Written evidence submitted by the North
West Mental Health and Welfare Rights Group |
The North West Mental Health and Welfare Rights Group
was established in 1998 for Welfare Rights Advisers who deal mainly
with people with mental health problems and meet regularly to
discuss issues pertinent to this client group. The NWMHWR group
is made up of a number of organisations across the North West
(eg from Sheffield to Liverpool), including Local Authorities,
CABx, Voluntary Agency's, Health Trusts, Housing Associations
etc. It is the only known such group nationally, with people from
other areas on the mailing list for minutes, information etc eg
Broadmoor Hospital advice workers. The aim of the group is to
share knowledge, information and good working practices in the
specialist area of Social Security Benefits and Mental Health.
This report has been compiled and agreed by the group,
with individuals providing examples of difficulties experienced
by their clients.
We welcome the fact that it has been recognised that
measures need to be put in place to explain the migration process
to vulnerable customers. However, we hope that it will also be
recognised that any form of communication may be a source of stress
for customers with mental health problems. We hope that DWP will
take into consideration some of the barriers faced by this client
group such as anxiety about talking over the telephone, feeling
intimidated by people in authority, language problems, literacy
problems and lack of insight into their mental health problems.
It is important for DWP staff to remember when giving
decisions over the phone that decisions are complex, at times
controversial, and carry a right of appeal. They need to be mindful
that the information needs to be conveyed in a fair and neutral
way, so that customers are not dissuaded from appealing.
The lines of communication should be consistent so
that advice workers can correctly advise people on what to expect
during the process.
There is no reference in the descriptors to self
harm/suicidal actions, psychosis or severe self neglect. The previous
PCA did not include this on the presumption they would be covered
by the Severe Mental Illness (SMI) exemption - although this was
not always the case in practice. Most people with a severe mental
illness have a [enhanced] CPA (Care Programme Approach) with intensive
support from Mental Health Services and are not in a position
to undertake work related activities, which could cause deterioration
in their mental health with associated hospital admissions.
A was on CPA with bi-polar
and had multiple incidents of deliberate self harm. WCA assessed
her to be "normal, adequate, no ideas of self harm, good
insight" and awarded zero points. First-tier Tribunal placed
her in the Support Group.
B is under a Psychiatrist
due to severe depression with three suicide attempts, one with
hospital admission and discharge with the Crisis Team visiting
daily at time of WCA. Disability Analyst identified "current
firm detailed plans for self harm" and "has symptoms
of depression and suicidal thoughts such as wanting to drive the
car off the road
although does not fit the Support Group
criteria may not be ready to look towards full time work",
but awarded zero points.
PROPOSAL: include self harm/suicidal actions,
psychosis, or being under an [enhanced] CPA in the Support Group
Many people with severe mental illnesses spend periods
in psychiatric hospital after either voluntary admission or under
section of the Mental Health Act or remain in community under
intensive support of a Mental Health Crisis Team to prevent hospital
admission. A WCA is often arranged within weeks of discharge,
when the person is still trying to re-establish themselves and
become stable in the community and needs time to do this to prevent
deterioration and re-admission.
C had psychiatric hospital
admissions 11 August-2 September and 9 September-12 September
when received ECT causing memory problems. Attended WCA medical
2 October and Disability Analyst assessed treatment as "average
strength" and failed the assessment.
D has paranoid schizophrenia
with psychosis, receiving anti-psychotic depot injections, under
the care of a Consultant Psychiatrist, weekly CPN visits and discharged
from psychiatric hospital one month prior to WCA. CPN accompanied
to WCA. Disability Analyst awarded zero points, First-tier Tribunal
put in Support Group.
PROPOSAL: people discharged from psychiatric hospital/under
Crisis Team are put into the Support Group for initial three months
Some people with mental health problems are discharged
from hospital under a Community Treatment Order or under section
117 After Care, with ongoing intensive input from Mental Health
E was detained in hospital
under section three Mental Health Act and discharged on a Community
Treatment Order. Underwent WCA less than three months after discharge
and assessed by Disability Analyst as having a "mild mental
health condition" and awarded zero points. DWP Decision Maker
returned this to Atos to query and ESA85 returned with assessment
changed to "moderate mental health condition", but still
given zero points. First-tier Tribunal placed in Support Group.
