UNIVERSAL CREDIT AND MENTAL HEALTH: RECOMMENDATIONS FOR CHANGE - SAMH
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for Scotland’s mental health UNIVERSAL CREDIT AND MENTAL HEALTH : RECOMMENDATIONS FOR CHANGE
'IT WAS A CONFUSION' 2
ABOUT SAMH
SAMH is the Scottish Association for Mental Health.
Around since 1923, SAMH operates over 60 services in
communities across Scotland providing mental health
social care support, homelessness, addictions and
employment services, among others. These services
together with our national programme work in See Me –
Scotland’s National Anti-Stigma Programme, respectme
– Scotland’s National Anti-Bullying Programme, suicide
prevention, sport and physical activity inform our public
affairs work to influence positive social change.UNIVERSAL CREDIT AND MENTAL HEALTH : RECOMMENDATIONS FOR CHANGE 3
CONTENTS
Summary ...............................................................................................................................................4
Context – What is Universal Credit?.........................................................................................6
Applying for Universal Credit.......................................................................................................6
Assessment for Limited Capability for Work Elements of Universal Credit........8
Delays to assessment..................................................................................................................9
Conditionality while waiting for assessment........................................................................9
Managing a Universal Credit Claim......................................................................................... 10
Initial payments:.......................................................................................................................... 10
Monthly assessment period ................................................................................................... 12
Conditionality and Work Coach Discretion....................................................................... 13
Sanctions and deductions...................................................................................................... 16
Impact of support........................................................................................................................... 17
Universal Support....................................................................................................................... 17
Community Partners Programme........................................................................................ 18
Other support.............................................................................................................................. 19
Scottish Flexibilities ...................................................................................................................... 20
Conclusion.......................................................................................................................................... 21
Recommendations......................................................................................................................... 22
Glossary .............................................................................................................................................. 24
Endnotes.............................................................................................................................................. 25'IT WAS A CONFUSION' 4
SUMMARY
The introduction of Universal Credit, starting in 2013, has
been one of the largest changes to the UK’s social
security system in the last 20 years.
This report explores the experience of The report brings together findings from Applying for
people with mental health problems in research reports from Scotland and
Scotland who have engaged with the across the UK. It has been informed by
Universal Credit
Universal Credit system, and makes three in-depth case studies of people The report outlines difficulties with the
recommendations for changes. The engaged with the Universal Credit ‘Digital by Default’ approach to Universal
report sets out how the aims of Universal System, including a young person and a Credit. For people with mental health
Credit have been undermined through its carer. It has also been informed by other problems digital by default is a clear
structure and delivery. Far from third sector organisations, working barrier when applying for Universal
simplifying the welfare system and directly with people in receipt of Universal Credit. The hurdles include a lack of
supporting people into work, for people Credit, who took part in a SAMH policy access to IT equipment and support;
with mental health problems Universal workshop on Universal Credit in difficulties accessing alternative
Credit has created new barriers and December 2018. application methods through the
added to people’s distress. Our Department of Work and Pensions
While the Universal Credit regime remains
recommendations aim to positively (DWP); problems for some people using
in its current form, SAMH believes no one
change policy at a governmental level, as IT due to their mental health condition;
should be transferred to Universal Credit
well as practice at delivery level in and overall digital literacy. We believe
from legacy benefits, either through
JobCentre Plus. that digital by default should be
natural migration or the forthcoming
scrapped and people should be
managed migration.
permitted to use the most appropriate
The report highlights a number of areas contact channel for them.
where Universal Credit is affecting people
applying for and receiving Universal
Credit, making recommendations on
each area:UNIVERSAL CREDIT AND MENTAL HEALTH : RECOMMENDATIONS FOR CHANGE 5
Far from simplifying the welfare system
and supporting people into work, for
people with mental health problems
Universal Credit has created new
barriers and added to people’s distress.
The Universal Credit Managing Support while receiving
Limited Capability for Universal Credit Universal Credit
Work Assessment The report highlights significant The final part of the report focuses on the
difficulties people with mental health level of support available to people in
In most cases, people who have a medical
problems face when managing their receipt of Universal Credit. Support is
or disabling condition must undergo a
Universal Credit claim. People are too available through Universal Support,
face to face medical assessment when
often subject to inappropriate which while helpful is overly restricted
applying for Universal Credit. This
conditionality, at times resulting in and requires additional investment. The
assessment decides whether they are
sanctions which cause financial and report highlights the Department for
entitled to the Limited Capacity for Work
emotional distress. No evidence has been Work and Pensions (DWP) Community
Element of Universal Credit and
found showing sanctions move people Partners programme as a good example
consequently, whether they will have to
towards employment. The report shows of partnership working to support people
undertake job searching or work related
how the substantial degree of discretion receiving Universal Credit. We are calling
activities in order to receive their benefit.
given to Work Coaches compounds for funding of this programme – due to
The report highlights how face to face
issues around conditionality and end in Match 2019 - to be continued. The
medical assessments do not work for
sanctioning. We call for strengthened report also highlights the positive impact
people with mental health problems. The
guidance to Work Coaches on setting that outside support from third sector
assessments fail to adequately gauge the
conditions on work related activity; and organisations such as SAMH can have on
impact of mental health and other
full use of Work Coaches’ powers to people with mental health problems
fluctuating conditions, with assessors
pause or modify conditionality.
lacking a full understanding of mental The full list of recommendations to the
health. Other issues include people UK Government and Job Centre
waiting for their assessment being management can be found at the end of
required to undertake work related the report. There is also a glossary at the
activities at their Work Coach’s discretion. end of the report explaining key
We call for a fundamental rethink of the terminology.
medical assessment process and an end
to applying conditionality to anyone
waiting to be assessed.'IT WAS A CONFUSION' 6
CONTEXT - WHAT IS
UNIVERSAL CREDIT?
