Welfare Reform and Work Bill

Written evidence submitted by a number of mental health organisations (WRW 22)

Joint submission from the Centre for Mental Health, Hafal, the Mental Health Foundation, Mind, Rethink Mental Illness, the Royal College of Psychiatrists, Scottish Association for Mental Health

About us

We are responding as a group of expert organisations from across the mental health sector. Many of our organisations provide information and advice to people with experience of mental health problems who are going through the benefits system. We have a number of concerns regarding the draft Welfare Reform and Work Bill, which we believe will have a detrimental effect on people with mental health problems. A full list of organisations that support this response is available in Appendix 1 at the end of the submission.

Key recommendations

- Remove Clauses 13 and 14 from the Bill

- Introduce a reporting obligation for Government on progress against halving the disability employment gap, broken down my primary medical condition.

- Remove the Work Related Activity Group (WRAG) of Employment and Support Allowance (ESA) from the benefit freeze

- Remove Housing Benefit from the benefit freeze, in particular for those in receipt of ESA (both groups) or Disability Living Allowance/Personal Independence Payment

- No changes should be made to ESA until the WCA is fit for purpose for people with mental health problems. A pilot for reasonable adjustments for this group should be implemented as a matter of urgency.

- The Government should urgently review the effectiveness of the use of benefit conditions and sanctions among people with mental health problems

- To increase transparency of the sanctions system, statistics on sanctions usage broken down by primary medical condition

- People with a mental health condition to be exempt from conditionality associated with back-to-work support

Response

1. Clause 13: Employment and support allowance: work-related activity component and Clause 14: Universal credit: limited capability for work element

1.1 We strongly oppose the removal of the WRAG component of ESA and the Limited Capability for Work (LCW) component of Universal Credit. We are concerned that having WRAG ESA at the same rate as Jobseekers Allowance (JSA) does not adequately recognise the distinction between people on JSA and those on ESA. As outlined in 2.1, people in receipt of the WRAG component of ESA have been assessed to have a limited capability for work. It is therefore unreasonable to treat this group as analogous to those who are capable for work.

1.2 We share the Government’s assessment that many people in receipt of ESA want to work.1 Therefore suggesting that the reason people currently do not return to work is because of the financial advantage of being in receipt of benefits is disingenuous. 70% of our survey respondents who are in the WRAG said they would like to return to work, with the right support.2 This latter part is crucial. It is often suggested that work is good for people’s mental health, but this is only the case if that work is appropriate and the person is supported properly.

1 Department for Work and Pensions (2015) Welfare Reform and Work Bill: Impact Assessment to remove the ESA Work-Related Activity Component and the UC Limited Capability for Work Element for new claims

2 Rethink Mental Illness (2015) Welfare benefits survey – unpublished results

3 Burns, T., White, S. J., Catty, J., Burns, T., White, S. J., & Catty, J. (2008). Individual Placement and Support in Europe: the EQOLISE trial. International Review of Psychiatry, 20(6), 498-502.

4 Statistic calculated from Department for Work and Pensions response to a Parliamentary Question (http://www.parliament.uk/business/publications/written-questions-answers-statements/written-questions-answers/?page=1&max=20&questiontype=AllQuestions&house=commons%2clords&uin=209801) and the Department for Work and Pensions tabulation tool.

5 Mind (2014) We still have work to do

6 Rethink Mental Illness (2015) Welfare benefits survey – unpublished results

7 Figures obtained from DWP Tabulation Tool (http://tabulation-tool.dwp.gov.uk/100pc/esa/esa_phase/ctdurtn/a_carate_r_esa_phase_c_ctdurtn_nov14.html) and ONS Labour Market Statistics June 2015 (http://www.ons.gov.uk/ons/rel/lms/labour-market-statistics/june-2015/table-ben03.xls)

8 Rethink Mental Illness (2015) Welfare benefits survey – published results

1.3 Further, we know that with the right support, people with mental health problems can move into employment. This is evident from the success of specialist employment models such as Individual Placement and Support (IPS) in supporting people back to work.3