PROPOSAL: people discharged from hospital under
a Community Treatment Order or S117 of the Mental Health Act are
put into the Support Group
There is no exemption for people with SMI, or in
receipt of Highest Rate Care Component (HRCC) of Disability Living
Allowance (DLA) (as previously was under PCA for Incapacity Benefit).
This means people who may need a high level of supervision; monitoring
and support to enable them to live in the community have to attend
medicals, often in busy cities, some distance from their home.
Many such claimants living in the community do not have any warning
of or are unaware of any relapse in their condition until they
reach crisis point. This can happen at any time or may be due
to a claimant ceasing their medication as they feel they are better.
F has severe depression
with psychosis (aural and visual hallucinations day and night),
panic attacks and insomnia. F is under a Psychiatrist,
receiving anti-psychotic medication and in receipt of HRC of DLA.
F's CPN accompanied F to WCA. Disability Analyst
assessed claimant as having mild mental health problems and awarded
zero points. First-tier Tribunal allowed appeal on evidence without
requiring oral submission from claimant.
PROPOSAL: people with SMI or in receipt of HRCC
of DLA should be exempt from the WCA and placed into Support Group.
Mental Health Champions
Where someone has a lack of insight into their condition
and does not think they are ill, Disability Analysts often take
the claimant's word at face value, without the time to undertake
a more in-depth assessment to reveal their actual problems.
G has paranoid schizophrenia
but does not accept this, stating she only has stress. Disability
Analyst assessed her as having anxiety and depression with good
insight into her illness and failed WCA.
H is delusional, hears
voices, has severe paranoia and thinks he was kidnapped and kept
locked in his own house for three weeks (was in psychiatric hospital)
and discharged just prior to WCA. But has no insight, thinks he
is well and shouldn't be on benefits, trying to sue hospital over
wrongful admission. Disability Analyst awarded zero points.
Although we welcome the proposal from Professor Harrington's
review of the WCA that a Mental Health Champion for each Atos
assessment centre has been implemented, we are concerned that
this role has been given, at least in our local area to a member
of Jobcentre Plus staff on top of their other duties.
PROPOSAL: Community Psychiatric Nurses to be recruited
by Atos to be the Mental Health Champion in each area. This champion
could assess claimants with mental health problems, give training
on mental health to their colleagues and spread good practice.
Claimants report experiences of Disability Analysts'
lack of interest, rudeness, not listening to their answers, cutting
them short when trying to qualify/explain their answers, not looking
at them whilst asking questions but just typing into the computer.
L attended medical where
the Assessor diagnosed client with hearing problems despite all
the medical evidence indicating mental health and learning difficulties.
No history of hearing impairment. Client has difficulties with
communication due to mental health and learning difficulties.
PROPOSAL: Disability Analysts are provided with
further training on Customer Care and given more time to undertake
ESA 85 Reports
ESA85 design fault in "drop down" boxes
and multiple reference to an absence of the most severe symptoms
eg "no rocking movements" purporting to indicate there
is little problem present.
PROPOSAL: ESA85 be adapted so that the Disability
Analysts cannot just cut and paste the same information to justify
each descriptor, but give individual reasons for their decision
on each descriptor.
There is often no evidence that the Disability Analyst
and Decision Maker have given any consideration to Exceptional
Circumstances such as substantial risk to the mental or physical
health of any person if the claimant were to be found capable
of work (ESA reg 29) eg due to deterioration in mental health/increase
in self harm/suicide risk/hallucinations/psychiatric hospital
M was found fit for work.
No account was taken to the ongoing treatment from Mental Health
Service Providers to the detriment of the clients mental health.
Mental Health providers have been extremely worried about possible
PROPOSAL: Decision Makers should demonstrate they
have considered Exceptional Circumstances and if not applied give
a full explanation as to how this decision has been made and what
evidence was taken into consideration.
Where people with mental health problems cannot travel
to distant busy cities for the WCA (eg Manchester) it is difficult
to arrange/get agreement for a taxi or a domiciliary assessment.
There are no disabled parking facilities at the Stockport venue.
These factors increase the risk of benefit being stopped due to
non attendance at the medical.