The benefits replaced by Universal Credit a mental health problem. We know that
Universal Credit replaces are Child Tax Credit; Housing Benefit; someone’s mental health is the most
six income-related and out Income Support; income based common reason for someone to be in
of work benefits with one Jobseeker’s Allowance (JSA); income-
related Employment and Support
receipt of ESA.5 From this it can be
inferred that the proportion of people
single payment. Payments Allowance (ESA); and Working Tax Credit.
with mental health problems in receipt of
are made to households These benefits are referred to as ‘legacy
benefits’ throughout this report.
Universal Credit now and in the future will
rather than individuals, be high.
The roll out of Universal Credit to new
with claims managed claimants in Scotland is now complete.
The original purpose of Universal Credit
online. Existing legacy claimants currently can
was to simplify the complex UK social
security system and support people into
be moved to Universal Credit by ‘natural
employment. SAMH supported these
migration’ when they have a change in
aims, recognising that good employment
circumstance, such as a change of
can support mental health, and that the
address or a change in health. An
UK social security system can be
individual’s final Universal Credit award
challenging to navigate, especially for
after natural migration can mean a
people with mental health problems or
reduction in income compared to their
other disabilities.6 However, the Universal
legacy claim.1 The UK Government is
Credit system must be fit for people with
planning for all people in receipt of legacy
mental health problems and not cause
benefits to be transferred to Universal
harm.
Credit through a process called ‘Managed
Migration’ by the end of 2023.2 Unlike for
natural migration the Government’s
intention is that no one’s Universal Credit
award will be reduced through managed
migration. People transferring to
Universal Credit by managed migration
will qualify for transitional protection to
guarantee their Universal Credit award
matches the value of their legacy
benefits.
As of August 2018, 102,139 households in
Scotland are in receipt of Universal
Credit.3 Of these 7,797 households
(7.63%) have at least one person with
limited capability to work.4 Statistics
provided by the UK Government
Department of Work and Pensions (DWP)
do not provide a breakdown of the
reasons why someone has limited
capacity to work, including when this is
due to a mental health condition. This
makes it impossible to know how many
people in receipt of Universal Credit haveUNIVERSAL CREDIT AND MENTAL HEALTH : RECOMMENDATIONS FOR CHANGE 7
APPLYING FOR
UNIVERSAL CREDIT
One of the defining features of Universal The experience of our case studies was and IT. The 2017 Scottish Household
Credit is that it is “digital by default”, mixed. For some people applying for and Survey found that only 66% of
meaning it has to be applied for and managing their UC claim online was households with low incomes (£15,000
managed online. This is a barrier for many beneficial. For example, case study B who or lower) had access to the internet at
people who do not have digital skills or was 19 and highly digitally literate, found home compared to 99% of households
lack access to a computer, and poses the processes easy to understand: with an income over £40,000.13 This
particular issues for people with mental means many people have to rely on
“I did the online application, I didn’t really
health problems.7 libraries and other public buildings to
find it was that hard. I grew up using
access the internet to make and manage
Research from the DWP itself has found technology, so it didn’t really bother me,
their Universal Credit Claim. This is
that: but someone like my aunt who has a mild
becoming more challenging due to
learning disability, I could see her really
24%
increasing number of library closures.14
struggling with it.”
For context, thirty Scottish libraries
(Case Study B) closed in 2017: up from 15 in 2016.15
of people with long term conditions could
This positive experience contrasted with The United Nations Special Rapporteur
not register a Universal Credit claim
Case Study A, who had to apply for on extreme poverty and human rights
online;
Universal Credit on behalf of his son who highlighted in his 2018 statement on the
53%
has significant mental and physical health United Kingdom that support from
problems. He required assistance from libraries to provide digital support to
his local Citizen Advice Bureau to make Universal Credit claimants is
needing support setting up a claim, and the application: insufficient.16 As a 2018 report by
Stirling’s Citizen Advice Bureau points
38%
“I’m terrible at filling out forms, I’m always
out, travelling to access the internet can
frightened I’ll put the wrong thing in and
be costly, especially in rural areas, and
I’ll have to begin again or “No, we’re not
access to libraries and other public
requiring ongoing support.8 going for that” or whatever so I got help
buildings is often time limited.17 For
from the Citizen Advice.”