1.4 Claiming that financial incentive is the cause of the high numbers on ESA also fails to recognise the extremely poor support that is being offered to the WRAG cohort. According to DWP figures, only 8% of ESA claimants who have been referred to the Work Programme with mental health problems have been helped into work compared to 24% of people who have been referred without a health condition.4 Research suggests that all too often people are not offered the right support and there is a lack of expertise in many back-to-work schemes.5 The concern is that this lack of support, coupled with a reduced income, will not create the optimal environment for people to move back to sustainable employment. In a recent survey by Rethink Mental Illness, 86% of respondents who were in receipt of the WRAG component of ESA said that a reduction in their benefits would decrease their ability to return to, or remain in, employment or education.6

1.5 It is also likely that people in receipt of ESA will be reliant on this as their main source of income over a longer period than people in receipt of JSA. Figures show that almost 60% people on JSA move off the benefit within 6 months. In contrast, almost 60% people in the WRAG need this support for at least two years. It is unrealistic to expect people to survive on £73 a week for this length of time.7 This reduced financial support over a longer period time is likely to decrease people’s financial stability, which in turn is likely to have an impact on their mental health.

1.6 We also challenge the assertion that these changes to ESA and Universal Credit will save the Government money. While it may reduce the welfare budget, it is likely that the impact on people will lead them to seek help from other parts of the system. In our survey, 78% of respondents said they would need more support from their GP, community health services or inpatient mental health services.8 This could result in

displaced expenditure from the welfare budget to health and social care budgets under the Department of Health.

Recommendation:

Remove Clauses 13 and 14 from the Bill.

2. Reports

2.1 We welcome the commitment from Government to halve the disability employment gap. We know that people affected by mental illness have a high ‘want-to-work’ rate.9 However, this group has a very low employment rate, for example of only 8% people with schizophrenia are in work.10 Many people are let down by the lack of mental health expertise in back-to-work support services and a limited understanding amongst employers of the reasonable adjustments and other support they could be offering employees with mental health problems.11

9 Perkins R, Farmer P, Litchfield P (2009) Realising ambitions: Better employment support for people with a mental health condition

10 Schizophrenia Commission (2012) The Abandoned Illness

11 Mind (2014) We still have work to do

12 Department for Work and Pensions (2015) Welfare Reform and Work Bill: Impact Assessment to remove the ESA Work-Related Activity Component and the UC Limited Capability for Work Element for new claims

13 http://tabulation-tool.dwp.gov.uk/100pc/esa/icdgpsumm/esa_phase/a_carate_r_icdgpsumm_c_esa_phase_feb15.html

2.2 We have concerns that the removal of the work-related activity component of Employment and Support Allowance (ESA) and the limited capability for work element of Universal Credit (UC) for new claimants will undermine, rather than support, this commitment to closing the disability employment gap. Removing these components could actually move people further from work as the reduction in financial support may have a detrimental impact on their health and wellbeing. Given that halving this gap is one of the key drivers in the impact assessment for these proposals, we feel that the Government should be held to account on whether this policy is meeting its objectives.12

Recommendation:

Following Clause 3 of the Bill, add in an additional clause:

4 Disability employment gap: reporting obligation

The Secretary of State must lay a report before Parliament annually that sets out the progress that has been made towards halving the disability gap, with information broken down by primary medical condition.

3. Clause 9: Freeze of certain social security benefits for four tax years

3.1 People in receipt of Employment and Support Allowance (ESA), whether in the support group or the work-related activity group (WRAG), have been assessed as having limited capability for work as a result of a health condition or disability. We therefore welcome the exemption of the ESA support group from the freeze but are very concerned that the WRAG is currently included in the proposal.

3.2 50.5% of people in the WRAG have a mental or behavioural disorder as their primary medical condition.13 The impact assessment for this proposal suggests that ‘this policy will gradually build the incentive for people to make the choice to move

into work’.14 However people in the WRAG, by definition, have a limited capability for work. We therefore feel that framing a move back to work as a choice is inappropriate for this group of claimants.

14 Department for Work and Pensions (2015) Welfare Reform and Work Bill: Impact Assessment of the benefit rate freeze

15 Rethink Mental Illness (2015) Welfare benefits survey – unpublished results

3.3 The impact assessment for clauses 13 and 14 states that there will be no cash losers from this policy and that vulnerable people are protected. We believe that this will not be the case if the WRAG is included in the freeze and recommend that ESA is removed in its entirety from this clause.

