Welfare Reform Bill

Memorandum submitted by Rethink Mental Illness (WR 60)

1 Summary:

1.1 People with severe mental illness are among the most socially excluded groups of people in the UK and should not be further disadvantaged by the effects of benefit reform.

1.2 The focus of the new PIP on those with the ‘greatest need’ may, perversely, leave some people who have the highest disability costs without support. Assessment for this new benefit must not replicate the old problems of WCA. It should be sensitive to mental health problems and be administered by well trained staff.

1.3 The reduction of the qualifying period for ESA goes against the Government’s strategy for mental health promoting early intervention.

1.4 Plans to extend Shared Room Rate from under 25s to under 35s could have a detrimental impact on the health of people with certain experiences of mental illness, which should be taken into consideration when applying this new rule.

2 Introducing Personal Independence Payments to replace the current Disability Living Allowance (DLA).

2.1 While we understand the DWP has departmental requirements to reduce spending, we do not support the aim for a specified percentage saving in DLA and believe that a reform process driven by such an imperative will fundamentally undermine the objectivity of the assessment process.

2.2 Under the present system many eligible people with mental health problems do not receive DLA, this can be because they do not apply for it or also because they have not been awarded it despite their considerable disability costs. We are therefore concerned about the focus on those with ‘greatest need’. It does not necessarily equate that those with the highest level of disability have the highest disability costs.

2.3 By concentrating on those with the ‘greatest need’ people who are receiving lower rates of DLA may not qualify for PIP. What is important is that even low amounts can be instrumental in achieving and maintaining people’s independence and involvement in society. If DLA were to be removed from low-rate applicants it could have an adverse effect on health and social care services. Payments currently made have a preventative and supportive effect on people’s mental health. Without this support health and social care services would have to cover the costs of relapse.

"We would lose our independence and, in no doubt whatsoever, our health will deteriorate. We would more than likely end up in a psychiatric hospital."

Rethink member

2.4 There are also concerns over the possibility that the new assessment system would replicate the same problems as the Work Capability Assessment (WCA). The PIP assessment has to be sensitive to mental health illness and accurately reflect the impact of mental health on daily lives. As mental health problems are variable and fluctuating, a judgement should be based on the applicant’s functioning at its worst. Assessors must ask questions about severity, duration and frequency. Judgments should never be made on the applicant’s appearance or behaviour on the day alone, which has been commonplace in assessment for ESA.

2.5 In order to provide a clear assessment of ability vital evidence should be used from relevant health or social care professionals who have had substantial contact with the applicant. The most appropriate person to provide this information will depend on their relationship with the applicant, therefore the applicant will have to be asked who they feel is best placed to give advice when identifying this person.

2.6 We would also recommend during reassessment that evidence be used from health and social care professionals instead of having the applicant complete another face to face interview.

2.7 Mental health conditions can be fluctuating in nature, this means that frequent reassessments make little sense. Consideration must also be made of the fact that the process of reassessment can be highly distressing for applicants and this can trigger serious problems including relapse and suicidal thoughts.

2.8 It is also important that assessors are trained to a high standard and are accustomed to assessing people with mental health problems. When experiencing WCA, service users have reported that their answers have been inaccurately recorded and that they felt they did not have the opportunity to explain the impact of their condition on their daily lives, instead being asked a series of closed questions. To overcome this Rethink Mental Illness suggests allowing the questions to be semi structured in nature. This would encourage dialogue and would therefore give a truer picture of the effect of disability. In order to help service users to adequately explain how their condition effects their lives, clearer explanation should be given about how fluctuating conditions are assessed.

2.9 Another area of concern is the extension of the qualifying period from 3 to 6 months. Mental health problems can have a rapid onset, it is therefore vital that support be attained as early as possible. Early intervention will avoid more expensive care further along the line. Extending the qualifying period for PIP to 6 months runs counter to the government’s early intervention agenda expressed in the mental health strategy. It also ignores the savings that could be brought about by following this strategy.