These figures are affirmed in Citizen people with mental health problems the
Advice Scotland’s Disconnected report, (Case Study A) use of public transport and engaging with
which detailed the experiences of people public facilities can be distressing or not
DWP guidance does allow the option for
seeking advice at 33 Scottish bureaux in possible.18
applying for Universal Credit by
2016.They found that 68% of people
telephone.10 However, there are barriers
seeking to claim a disability benefit would
to accessing this service. Call handlers
require assistance to make an online
must establish “overwhelming evidence
claim.9 Participants from the advice and
employability sector who attended
to suggest a claimant is digitally SAMH recommends that
excluded”, then “stress the importance
SAMH’s Universal Credit policy workshop
and benefits of claiming online”.11 Even the UK government
reported that people with mental health
problems commonly experience
where the claimant is vulnerable, the call scrap Digital by Default
handler must first ensure there is no one
increased anxiety when claiming
else who could support the claimant for Universal Credit and
Universal Credit online. There can be
practical issues arising from their mental
before allowing a phone application.12 permit people to use
This places unacceptable pressure and
health problem, such as difficulty
stress on an already vulnerable person. the most appropriate
remembering log in details.
Another problem with the digital by contact channel for
default system is access to the internet them'IT WAS A CONFUSION' 8
ASSESSMENT FOR LIMITED
CAPABILITY FOR WORK ELEMENTS
OF UNIVERSAL CREDIT
People who have a medical condition or One of our case studies who has social Personal Independence Payment (PIP)
disability that affects their ability to work anxiety and depression explained how his and Disability Living Allowance (DLA).
usually have to undergo a face-to-face requests for reasonable adjustments to
The Scottish Government has
Work Capability Assessment (WCA) the assessment were ignored:
committed to: reducing face-to-face
when claiming Universal Credit. This is a
“I’d wrote on the form that it medical assessments; giving people
functional assessment of their capacity
would be good to do a home choice and flexibility over assessment
to work which determines whether the
location, including home assessments;
person will be required to undertake job visit, or do it over the phone.
and audio recording as standard for all
searching or other work related activities. Or if I come in, could I be put assessments, with claimants and
This assessment is the same as the WCA
just in a room. I’m not asking tribunals having access to the recordings
for people applying for ESA.
them to sit with me, just put to ensure accuracy and build trust in the
If someone is found unable to work, assessment process.26 The legislation
me in a room where it’s just
following assessment, they are placed in underpinning the new Scottish system
the Limited Capability for Work Group me. But I don’t even know if also requires that assessments are
and will not need to do any job searching, they read that at all to be carried out by a suitably qualified person
but are required to undertake work honest. with experience and training, meaning
preparation activities.19 If they are found people with mental health problems
“So, I went up, and I was sitting there
to be unable to undertake work or work should be assessed by someone with
for about an hour and a half. An
related activities due to their health, they relevant mental health experience and
hour and a half is long enough when
qualify for the Limited Capability for Work training.27
you’re sitting waiting and you’re
and Work Related Activity group and will
really, really uncomfortable, it feels This model has potential to significantly
not have to undertake any work
like 12 or 13 hours, that’s just how it improve the experience of assessment in
preparation activities.20 Being placed in
felt... I was just sitting there shaking Scotland for non-income related
the Limited Capability for Work and Work
and I didn’t feel safe, it felt disability benefits.
Related Activity group makes you eligible
uncomfortable”
for additional money as part of your
Universal Credit payments – currently (Case Study C)
£328.32 extra a month.21 The WCA requires urgent and SAMH recommends that
SAMH has consistently highlighted that
fundamental redesign to make it work for the UK Government
people with mental health problems. A
the WCA does not work for people with
face-to-face assessment should only be should use learning
mental health problems.22 , 23 The
assessments do not adequately gauge
a last resort, where a decision on from the development
capability to work cannot be made on the
the impact of mental health and other
basis of existing written evidence about of the Scottish Social
fluctuating conditions, with assessors
lacking a full understanding of mental
the claimant. Claimants must be given a Security system,
home assessment where they request
health. This can result in stigmatising
one. particularly on
behaviour and increased distress for
claimants, as well as a focus on physical The creation of the new Scottish Social disability assessments
impairments by assessors.24 We also Security System and legislative to inform the
know that people are not being underpinnings provides a potential
proactively offered adjustments to their model to redesign the WCA. While the development of a
assessment, such as the option for a Scottish system does not have powers replacement to the
home assessment.25 over the WCA for Universal Credit, it will
have responsibility for the delivery of Work Capability
non-income related disability benefits: AssessmentUNIVERSAL CREDIT AND MENTAL HEALTH : RECOMMENDATIONS FOR CHANGE 9
Delays to assessment “I don’t think they know what’s searching, with the threat of sanction if
Another particular problem under the going on as well, they’ve no answers they don’t comply. This can be as much as
Universal Credit system has been to what’s happening, “when’s his 35 hours of job searching per week.31 This is
unacceptable delays and a lengthy wait assessment?”, “don’t know, just a marked contrast to the legacy system
before assessment. At the start of a claim have to wait and see”. If I go to the where work related activities are not
for Universal Credit, claimants are given Job Centre with his fit note, I’ve still applied until the WCA is complete and the
four weeks to gather evidence on their got to go online to do his Universal person has been placed in the relevant ESA
health and capacity to work and Credit online, take in the fit note and group.32 This means someone who is
complete a UC50 form.28 Following the get them to verify it and it’s obvious unable to work due to a disability, such as a
completion of the UC50 someone with a when you see him that he’s not fit for mental health problem, could be made to
health condition will usually need to then work.” undertake work activities they are
attend a WCA. With limited exceptions, incapable of completing and then be
“There’s nobody assessed him to see
such as terminal illness, the person will sanctioned – potentially losing all of their
what he’s like, that’s the annoying
not be paid the additional limited income - for failing to meet the conditions
thing, the Job Centre sees what he’s
capacity to work and work related activity set out without an assessment having
like but they’ve got to wait on
(LCWRA) element during the waiting taken place. This is unacceptable and must
obviously an appointment coming in
period. The current (2018/19) value of the be stopped.