N completed an ESA50 requesting
a Domiciliary with reason. No contact appeared to be made with
GP or Care Co-ordinator. Despite this he was still asked to attend
a medical in person. Eventually after several letters and calls
a Medical Assessor attended his home. Assessor was invited to
his room because he very rarely leaves his bedroom. This was declined
and Assessor had a brief conversation with N's Dad. As
a result of this visit N was placed in the Work Related
Activity Group and asked to attend a further medical again in
P suffers with depression
and severe anxiety. P lives in Rochdale and had a WCA arranged
in Bolton. P tried to attend but had a severe panic attack
on the way and had to return home. P repeatedly tried to
ring Medical Services but could not get through. P's benefit
stopped. Good cause for non attendance accepted and further WCA
arranged, but same problems and benefit ceased again. P
reclaimed ESA and identified on ESA50 the need for a home visit
for WCA with supporting letter from GP but WCA arranged in Manchester.
PROPOSAL: more local centres where WCA's can be
Where someone has a fluctuating mental health condition
eg bi-polar disorder, which can involve severe low and high moods,
a one off WCA assessment cannot reflect this condition and its
effects on the claimant. The ESA50 is very hard for a claimant
with such a condition to complete the answers depending on what
part of the cycle they are currently in. For example the distinctions
between often/frequently/for the majority of the time on the ESA50
are often meaningless to claimants.
Q was in a heightened
state of mood, believing he was invincible. He completed the ESA50
without any help. Unfortunately in this state there was little
insight into his illness believing he was well and subsequently
was found fit for work.
PROPOSAL: ESA50 wording should be changed to reflect
fluctuating conditions. Disability Analysts are given more training
in fluctuating conditions, and where diagnosis suggests this eg
bi-polar, be particularly aware of taking a snap shot picture
of the claimant's difficulties.
People from some cultures can have difficulty voicing
and describing mental health problems due to associated stigma/lack
of appropriate language/words, and these can therefore be missed
at the WCA.
T, a female Asian client
was assessed by an Asian male Doctor despite requesting a female.
She felt he was biased towards her due to cultural differences
and found it difficult to be open with him about her mental health
PROPOSAL: Disability Analysts are trained in cultural
issues in relation to mental health and are given more time to
undertake the medical in order to do a full assessment.
Consideration should be made for whether ESA Reg
29 applies (exceptional circumstances).
It would be good if there was training for all decision
-makers on common mental health conditions and symptoms so that
they can spot cases where it is useful to request further medical
evidence from client's GP, CPN etc
It would be good if Decision Makers had directions
to fully scrutinise ESA85s in order to pick up on inconsistencies.
We welcome that it has been recognised that the appeals
process is very lengthy. We would like to point out the extra
stress that this causes claimants with mental health problems.
The prolonged uncertainty, and hardship caused by living on a
lower income throughout the process, carries a real risk of relapse,
and possible hospital admission, for some claimants in this group.
We welcome that steps have been taken to increase the number of
appeals that can be revised on reconsideration, but hope that
this will be taken a step further for the migration process, by
ensuring WCA medical reports are as accurate as possible, and
Decision Makers are empowered to collect further evidence when
We would like the DWP to understand that it can be
very difficult for claimants to gather their own supporting evidence
for an appeal. Busy GPs sometimes have a policy of not supplying
tailored evidence requested by patients, and sometimes there is
We are concerned that some vulnerable claimants will
still slip through the net of the appeal process, and will then
need to sign on for Jobseeker's Allowance. The added pressure
of conforming to a Jobseeker's Agreement could have a very negative
impact on a claimant's mental health condition.
Claimants who find that they do not meet the criteria
of the WCA are likely to find themselves on Jobseekers' Allowance
long-term. Today's labour market is very competitive, and it is
hard to see how someone who has been too ill to work for a long
time can compete when there are so many healthy and able-bodied
jobseekers with more up to date skills around. Sadly, the future
looks bleak for many of those transferred from Incapacity Benefit
to Jobseeker's Allowance.
The proposal to time limit contribution-based ESA
for those in the Work Related Activity Group to one year fundamentally
changes to nature of the Welfare State. This change will leave
many who don't qualify for income-based ESA without any income
of their own. This undermines that principle of the Welfare State
as a system that gives financial security to those who pay into
it. We are likely to see an increase in the number of appeals
for claimants seeking to be put in the support group, because
there is so much more to gain by this decision. This will increase
the backlog of appeal waiting for a hearing at a time when it
is expected to increase already.
Claimants that don't qualify for income-based ESA
because of a partner's income will lose their financial independence
because of this proposal. This will disproportionately affect
women, and could have a damaging effect for those in abusive relationships.