nature of people's mental health conditions and; the assessment remains biased towards physical functions


Mind is concerned that staff who are responsible for carrying out Work Capability Assessments (WCAs) and for supporting people into work are insufficiently trained on mental health issues.


Mind is concerned that the WCA does not perform an adequate assessment of a person's functionality in relation to the average workplace.


Medical Services doctors and Benefits Decision Makers should be subject to a rolling programme of mental health training provided by mental health service users.


All Employment Advisors should be trained to NVQ level four in Advice and Guidance and be subject to a rolling programme of mental health training provided by mental health service users.


Anecdotal evidence from claimants and support workers from local Mind associations suggests many people are being placed on JSA despite being unwell and not able for work.


Mind is concerned about decisions based on insufficient medical evidence.


The 'President's Report' of 2007-2008 illustrated consistent reports of underestimation of the severity of disability in medical reports as well as decision makers poorly interpreting medical evidence and deciding questions of causation of disablement.


Errors related to decision-making involving medical evidence commonly included the production of new evidence, under-estimation of the severity of disability, the impact of oral evidence and the inability of the system to deal adequately with mental health issues.


This is evidence to suggest that poor decision-making, information sharing and training exacerbates claimants' mental distress.


Recent case studies


Case study

James left work in January 2009 due to depression and anxiety. He made a claim for ESA. He had a phone interview, completed the full paperwork and a medical questionnaire. He was then called in for his Work Capability Assessment. He asked for it to be conducted in a private quiet space, which was agreed to. However, when he arrived he was told the interview would be conducted in the main office. When he insisted he needed a private space they provided a separate room with no door. James found this very distressing and asked if he would be able to take a break if he found the interview too stressful. He was told that he would be viewed as terminating the interview. The interview was then conducted over 75 minutes. He found the medical officer's attitude to be very aggressive and found the whole process very stressing. He also felt that the assessment process was more sensitive to physical health conditions not mental health.



Case study

Paul has been claiming IB for a number of years. He received an IB50 form in December 2008, which needed to be completed and returned in February 2009. He received support from his Benefits Adviser to complete the form as he finds forms very difficult to deal with. He received a letter two weeks later telling him to make an appointment for his medical assessment within 2 days. He contacted his doctor who advised Paul to call Job Centre Plus to inform them that he could not attend the medical assessment and to request their fax number so his doctor could send a letter and medical report explaining why Paul could not attend the assessment, and to request a home visit. Paul had to contact JCP three times even though he finds communicating by telephone very difficult. He was told that he had to attend the assessment or face a sanction.



Case study

Sarah has been diagnosed with PTSD and has mobility problems. She was made redundant in October 2008, which she found very distressing. As a result of her distress she was unable to search for work. She made a claim for ESA in November 2008. She has found the experience very traumatic despite receiving support from a local advocacy service. After her Work-Focused Interview was conducted in March 2009 she was referred to 'In-Training', an employment service provider. She had one session with them and was informed that they wanted her to attend a two day course 30 miles from her home called 'Activate'. She was given very few details about the course. She was told that she would be seeing a different adviser for her next appointment. She then asked if it would be possible to see the same person over the next four appointments to help build a relationship.

She then received a call inviting her to attend the two day course at the start of the next week. She contacted the provider raising concerns about the short notice and the impact on her mental health. She was informed that they had not received any medical information about her from JCP due to system problems. She said that she did not want to attend the training course until they had her medical information which they agreed to. Two weeks later she received a letter requesting that she attend the course at the start of the following week.


She informed the organisation once again that she would not be able to attend at such short notice. An advocate from her local advocacy service wrote them a letter and they agreed that they would postpone contact until the end of May 2009 while they awaited her medical assessment.

She has found the experience incredibly stressful as she has been given no indication of time scales and has found it extremely difficult to manage her finances.


September 2009