Evidence session on the impact of Universal Credit on mental health
Report from informal meeting on 23 June 2020
OVERVIEW
The APPG on Universal Credit (UC) is a cross-party group, which was established in order for Members of Parliament and Peers of all parties to be able to come together to discuss their experiences of UC and those of their constituents, to receive advice and support from various agencies, to share best practice at supporting claimants and monitor this critical policy as it is rolled out.
The APPG accepts the core aims of UC in simplifying the benefits system and making it easier for people to move into work. The reality of UC, however, does not live up to these good intentions. We are seriously concerned that the design of UC does not sufficiently take into consideration the specific needs of the poorest working age people in the UK, that it fails to provide many of households with sufficient income to get by and that in its current form, UC does not work in their best interest. When this is coupled with the cuts to UC, for example, from the work allowances, taper rate and disability premiums, evidence indicates that some groups of claimants, including disabled people and single parents, are worse off than under the legacy system.
On 23 June 2020, the APPG held a virtual evidence on the impact of Universal Credit on mental health hearing evidence from: Mind, Money and Mental Health Policy Institute and University of Liverpool.
Of the 120 attendees, the following parliamentarians were present: Debbie Abrahams MP (Chair of the APPG on Universal Credit), Baroness Bennett of Manor Castle, Jonathan Gullis MP (Secretary of the APPG on Universal Credit), Baroness Ruth Lister of Burtersett, Anne Mclaughlin MP, Jeff Smith MP and Stephen Timms MP.
SPEAKERS
- UNIVERSITY OF LIVERPOOL
About
The department of public health, policy and systems at the University of Liverpool have been undertaking extensive research on the effects of welfare reform and poverty on different aspects of health and health inequalities in the UK.
Sophie Wickham’s research (March 2020) is the first nationally representative quantitative study looking at the mental health impact of UC. The study looked at whether mental health changed for unemployed working age people eligible for UC when it was introduced in their area. It used a nationally representative data source of over 50,000 people across multiple time points between 2009 and 2018, as well as DWP data on UC claimants.
Mental Health overview
- Mental health in the UK has deteriorated in the last 2 decades.
- Depression is one of the leading causes of disability worldwide.
- Close to 800, 000 people die due to suicide every year according to the World Health Organisation.
- In England alone, 1 in 6 people report experiencing a common mental health
problem (such as anxiety and depression) in any given week.
- Mental health problems are associated with large direct costs for individuals and society, such as the provision of health and social care, and indirect costs including lost employment.
- In England, these wider economic costs have been estimated at £105.2 billion
each year.
- A 2015 a study showed that mental health related issues led to 18 million sick days leave, or 13% of all total sick days taken in the UK and the cost to society of those problems has been estimated at 5 and a half billion.
- So, considering the potential health impacts of UC now are imperative – as a there is little point having a policy that is moving people back into work if it is also having a negative mental health impact.
Key findings
- The study gives robust evidence of that UC is having a negative impact on the mental health of unemployed people moving onto UC.
- The study found that the introduction of UC led to an additional seven people experiencing worse mental health for every 100 people affected by UC.
- From this the study estimated that the introduction of UC led to an additional 64,000 unemployed people experiencing psychological distress between 2013 and 2018.
- Of these the study saw 21,000 additional people moving on UC developing clinical level of depression.
- The study looked at the primary aim of UC- to move people into employment. The study found no evidence that UC moved people from unemployment into employment.
- UC is generating mental health problems and is unlikely to be cost saving if its pushing people into other services and health and social care.
Recommendations
- Health and health equity must be at the heart of welfare policy. With over half of families in the UK received some type of state support and an additional 3 million moving onto UC as a result of COVID, the welfare system can have major implications for population health.
- It is crucial that the Government includes robust evaluation and assessment of health impacts of UC and other welfare changes. The Government has commissioned an evaluation UC, but the evaluation framework only includes an assessment of labour market outcomes.
- From a health perspective it is so important to ensure that the benefit entitlement is adequate to live a healthy life. This includes reducing uncertainty around the benefit assessment, implementation and delivery. The benefit system also needs be flexible to the individual needs of claimants.
- MONEY AND MENTAL HEALTH POLICY INSTITUTE
About Money and Mental Health Policy Institute
Money and Mental Health Policy (MMHP) Institute was established by founder of MoneySavingExpert.com Martin Lewis in 2016 to help try to break the links between financial difficulty and mental health problems. At the heart of everything MMHP do, are the MMHP’s RC, (5,000) who feed into all of our research and policy. Issues with benefits system is amongst the topics most commonly raised by the RC.
Alongside the RC, MMHP’s evidence draws on their two key reports: Benefits assault course (2019) and Income in crisis (2020)
Key findings
- MMHP have found that significant number of people claiming benefits also experiencing mental health problems.
- Nearly half of working-age adults receiving an out-of-work benefit have a common mental disorder like depression or anxiety. Rising to two-thirds of people claiming Employment and Support Allowance.
Applying for UC
- Parts of the UC system can only be accessed online such as managing your journal. While claimants are expected to telephone to make an initial UC appointment with the Jobcentre. If you can’t jump through these hoops or you can’t do it in the strict timescales, claimants risk their claims being closed or delayed, which leads to delays in payments.
- 4 in 5 claimants who responded to MMHP’s survey had difficulty finding the right information to support their claim, eg. proof of income, savings and housing tenancies. This was often due to not opening the post or being disorganised with paperwork because of a mental health problem.