3 Time limit the payment of contributory Employment and Support Allowance to twelve months.

3.1 The 12 month limit to contributory-based claims for those in the Work Related Activity Group of ESA is arbitrary. By including this in the reforms it will cause intolerable stress to many people suffering from mental health problems. People are ready to return at different stages, ending their support at an arbitrary stage may actually reduce their chance of finding work in the future.

3.2 Rethink members have also expressed concern that this time limit will have a serious impact on carers. It is a grave worry for many that they will be financially dependent on a carer, such as a spouse.

3.3 There is no evidence that removing benefits encourage people with mental health problems to seek or gain paid work. In many cases it may actually undermine a return to work because of the adverse affects of removing benefits on an individual’s mental health. It is vital that the applicant’s journey back to work is highly personalised and takes full account of their specific circumstances and barriers. An arbitrary removal of benefits will not encourage this.

3.4 It is also important to recognise that people suffering from mental health problems often face discrimination in the field of employment. 80% of people with mental health problems want to work, yet only 20% of people with severe mental health problems and 50% of those with less serious problems are in paid employment [1] . It is therefore important to take into consideration the effects of discrimination and stigma in seeking work on a group who may be facing their ESA being discontinued.

3.5 The prospect of having a time limit for those in the Work Related Activity Group of ESA has meant an increase in pressure for people suffering from severe mental health problems that they after assessment they will be assigned into the wrong group. This will mean that they will face added pressures and a potential time limit on their support when they are not ready to gain employment.

"I am very worried, like many others with severe mental illness, about the prospect of reductions in benefits- from being assigned to the "wrong" group under ESA."

3.6 Granted, part of the worry around this change is that claimants cannot trust that they will be fairly assessed, for the reasons detailed in Professor Harrington’s review of the Work Capability Assessment. However, there is also a fundamentally unfair element to this time limit, which puts disabled people forward to take the brunt of spending cuts. It is galling that those who have contributed to the economy and have later become vulnerable in their inability to work would lose the promised safety net and be forced to work through any assets or savings they may have built to support themselves indefinitely.

4. Shared Room Rate

4.1 This call for evidence does not ask for information about the extension of Shared Room Rate to under 30s. However, we ask that the Scrutiny Unit considers the significance of this proposal for people with fluctuating severe mental illness. Many young adults affected by severe mental illness are socially excluded such that living alone, and being reliant on benefits is often a consequence of the stigma and discrimination they face. For many, living alone can be an important part of staying well – especially for those who experience paranoia during times of ill health.

4.2 Moreover, the sudden reduction in housing benefit for those under 35 is likely to lead to an increase in homelessness amongst the most vulnerable. Lack of available shared living space plus discrimination from landlords and potential ‘house-mates’ is likely to displace a great many people, and leave so many with mental illness with no options. A recent mini-campaign within the national anti-stigma campaign Time to Change, has considered this issue. Their autumn campaign ‘Don’t get me wrong’ was based on the results of a social experiment and ran for five weeks. The social experiment involved six people with mental health problems posting ads on dating and flatshare websites. The ads were posted for two weeks without revealing the persons mental health problem. They were then re-posted with one line added – ‘I have a mental health problem.’ Adding this line led to a big drop in responses – 50% fewer responses to dating ads, and 68% fewer responses to flatshare ads.

4.3 We therefore strongly recommend that this proposal is considered more carefully – perhaps introducing exemptions for those for whom a serious health condition or disability makes sharing a home impossible.

5 Rethink Mental Illness: who are we?

5.1 Rethink Mental Illness, the leading national mental health membership charity, works to help everyone affected by severe mental illness recover a better quality of life.

5.2 We help over 48,000 people each year through our services and support groups and by providing information on mental health problems. Rethink’s National Information and Advice Service help almost 8000 people each year, including many who ask for help with the Work Capability Assessment.

May 2011

[1] Fit for Purpose: The Reform of Incapacity Benefit IPPR, Stanley K & Maxwell D, 2004.