for an assessment.“
LCWRA element is £328.32 a month. This
(Case Study A) The decision to apply conditions while
a significant loss of income for some of
someone is waiting for their WCA is at the
the most vulnerable people in society The lack of an assessment means that
discretion of their Work Coach and should
while they are waiting for this there is no certainty over the financial
be based on the Work Coach’s
assessment.29 value of his son’s future Universal Credit.
understanding of the claimant’s health.33
People are being left in financial
In June 2018 the median time from As will be discussed in the following section
uncertainty completely unaware of what
application to final decision following a on conditionality, it is clear that Work
income they will receive, leaving people
WCA was 15 weeks.30 We know from our Coaches do not currently have the
unable to plan for their future. In this case
case studies that these waits can be necessary skills or time to make accurate
it is causing significant distress to a father
significantly longer than the average, and assessments of someone’s health to set
who has been unable to organise or pay
that they add to the distress and anxiety appropriate conditions. It is crucial, as
for additional support for his son:
of navigating the system. It also leaves called for by the House of Commons Work
claimants with no certainty over the final “I can’t say to people [carers etc.], and Pensions Committee, that guidance to
level of payment or what work related “Can you come in and do this and do Work Coaches is amended to ensure no
activities, if any, they will be expected to that?”, because I don’t know how one should be expected to undertake any
do. much money he’s going to get, I conditionality while waiting for their WCA.34
haven’t got a clue and [son]
Case study A manages his son’s Universal
wouldn’t know, I find that one day
Credit claim on his behalf, due to his
significant mental and physical health
he’s going to go “Where’s all my SAMH recommends that
money went?”, or I will have to say
conditions. At the time of interview his
“sorry, we can’t employ you no one should have to
son had been waiting for over six months
to receive his work capability
anymore”.” undertake job searching
(Case Study A)
assessment; his Work Coach was unable or work related activities
to give them clarity over a date for Conditionality while waiting for
assessment. This was having a significant assessment while waiting for a Work
negative impact on both their mental While someone is waiting for their Capability Assessment
health: assessment they can still be required to
undertake work related activities and job and its outcome'IT WAS A CONFUSION' 10
MANAGING A
UNIVERSAL CREDIT CLAIM
Initial payments:
The experience of many people with mental health There is a five week wait for receipt of the
problems in receipt of Universal Credit is one of first Universal Credit payment. It is
uncertainty and a lack of control. The reasons for this important to be clear that this delay is
deliberately built into the system and is
are both structural and due to the large amount of not, as it is sometimes presented in
discretion over conditionality given to Work Coaches. public discussions, an error or fault
affecting a few people. Citizens Advice
Scotland reviewed areas where UC has
been fully rolled out and found that this
wait, combined with complications in
accessing short-term support has
contributed to:35
• A 15% rise in rent arrears issues
compared to a national decrease of 2%
• A 87% increase in Crisis Grant awards
nearly tenfold the national increase of
9%
15% increase in • In two of five bureaux in affected areas,
a 40% and 70% increase in advice
rent arrears about access to food banks, compared
issues to a national increase of three per cent
People using SAMH services have
reported similar negative impacts. People
using our housing support service in
Inverclyde reported waits of up to seven
up to 70% increase in weeks for initial Universal Credit
advice about access to payments. This resulted in arrears, the
threat of eviction and a great deal of
foodbanks
distress. The impact of poverty and debt
on mental health is clear with 86% of
people with mental health problems
feeling their financial situation made their
87% increase in Crisis mental health worse.36 A study on the
Grant awards impact of Universal Credit in the North
East of England found that managing a
low income while navigating the Universal
Credit system had led to deterioration in
people’s mental health, including an
increase in thoughts of suicide.37UNIVERSAL CREDIT AND MENTAL HEALTH : RECOMMENDATIONS FOR CHANGE 11
To reduce the impact of the wait for first The advance payment system, while
payment, claimants can apply for an providing short term support, can
‘advanced payment’ any time before the exacerbate financial hardship, debt and
last three days of the end of the initial increase emotional distress over an
assessment month. The value of the extended period of time. SAMH is clear
payment can be up to the full amount of that the built in waiting period for initial
the first Universal Credit payment.38 payment is unacceptable: this needs to
However, advanced payments are a loan be abolished. We agree with Citizens
which must be repaid. The Government Advice Scotland that the advance
recently extended the repayment period payment system should be replaced by
from six months to a year, with the option a non-repayable assessment grant for
of a three month delay to starting new Universal Credit claimants to
repayment.39 The rate of repayment is prevent hardship and debt.41
high - up to 40% of a standard monthly
Universal Credit payment, or 15% if
someone is not in any employment.40
The repayments are automatically SAMH recommends the advanced payment
deducted from someone’s Universal system should be replaced with a non-
Credit.
repayable assessment grant for new
“I phoned up and got an
advance. It’s not ideal, it’s not
Universal Credit claimants
ideal having to wait that long
[6 weeks]. The Universal Job
Match was a bit better that SAMH recommends the immediate
way, but once you get
abolition of the unjustified five week
through that, you’re sort of
all right, but that’s not ideal.”