3.4 We also have concerns about the inclusion of Housing Benefit in the benefit freeze. Many people affected by mental illness rely on this financial support to be able to live in a safe and stable home environment, which is crucial in promoting recovery. In our survey, 40% of people affected by mental illness who receive benefits are in receipt of Housing Benefits.15 We therefore recommend that Housing Benefit is excluded from the freeze, in particular for those in receipt of ESA (both groups) or Disability Living Allowance/Personal Independence Payment.

Recommendation:

Under paragraph 1 of the Schedule, remove the following:-

(f) specified in regulations under section 2(1)(a) of the Welfare Reform Act 2007;

(g) specified in regulations under section 2(4)(c) of the Welfare Reform Act 2007, so far as relating to the component under section 2(3) of that Act;

and (h) specified in paragraph 1 of Schedule 4 to the Employment and Support Allowance Regulations 2008 (S.I. 2008/794S.I. 2008/794);

and

Insert the following after paragraph 1 of the Schedule:-

2 The freeze will not apply to the sums specified in 1(b) and 1(c) of the Schedule where –

(a) the claimant or the claimant’s partner is receiving an employment and support allowance under Part 1 of the Welfare Reform Act 2007;

(b) the claimant, the claimant’s partner or a child or young person for whom the claimant or the claimant’s partner is responsible, is receiving a disability living allowance;

(c) the claimant, the claimant’s partner or a child or young person for whom the claimant or the claimant’s partner is responsible, is receiving a personal independence payment;

4. Wider factors

4.1 This Bill will not be operating as a stand-alone piece of legislation and there are a number of elements in the current system that may exacerbate the detrimental provisions of the Bill. Although these may be out of scope of the Bill Committee, we feel they are important dependencies to be considered.

Work Capability Assessment (WCA)

4.2 The current accuracy of the Work Capability Assessment in assigning people to the correct group, particularly those with mental health problems, is a serious concern. In May 2013, the Upper Tribunal ruled that the WCA put people with mental health problems at a ‘substantial disadvantage’ as part of its interim judgement in a Judicial Review brought forward by two anonymous claimants.16 If people who are at already at a disadvantage through the system are then placed wrongly in the WRAG, this will have a significant financial impact on them.

16 MM & DM v Secretary of State for Work and Pensions (WCA) [2013] UKUT 0259 (AAC); [2013] UKUT 0260 (AAC)

17 MM & DM v Secretary of State for Work and Pensions (WCA) [2015] UKUT 0107 (AAC)

18 Catherine Hale (2014) Fulfilling Potential? ESA and the fate of the Work-Related Activity Group

19 Litchfield P, R Perkins, P Farmer (2009) Realising Ambitions: Better employment support for people with a mental health condition

20 Department for Work and Pensions (2013) What works for whom in helping disabled people into work?

21 Work and Pensions Committee, Benefit sanctions policy beyond the Oakley Review (HC 2014-15, 814)

4.3 As part of the final decision of the Upper Tribunal, it was recommended that he Secretary of State for Work and Pensions carried out his proposed pilot of reasonable adjustments to the WCA for claimants with mental health problems.17 We urge that this pilot be introduced and reported on before any changes are made to ESA that could impact on this group of claimants.

Recommendation:

- No changes should be made to ESA until the WCA is fit for purpose for people with mental health problems. A pilot for reasonable adjustments for this group should be implemented as a matter of urgency.

Conditionality

4.4 According to DWP figures, 60% of sanctioned ESA claimants have a mental health condition or learning disability.18 We believe that the sanctions system currently does not take mental health into account or understand the potential impact of symptoms on someone’s ability to engage with work-related activity.

4.5 There is also very little evidence that conditionality works for people affected by mental illness. Instead it is likely to have a negative impact on the support available to people. An independent report on employment support for people with mental health conditions found that ‘the actions of the advisor and the relationship they build with their client are key to helping any individual back to work.’19 This was echoed in a DWP Research Report which stated ‘trusting relationships between claimants and case managers is key to success in overcoming claimants’ concerns and building confidence about going back to work’.20 We are concerned that this important relationship is negatively impacted by the ‘us and them’ approach created by conditionality.

4.6 Sanctions data is not currently available broken down by primary medical conditions other then through a Freedom of Information request. It is therefore difficult to assess whether any one group is being disproportionately sanctioned and to scrutinise the use of sanctions. Earlier this year, the Work and Pensions Select Committee highlighted that ‘there is a lack of evidence for the efficacy of financial sanctions in moving claimants with long-term health conditions and disabilities closer to employment or into work’.21 We echo their calls for a review of the sanctions

system, particularly their impact on vulnerable claimants with a mental health condition.