Assessments
- Work Capability assessments can be a source of distress and often produce incorrect results. Leaving claimants with claimant commitments and conditionality unrealistic to their health condition
- 9 in 10 claimants who responded to MMHP’s survey said their mental health deteriorated in anticipation of an assessment. Fewer than 1 in 5 felt their assessor understood the impact of their mental health problems.
- Often claimants felt an assessors lack of understanding of the impact of their mental health problem or claimants were unable to articulate what they want to say or advocate for themselves due to their mental health problem.
Challenging decisions
- 4 out of 5 claimants who responded to MMHP’s survey said they had been unhappy with a benefits decision, but most didn’t challenge it.
- Where people do challenge decisions, a large number of Mandatory Reconsiderations and appeals are successful.
- Having mental health problems makes advocating for yourself, and articulating yourself can incredibly hard when you’re struggling with low motivation, concentration or self-worth.
The 5-week wait
- People with mental health problems are more likely to be living in a financially precarious situation that those without because many are in low paid, high turnover and part-time work.
- Almost 7 out of 10 claimants who responded to MMHP’s survey reported they can’t afford to regularly save.
- Therefore, when applying for UC, people with mental health problems are less likely to have the financial means to see them through the 5 week wait.
- Advance payments are a lifeline for many claimants with mental health problems. But this lifeline comes at a cost plunging them further into debt and repayments the often can’t afford.
- Understanding repayment terms and deciding to request an advance can be difficult for claimants with mental health problems to navigate
The mental health consequences
- 9 out of 10 claimants who responded to MMHP’s survey reported symptoms of anxiety in dealing with the benefits system – nearly half of these displayed symptoms of severe or extreme anxiety.
Recommendations
- Make permanent some of the welcome temporary changes introduced as a result of COVID, such as the UC uplift and extending it to legacy benefits.
- Offering advanced sight of WCA questions so claimants can prepare.
- Provide reminders of the steps claimants need to make in processing and managing their claims.
- Make sure claimants can complete different tasks across multiple channels eg. booking initial UC appointments not just on the phone, but online too.
- Offer protection from sanctions to all claimants receiving NHS treatment for a mental health crisis.
- Protection should be introduced for claimants who might be experiencing delusions or be acutely suicidal to avoid sanctions, in the same way that protection is already provided to victims of domestic abuse or claimants receiving treatment for drug or alcohol addictions.
- Advance Payments should be grants not loans to make sure people don’t end up further in debt during the 5-week wait.
- Failing this, the Government should take further steps to mitigate the harm caused by the 5-week wait. For example, currently, in exceptional circumstances, claimants can defer repayments for three months. This should be introduced as the default option for claimants with mental health problems.
- MIND
Mind offers information and advice to people with mental health problems in England and Wales.
Key findings
- UC is simply inaccessible for many people with mental health problems.
- Claimants have little option but to either struggle with the UC process making them more unwell, or try to access an alternative provision which may also be inaccessible, or hand over control and autonomy of their claim to someone else who can help them.
- However, as a result of Coronavirus there have been some positive examples of changes to the benefits system and an opportunity make permanent those changes.
Suspension of face to face assessments
- Remote assessments were introduced in March and face-to-face assessments suspended due to COVID.
- Pre COVID claimants who found it almost impossible to travel somewhere totally new to meet a complete stranger had to go to a mandatory face-to-face assessment. Some claimants had home visits instead, but for many the idea of having a stranger inside your one safe space is even worse.
- The DWP have introduced phone assessments for PIP and ESA during COVID.
- However, for some claimants, phone assessments also aren’t the right thing.
- Mind have heard from people starting a UC claim that they are still being told they have to wait to have a face-to-face assessment. Without an assessment these claimants will be going without the money they need, and they are entitled to.
Suspension of third-party debts
- Debt and the fear of debt are a significant concern for many claimants with mental health problems. Deductions from UC payments are often set at unaffordable levels for an individual’s circumstances. The suspension of the repayment of third-party debts has been another positive change as a result of COVID.
Suspension of sanctions
- Another important change was the requirement to search for work being suspended.
- For people who previously would have been on legacy benefits which supported those whose health condition or disability makes it hard for them to work, UC has introduced significantly more conditionality.
- Under UC anyone making a claim is also required to attend Jobcentre appointments and commit to searching for work from the first day of their claim.
- People who are too unwell to work can only have their requirements ‘switched-off’ once they have been through a Work Capability Assessment, which in some areas may take several months to arrange.
- Research from the DWP found that increasing conditionality requirements on people with mental health problems was associated with a lower likelihood of returning to work.
- For people who are having to claim benefits as a result of their mental health problems, people often tell Mind that being forced to either search for work or do work-related activity just makes them more unwell.
- Suspending the requirement to search for work over this period has been a huge relief for many claimants with mental health problems, and despite the incredibly difficult circumstances, has allowed them to better manage their mental health.
Recommendations
- For UC to work for people with mental health problems, it needs to have flexible options built into the system, and to proactively offer them to people.
- When face-to-face assessments are able to return, phone and paper assessments should also remain as assessment options. There might be other alternatives, like video calls. The DWP should proactively offer people a range of options to provide an effective, accessible process and ensure many people with mental health problems do not continue to fall through the gaps.
- Reassessments should be brought back at the moment, as claimants currently have less access to support and medical evidence.
- Initial assessments must continue however, otherwise people will go without money they are entitled to.
- Once a likely or intended decision has been reached the evidence for it must be shared with the person making the claim so they are able to raise any concerns with accuracy immediately.
- The suspension of the repayment of third-party debts must continue and a process put in place to make sure that deductions never reduce a claimants’ income below what they need to live on.
- Sanctions should be removed and replaced with voluntary support that’s tailored to meeting a claimants’ needs.