waiting period for first payment
(Case Study C)'IT WAS A CONFUSION' 12
Monthly assessment period The impact of this uncertainty on the
Payments of Universal Credit are case study’s mental health was clear: SAMH recommends that
calculated each calendar month. 42 For
people who have a varying income this
“lt brings it [my anxiety] out the UK Government
can mean it is difficult to plan their a lot. I try not to think about should replace the
finances. For example one of our case it, I’m sort of just coasting… I
studies has recently been supported into
monthly assessment
should realistically receive a
employment with the help of a SAMH
letter next week at some
period for Universal
Individual Placement and Support (IPS)
employability service. Despite seeking point, but whether I do or Credit with a system
assurances from his Work Coach and the don’t, sometimes they don’t that looks at average
DWP information support line, he has
been given no clarity on the level of future
send the letters out, income over a longer
sometimes I get letters. Then
payments: period
sometimes I just get letters
“So, I’m still receiving
and nothing’s changed,
Universal Credit at the
telling me something has
moment, I can’t tell you how
changed and I’m like, “What’s
it’s going to work though,
changed?” It’s stressful”
because I’ve not received my
(Case study C)
first payment [from work] …
Financial uncertainty can negatively
the folk in the Job Centre, the
affect mental health and act as a
folk in the call centre, I spoke disincentive to work, undermining one of
to four different people. I’ve the key policy objectives of Universal
had four different answers Credit. One way the Government could
act to mitigate this uncertainty would be
about how is this financially,
to change the assessment period to look
what’s the financial impact, at average earning over a longer period of
how is this going to work? time, for example three months.
How much help am I going to
get?
(Case study C)UNIVERSAL CREDIT AND MENTAL HEALTH : RECOMMENDATIONS FOR CHANGE 13
Conditionality and Work Coach However, the onus is on the claimant at
Discretion their initial meeting with a Work Coach to
Conditionality has become a key feature disclose factors, such as their mental
in the UK social security system for health problem, which will affect their
income related benefits. SAMH has long ability to comply with conditions.45 The
been concerned that conditionality does need for disclosure is a significant barrier
not work for people with mental health and source of distress for people with
problems and can damage claimant’s mental health conditions, diagnosed or
mental health, pushing people further otherwise, who may not have the
from employment. Conditionality is a confidence to discuss their mental health
central feature of Universal Credit, on first meeting a Work Coach.
including the threat of sanctions.
One of the case studies did not disclose
Conditionality is the requirement that to their mental health problems while
receive particular benefits (for example applying for Universal Credit, as a
Universal Credit) the person has to agree previous face-to-face assessment for PIP
to undertake specific obligations or had been so stressful. There was,
activities. These activities are mainly job therefore, the potential that this person
searching or other work related activities, was being left short of money and facing
such as engaging in an employability inappropriate conditionality:
programme. Where the person does not
comply with their conditions they risk
“For anyone who’s been on the PIP, the medical assessments
having their benefits reduced or
completely stopped, i.e. sanctioned. that you have to go through for that and especially mental
health conditions, you can find that you just have enough and
People awarded Universal Credit must
agree a ‘Claimant Commitment’. These that you don’t want to then have to add another thing on top of
set out the actions that the claimant that…. When you’re hearing all those stories you just kind of
agrees to take, in order to progress decide that it’s just not worth the risk of losing your benefit”
towards employment. People who are
(Case Study B)
placed in the ‘Limited Capability for Work
and Work-Related Activities’ (LSWRA) are
exempt from conditionality, while those
found “Fit to Work” must undertake all
work related requirements including
intensive job searches.43 People placed
in the “Limited Capability to Work” (LCW)
must take steps to prepare for work, but
are not required to job search. This is the
same as those in the legacy ESA WRAG
group.44'IT WAS A CONFUSION' 14
The exact conditions people are conditions. Evidence from the ESRC The case studies who have informed this
expected to undertake are largely at the Welfare Conditionality project found that report highlighted the importance and
discretion of their Work Coach.46 Work Work Coaches are not routinely applying, impact of someone’s personal
Coaches are expected to tailor discussing or implementing easements relationship with their Work Coach, as
conditions and support to each person’s with claimants52 Currently the DWP does well as the inconsistent approach to
individual needs, taking into account not systematically gather data on applying conditionality. In one case study,
claimants’ vulnerabilities such as their claimant vulnerability or monitor the Work Coach showed an
mental health.47 Evidence shows that this adjustments made for vulnerable understanding of the person’s mental
is not always occurring. Indeed the DWP’s claimants. health and allowed their monthly meeting
own research found that work coaches with the client to be done over the phone
felt overwhelmed by the number of when he felt unable to go to the
claimants with health conditions, lacked SAMH recommends that Jobcentre:
the time or means to confidently identify
vulnerable claimants and did not have changes are made to “Once a month meetings aye.
