THE BENEFITS ASSAULT COURSE Making the UK benefits system more accessible for people with mental health problems Nikki Bond, Rachel Braverman and Katie Evans Contents Executive summary 5 Introduction 8 This report 10 Section one: The context and the challenge 13 1.1 The problems faced by people experiencing mental health problems 14 1.2 Why are people experiencing mental health problems struggling to access benefits? 16 1.3 Mapping the pain points 17 Section two: Initial application 19 2.1 Complex and demanding administrative processes 19 2.2 Inaccessible communication channels 20 Section three: Providing information and evidence 23 3.1 Complex and demanding administrative processes 23 3.2 Relationship dynamics 23 Section four: Assessments 26 4.1 Inaccessible appointments 27 4.2 Relationship dynamics 27 Section five: Ongoing management 30 5.1 Complex and demanding administrative processes 30 Section six: Challenging decisions 34 6.1 Complex and demanding administrative processes 34 6.2 Relationship dynamics 36 Section seven: Conclusion and recommendations 38 7.1 Universal Design amendments 38 7.2 Acute mental illness 40 2 moneyandmentalhealth.org Publication About the authors The Money and Mental Health Policy Institute, Nikki Bond works as a Research Officer at Money March 2019 and Mental Health. Nikki’s background is in financial services where she worked supporting people with 22 Kingsway, London, WC2B 6LE mental health problems to manage their finances. © Money and Mental Health Policy Institute, 2019 Prior to this she worked in social care advocating for disadvantaged and marginalised groups. The moral right of the authors has been asserted. Rachel Braverman is a Research Officer at Money and All rights reserved. Without limiting the rights under Mental Health. She holds a Master’s degree in Public copyright reserved above, no part of this publication and Social Administration and has lived experience of may be reproduced, stored or introduced in a retrieval mental health issues, both as a carer and an ‘expert system, or transmitted, in any form or by any means by experience’. Her background is in the voluntary (electronic, mechanical, photocopying, recording or advice sector, where she worked for two decades as otherwise), without the prior written permission of both a money adviser, manager, CEO and consultant. the copyright owner and the publisher of this report. Katie Evans is Head of Research and Policy at Money This report represents the research and views solely and Mental Health, where she leads a groundbreaking of the authors and of the Money and Mental Health research programme exploring the links between Policy Institute. mental health problems and financial difficulty. She previously worked as an economist and holds Acknowledgements degrees from the University of Oxford and the London School of Economics. The Money and Mental Health Team would like to express our gratitude and admiration to all those members of our Research Community who gave up their time and shared their experiences. Thank you to Ayaz Manji, Chilli Reid, Gwennan Hardy, Lee Healey, Jamie Thunder, Josie Tucker, Chloe Wright and Billy Boland for their advice and support of the project. All views remain those of the authors, as are any mistakes. A special thanks to the rest of the team at Money and Mental Health, in particular to Helen Undy and Brian Semple for excellent editorial support, and Merlyn Holkar for assistance checking statistics. 3 ASSESSMENT FORM 4 moneyandmentalhealth.org Executive summary Many people claiming benefits are experiencing mental health problems • When people experiencing mental health problems • The Adult Psychiatric Morbidity Survey, the largest can’t access benefits alone, mental health survey of the mental health of the English population, practitioners spend clinical time supporting them. shows nearly half (47%) of working age adults Problems with the benefits system drive increased receiving an out-of-work benefit have a common demand for third sector services, including advice mental disorder, such as depression or anxiety. and food banks. • Two thirds of people claiming Employment and • The paused rollout of Universal Credit, and Support Allowance have a common mental disorder, proposed pilot of Managed Migration, offer an and 43% will have attempted suicide at some point opportunity to make the system more accessible. in their lives, compared to just 7% of people not claiming ESA.1 • Levels of undiagnosed mental illness are Problems affect all parts of the claiming high, meaning some people claiming due to process, from initial applications through unemployment, low income or a physical health providing evidence and attending assessments, problem may also be experiencing a mental health to managing payments and challenging problem, but be unaware of it. In other cases, decisions people may not feel comfortable telling benefits In a survey of 455 people with mental health problems agencies about their mental health problems. who claimed Universal Credit, Housing Benefit, Employment Support Allowance, JobSeeker’s Allowance, Council Tax Reduction or Personal Mental health problems can make navigating Independence Payment in the last two years: the benefits system harder, with serious consequences • Nearly all participants reported finding application forms difficult • Common symptoms of mental health problems include reduced concentration, increased • Four in five (82%) participants had difficulty finding impulsivity, memory problems and reduced planning the right information to send and problem solving skills, all of which can make it • Nine in ten participants (93%) said their mental health harder to claim and manage benefits. deteriorated in anticipation of a medical assessment • Over 90% of recent claimants with mental health • Over two thirds of participants said they always problems who responded to a survey of Money or often need help to attend appointments and and Mental Health’s Research Community reported assessments some level of social anxiety when engaging with the benefits system. People report physical symptoms • Four in five (81%) said they had been unhappy with like a racing heart or sweating, and behavioural a benefits decision, but many did not feel able to changes like avoiding dealing with benefits or using challenge the system. alcohol to cope. 1. McManus S et al (eds.) Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. NHS Digital. 2016. 5 Improving access to benefits for people experiencing mental health problems A combination of high levels of undiagnosed mental In some cases, people with mental health problems illness and stigma means efforts to improve access will experience symptoms so severe that even an to the benefits system for people experiencing mental accessible process won’t suffice. To ensure the most health problems that either focus on those who are vulnerable people are not left behind, we must ensure claiming because of a mental health problem, or rely on additional, targeted support is available to people with disclosure, will never completely address the problem. more complex needs, including people experiencing a Instead, the government must take a universal design mental health crisis or with severe and enduring mental approach – assuming any claimant could be affected health problems. by a mental health problem, and creating systems that a person experiencing common symptoms would not struggle to access. Specific adjustments could include: Recommendations • Designing online forms so people can save their We recommend that the government should: progress and return at a later time, and clearly communicate that this is possible to claimants, • Amend Universal Credit Regulations to which would help those struggling with reduced introduce a new easement for people receiving concentration, memory problems or low energy treatment for a mental health crisis • Providing reminders of actions claimants should • Immediately provide adjustments to take and the relevant deadlines through a variety of assessment processes for people with severe channels – ideally using channels beyond telephone mental illness, following the model used for and post, which many people experiencing mental Health and Social Care assessments health problems struggle to use • Simplify the reassessment process for people • Offering advanced sight of interview questions to with severe mental illnesses. HOUSEHOLD BILLS help claimants with mental health problems which MEDICAL NOTES EMPLOYMENT HISTORY make understanding and processing information PROOF OF ELIGABILITY harder than usual, and who may struggle to give an accurate answer to questions unless they’ve had a chance to prepare. 6 moneyandmentalhealth.org MEDICAL NOTES HOUSEHOLD BILLS EMPLOYMENT HISTORYPROOF OF ELIGABILITY 7 Introduction The benefits system is intended to be a safety net, “I was given ESA without an assessment but PIP ensuring our basic needs are provided for when we are took me to tribunal to fight for what I deserved… unwell, unable to find work or our income isn’t enough Things got so bad I made suicide attempts while to make ends meet. waiting for my PIP brown envelope. I was so low and was shamed. I needed the help but wasn't being Unsurprisingly, these challenging times can affect our believed even with lots of supporting evidence from mental health too – whether or not this is the reason for health professionals.” our claim. A third of Housing Benefit claimants (35%), and nearly half (47%)