Recommendations:

- The Government should urgently review the effectiveness of the use of benefit conditions and sanctions among people with mental health problems

- To increase transparency of the sanctions system and publish data on sanctions usage broken down by primary medical condition

- To add people with a mental health or behavioural condition to the list of people exempt from conditionality associated with back-to-work support

Proposed amendments

Clause XX

The Welfare Reform Act 2007 is amended as follows.

After 11J (8) insert:

(9) The Secretary of State must publish a report in each quarter of the calendar year setting out information about :

(a) the number of people who have been sanctioned for failing to comply with a work related requirement

(b) the Primary Medical Condition of the person who has been sanctioned

(c) the amount of the reduction applied to the person

(d) the period for which the reduction had effect

(e) the number of people who have been sanctioned on more than one occasion in the last financial year

Clause XX

The Welfare Reform Act 2007 is amended as follows.

After 11E, (1),(b), insert:

(c) the person has a ‘Mental and Behavioural Disorder’ as a Primary Medical Condition and is in receipt of either the work-related activity component of Employment and Support Allowance (ESA) or the limited capability for work element of Universal Credit (UC)

Appendix 1: Who we are

Centre for Mental Health

Centre for Mental Health is an independent, national charity that aims to help to create a society in which people with mental health problems enjoy equal chances in life to those without. We aim to find practical and effective ways of overcoming barriers to a fulfilling life so that people with mental health problems can make their own lives better with good quality support from the services they need to achieve their aspirations. Through focused research, development and analysis, we identify the barriers to equality for people with mental health problems, we explore ways to overcome those and we advocate for change across the UK.

Hafal

Hafal is run by its 1,000 members - people with a serious mental illness and their families and carers. Every day our 160 staff and 150 volunteers provide help to over 1,000 people affected by serious mental illness across all the 22 counties of Wales. The charity is founded on the belief that people who have direct experience of mental illness know best how services can be delivered. In practice this means that at every project our clients meet to make decisions about how the service will move forward and the charity itself is led by a board of elected Trustees, most of whom either have serious mental illness themselves or are carers of a person with a mental illness. 'Hafal’ means equal. Our mission is to empower people with serious mental illness and their families to enjoy equal access to health and social care, housing, income, education, and employment, and to achieve a better quality of life, fulfil their ambitions for recovery, and fight discrimination.

Mental Health Foundation

For over 65 years across the UK, the Mental Health Foundation has been securing better mental health for all. Its work is centred on prevention. The Foundation believes that there is far more scope for interventions that prevent people developing mental health problems and help sustain recovery. Through research and evaluation the Foundation expands understanding of how to improve mental health; and then shares this knowledge with decision makers and the public, advocating for supportive policies and the roll out of best practice more widely.

Mind

We're Mind, the mental health charity for England and Wales. We believe no one should have to face a mental health problem alone. We provide advice and support to empower anyone experiencing a mental health problem. We campaign to improve services, raise awareness and promote understanding.

Mind has a network of over 150 local Minds, running services across England and Wales. Each local Mind is an independent charity run by local people, for local people. Each is responsible for its own funding and the services it provides, but all are affiliated to Mind. In 2014, local Minds worked with more than 400,000, and services include supported housing, crisis helplines, drop-in centres, employment and training schemes, counselling and befriending.

Rethink Mental Illness

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. We help over 52,000 people each year through our services and support groups and by

providing information on mental health problems. Our website receives over 600,000 visitors every year. Rethink's Advice and Information Service helps almost 8,000 people each year and advises people daily with benefit claims.

Royal College of Psychiatrists The Royal College of Psychiatrists is the leading medical authority on mental health in the United Kingdom and is the professional and educational organisation for doctors specialising in psychiatry.

The Scottish Association for Mental Health

SAMH is Scotland's largest mental health charity, providing services across Scotland and campaigning on mental health issues. Every day staff and volunteers work to prevent suicide, challenge stigma, promote good mental health and well-being. SAMH is highly active in campaigning for positive change and aims to influence mental health policy and legislation, all the while raising funds to continue this vital work.

August 2015

Prepared 11th September 2015