If I was struggling I could do it
the confidence to apply reasonable the way the ‘Claimant
adjustments to conditions.48 over the phone, things like
Commitment’ is set. that, but I think that just
Work Coaches high caseloads which are
predicted to quadruple, from 85 clients This should include the depends on the person, what
per Work Coach in March 2018, to 373 by Jobcentre proactively coach you get and how they
2024/25. 49 Other factors such as a lack
of facilities to meet clients’ needs gathering information take to you as well.”
undermine the ability of Work Coaches to about the person’s “Because [in the past] I’ve
properly identify and support clients with been on Job Seeker’s
mental health problems.50 health, and explaining
Allowance and there’s times
The case studies discussed practical adjustments that are in Job Seeker’s Allowance
difficulties related to their mental health available. where it’s not been like that,
that Work Coaches did not appear to
adequately understand or make it’s been very, very hard. I
adjustments for. For example, one of the SAMH recommends that think if I wasn’t classed as
case studies found travelling difficult due unwell, I think I would have
to her medication, but the Work Coach the DWP should
found that a lot harder,
would not allow their appointments to be routinely gather and because I think the
over the phone, except on one occasion.
publish data on expectations they’ve got of
Adjustments (‘easements’), including
pausing conditionality, can be applied claimant vulnerability, somebody who is willing to
where someone has a complex need and including adjustments work, is just unrealistic.”
their Work Coach believes “complying
with their work related requirements made to support (Case Study C)
would be unreasonable in the vulnerable claimants.
circumstances.”51 It is essential that Work
Coaches make full use of these powers,
particularly where someone’s mental
health may fluctuate making it impossible
to adhere to strict work relatedUNIVERSAL CREDIT AND MENTAL HEALTH : RECOMMENDATIONS FOR CHANGE 15
The same person expressed that the Unlike the other two case studies the
personal relationship with the Work third case study, who cares for his son,
Coach was key: has trouble complying with conditionality.
He has not been offered flexibility and
“Aye, the work coach I had at
feels the Work Coach does not
the time was pretty understand the impact of his son’s
understanding. I was quite mental health on both of them:
pally with him, and he was “I don’t think so, no, they see
new as well. I think if I had my you’re disabled, yes, but the
second work coach at the impact it’s having on him and
start, I don’t think she’d have me, no, they don’t, there’s no
been as understanding. She help at all, there doesn’t seem
was fine when I spoke to her, to be that sort of …
but I think if I had been in understanding of his health
there and handed in a sick problems, no, they
note, I think I’d have got a understand that he’s
harder time with her than disabled but not what he’s
what I got off of him. I don’t going through mentally. “
know, I just got that vibe.”
(Case Study A)
(Case Study C)
A reliance on good personal relationships
between Work Coaches and claimants is
not a sustainable way to deliver a fair and
equitable social security system.
SAMH recommends that DWP guidance to Work
Coaches over setting appropriate conditions is
strengthened for vulnerable claimants including
people with mental health problems
SAMH recommends that Work Coaches should
make full use of powers over easement to
conditionality, and inform claimants about their
rights to easements'IT WAS A CONFUSION' 16
58% of all ESA sanctions in the first six
months of 2013 were applied to people
with a mental health condition or
learning difficulty.
Sanctions and deductions There is growing evidence about the use
There is no evidence that benefit SAMH recommends that of sanctions for trivial matters such as
sanctions for people with mental health genuine mistakes and being late for an
problems incentivise employment.53 the DWP publish interview with their Work Coach, even
Indeed, the experience and fear of sanction statistics when claimants had good cause.64
sanctioning reduces trust in the UK
welfare system, exacerbates claimants’ disaggregated by Research SAMH undertook in 2016
regarding ESA highlighted the impact that
mental health problems and creates an disability and medical sanctions and the threat of sanctions can
additional barrier to gaining
employment.54 The Scottish findings condition have on someone’s mental health.65
People using our services told us that the
from the Welfare Conditionality project
overhanging threat of sanctions was
found that benefit sanctions
As stated above people in receipt of debilitating:
exacerbated both physical and mental
Universal Credit can be subject to
health problems and did not promote “The fear of being sanctioned
sanctions when they do not comply with
behavioural change in regards to moving is enough to ruin your life
conditions outlined in their interim or full
towards employment.55
claimant commitment. This could involve without [actually] being
The latest statistics from the DWP show not meeting the work search requirement sanctioned.”
that, in August 2018, 2.9% of people in of their commitment or not attending
(SAMH Service User).66
receipt of Universal Credit had a their work-focused interview without
deduction to their award due to a good cause.60 Claimants who are placed As discussed above, Work Coach
sanction.56 This is a much higher in the ‘Limited Capability for Work and discretion results in inconsistency in
sanction rate compared to legacy Work-Related Activities’ group are not when and for what reasons sanctions
benefits where, in August 2018, 0.2% of subject to any conditionality or are applied.
