Migration to ESA

ESA 10

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 (e.g. 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 e.g. 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.

· Communication

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.

· Work Capability Assessment

Support Group

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.

Example:

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 0 points. First-tier Tribunal placed her in the Support Group.

Example:

B is under a Psychiatrist due to severe depression with 3 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 0 points.

PROPOSAL: include self harm/suicidal actions, psychosis, or being under an [enhanced] CPA in the Support Group criteria.

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.

Example:

C had psychiatric hospital admissions 11/08-02/09 and 09/09-12/09 when received ECT causing memory problems. Attended WCA medical 02/10 and Disability Analyst assessed treatment as ‘average strength’ and failed the assessment.

Example:

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 1 month prior to WCA. CPN accompanied to WCA. Disability Analyst awarded 0 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 3 months after discharge.

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 Services.

Example:

E was detained in hospital under section 3 Mental Health Act and discharged on a Community Treatment Order. Underwent WCA less than 3 months after discharge and assessed by Disability Analyst as having a ‘mild mental health condition’ and awarded 0 points. DWP Decision Maker returned this to ATOS to query and ESA85 returned with assessment changed to ‘moderate mental health condition’, but still given 0 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

Exemptions

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.

Example

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 0 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.

Example:

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.

Example:

H is delusional, hears voices, has severe paranoia and thinks he was kidnapped and kept locked in his own house for 3 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 0 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.

Delivery

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.

Example

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 medicals

ESA 85 Reports

ESA85 design fault in ‘drop down ‘ boxes and multiple reference to an absence of the most severe symptoms e.g. ‘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.

Exceptional Circumstances

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) e.g. due to deterioration in mental health/increase in self harm /suicide risk / hallucinations /psychiatric hospital admission.

Example

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 relapse.

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.

Assessment Centres

Where people with mental health problems cannot travel to distant busy cities for the WCA (e.g. 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.

Example:

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 person.

Example:

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 carried out.

Fluctuating Conditions

Where someone has a fluctuating mental health condition e.g. 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.

Example

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 e.g. bi-polar, be particularly aware of taking a snap shot picture of the claimant’s difficulties.

Equality Considerations

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.

Example

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 problems.

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.

· Decision-making Process

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 G.P ,C.P.N etc

It would be good if D.Ms had directions to fully scrutinise ESA85s in order to pick up on inconsistencies.

· Appeals Process

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 necessary.

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 a charge.

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.

· Outcome of Migration

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.

March 2011