JSA claimants and 0.1% of ESA WRAG sanctioning, though they are at risk of
claimants had a benefit deduction due to sanction prior to their WCA.
a sanction. 57 The number of people with
There are various levels of sanctions:
mental health problems who are
sanctioned is not publically available as
higher, medium, low and lowest, with SAMH recommends that
lengths of sanctions increasing the more
the DWP do not produce these figures.58
times someone is sanctioned.61 The the UK Government
We are concerned that people with
mental health problems will be
maximum length of sanction is three should end benefit
years; this is for three or more ‘higher
disproportionately sanctioned. Freedom
level sanctions’ within a one year sanctions for people
of information requests in 2014 found
that 58% of all ESA sanctions in the first
period.62 The rate of sanction is 100% of with mental health
the standard Universal Credit Allowance.
six months of 2013 were applied to
In a limited number of circumstances the problems
people with a mental health condition or
rate is 40%, such as when someone is a
learning difficulty.59
carer of a child under the age of one, or
someone’s claimant commitment
requires only attending work-focused
interviews.63 There is no exemption for
people with disabilities, including mental
health problems.UNIVERSAL CREDIT AND MENTAL HEALTH : RECOMMENDATIONS FOR CHANGE 17
IMPACT OF SUPPORT
Universal Support Reasons for this include structural
People applying for and A DWP evaluation of Universal Support problems with Universal Credit such as
receiving Universal Credit trials in 2016, found that 45% of the the initial waiting period for the first
can access support for claimants in the trial were disabled, with payment; high rates of deductions from
mental health problems the most Universal Credit payments, including to
managing their claim from commonly reported condition.67 Of pay back advanced payments and
the DWP Universal those with a disability 60% reported difficulty budgeting, especially where
Support (US) service. stress and anxiety; 58% depression and someone is paid Universal Credit
28% another mental health problem, monthly.76
Universal Support compared to 46% with mobility
provides ‘Assisted Digital impairment.68
The move of delivery from April 2019 to
Citizens Advice and Citizens Advice
Support’ (ADS) to help While the provision of government Scotland is welcome and can hopefully
people make and maintain funded support is welcome, to date it has provide more consistent support, as well
online claims; and been insufficient, time-limited and as links to co-locate support beyond the
challenging for people to access.69 The limited scope of Universal Support.
‘Personal Budgeting DWP’s own figures found that the take-up However, this positive move risks being
Support’ (PBS) to help of Universal Support has been one third undermined if the budget provided by
people manage their of what was expected, with the service the DWP to deliver Universal Support is
not being routinely offered to not increased to meet demand and the
money.92 The service has claimants.70 service is not expanded to offer longer
been delivered by local Universal Support is time limited to the
term support, including debt advice.
authorities, but from April first three months of someone’s
2019 it will be delivered by Universal Credit claim.71 The House of
SAMH recommends that
Commons Work and Pensions
Citizen Advice and Citizen Committee found that, in reality, people Universal Support be
Advice Scotland.93 were restricted to as little as two hours of
support, as this is all that is funded by the funded to meet demand
DWP.72 Furthermore, Universal Support with longer term
provides no debt advice through its
personal budgeting service, despite this support provided,
being a key issue for claimants. Indeed, including debt advice
debt is a recurring problem for people
who have to take an advance payment,
while waiting for their initial Universal
Credit payment.73
Evidence from Citizen’s Advice shows
that Universal Credit actively increases
the likelihood of someone getting into
debt: including rent arrears and council
tax arrears.74 Citizen Advice clients in
receipt of Universal Credit were more
likely to have problems with debt
compared to legacy benefit clients –
26% compared to 19%; and less available
credit to help pay off the debts.75'IT WAS A CONFUSION' 18
Community Partners Programme claimants to access; organising job clubs
Research published by the DWP in 2017 in the Jobcentre facilitated by peer
found that Work Coaches often lack workers; and encouraging Work Coaches
previous experience working with people to focus initial conditionality around
with mental health problems, and find wellbeing, rather than job searching and
conversations about mental health traditional work related activities.
“difficult, personal and uncomfortable to
It is unacceptable that the UK
handle”.77 While this research focused on
Government has not confirmed funding
ESA one of its aims was to inform the
for the Community Partners programme
DWP about the needs of Work Coaches
or the DEAs past March 2019.82 This cut
during the roll out of Universal Credit. 78
comes at a time when the UC case load
To assist Work Coaches in supporting will substantially rise due to natural and
disabled people, including people with managed migration Indeed, witnesses to
mental health problems, the UK the Work and Pensions Committee’s
Government funded 200 Community Universal Credit Inquiry highlighted the
Partners and additional Disability need to increase the number of
Employment Advisors (DEAs) to work Community Partners and DEAs, as Work
within Jobcentres.79 Both these roles Coaches were struggling to support
provide specialist disability experience to disabled people due to high caseloads
support Work Coaches. and a lack of expertise.83
Community Partners are people with
professional or personal experience of
disability. Their role is to provide local SAMH recommends that the UK
knowledge to identify opportunities for
tailored support to claimants and provide Government commit to ongoing funding to
insight on the additional barriers disabled the Community Partner programme and
people face entering the workplace.80
Community Partners have individual additional DEAs
specialisms. For example, the
programme includes Mental Health
Community Partners, Young Person’s
Community Partners and partners SAMH recommends all Jobcentre Plus’ must
specialising in drug and alcohol
addictions.81 have access to a mental health Community
In researching this report, we heard of Partner, with shared learning and good
initiatives by Mental Health Community practice between Community Partners
Partners to support both Work Coaches
and claimants around mental health. facilitated
These included: holding focus groups
with Jobcentre clients who have mental
health problems; working with local GPs
and mental health organisations,
including bringing mental health
organisations into the Jobcentre forUNIVERSAL CREDIT AND MENTAL HEALTH : RECOMMENDATIONS FOR CHANGE 19
Other support “Aye, it’s [IPS] definitely In contrast, for legacy benefits such as
Support provided by the advice, helped me. It’s helped in ESA, Welfare Advisors can contact the
advocacy and wider third sector is DWP using “implicit consent”. This means
regards to I got offered
crucial to help people with mental health that the client can give prior consent to
problems navigate the complex Universal various different things that I the Welfare Advisor, so they do not have
Credit system. All three of the case thought were brilliant, like to contact the DWP themselves and do
studies who informed this report had they get me some new clothes not need to be present when the Welfare
been supported by a variety of Advisor contacts the DWP. The removal
and that for starting work,
organisations when making and of implicit consent has made it harder for
managing their Universal Credit claim. and getting a bus pass...It’s welfare advisors to do their job resulting
definitely helped me, [IPS in delays to addressing problems with
Two of the case studies were clients at
worker] was going to come to people’s claims causing subsequent
SAMH’s Individual Placement and
hardship and distress to clients.87
Support (IPS) employability services. IPS one of my meetings with my
provides specialist employability support Work Coach as well, this when
to people with mental health problems,
and is two to three times more effective
all the confusion was SAMH recommends that
happening, and nobody knew
than other interventions.84 Both case implicit consent to
studies found that their IPS worker it was happening when I’d
helped them to prepare for the started work. She was going
welfare advisors and
workplace, supported them in work and
to come up and she was going other relevant
helped them to engage with the Universal
Credit system: to ask, because obviously I representatives be
“I’d say especially stuff like the
don’t like to do the ... I don’t reinstated for Universal
like to interact as it is, so
IPS scheme that really helped Credit
confrontation, it’s a lot
me out and it’s quite good
harder. “
because I think they can give a
(Case Study C)
bit more specialised support
that the Jobcentre just can’t Despite these positive experiences there
are structural problems in the Universal
because if you have someone
Credit system that can make it more
who’s been trained, a difficult for external support to engage
specialist like SAMH, who know clients. Unlike the practice for legacy
about mental health, they’re benefits, Welfare Advisors can no longer
contact the Jobcentre or DWP on behalf
going to know what’s
of their client about Universal Credit
appropriate, what’s not.” without “explicit consent”.85 In practice
(Case study B) this means that the client must give
permission in writing, over the telephone
or in person to the DWP, in order for a
representative to speak to the DWP
about their claim.86'IT WAS A CONFUSION' 20
SCOTTISH
FLEXIBILITIES
While Universal Credit is a reserved “it was about his rent, it was a
benefit – meaning the UK Government confusion to me because they SAMH recommends that
has responsibility for it - aspects of its
delivery have been devolved to the
were taking [X amount of the DWP and Scottish
money]. I left a message and
Scottish Government by the Scotland Government work
Act 2016. it took them over a month to
answer it. Why was he only
together to urgently
Specifically the Scottish Government has
powers over the frequency of payment of getting X amount when he correct issues over the
Universal Credit; the ability to pay the should be getting Y amount? delivery of the Scottish
housing element of Universal Credit
directly to a landlord; and powers over
It’s the system, the way they Choices to provide
do the system and the
splitting the payment between members assurance to Universal
of a household where a couple is in problem with the council,
receipt of Universal Credit. To date, the they kept telling me he’s in
Credit claimants and
Scottish Government has exercised their
arrears with his rent but the landlords
powers over direct payments to
landlords and frequency of payments. Universal Credit paid his rent,
These are called Universal Credit that’s not my problem, that
Scottish Choices.88 Since October 2017 they don’t pay you till a
Scottish Universal Credit claimants have
month later, that’s not my
had the choice to receive their payment
twice monthly rather than monthly and problem, they keep sending
can choose to have their housing me letters or phoning me that
element paid directly to their landlord. he’s in arrears and he’s not
The payments themselves are still
because it’s Universal Credit
delivered by the DWP.
that’s paying his rent and so
SAMH welcomes these choices and
on.”
believes that they will assist people in
managing their money and avoiding (Case Study A)
financial hardship.89 Despite the positive
It is unacceptable that administrative
impact of the Scottish Choices, their
problems should be a barrier to people in
administration has caused some
receipt of Universal Credit accessing
problems to social landlords.90 For
their right to the Scottish Choices.
example, the housing element under the
Scottish Choices is paid to landlords in
arrears on a four weekly basis and does
not match the calendar monthly
schedule for Universal Credit payments
to claimants. This has caused
administrative problems and uncertainty
over arrears and income for social
landlords as well as confusion to
claimants.91UNIVERSAL CREDIT AND MENTAL HEALTH : RECOMMENDATIONS FOR CHANGE 21
CONCLUSION
UNIVERSAL CREDIT IS
NOT WORKING FOR
PEOPLE WITH
MENTAL HEALTH
PROBLEMS.
SAMH welcomed the principles of simplifying the UK social security system and
supporting people into employment. But the operation of Universal Credit has
undermined these aims and caused hardship and additional emotional distress to
people using the system.
The reliance on a rigid digital by default system is a significant barrier to people
with mental health problems when claiming and then managing their Universal
Credit entitlement. There are also structural issues with Universal Credit that are
direct obstacles to people with mental health problems accessing essential
support and financial security. These include the initial five week wait for payment;
the reliance on face-to-face assessment to establish eligibility for the disability
component of the award; the time-limited nature of Universal Support; and
removal of implicit consent for welfare rights advisors. The central feature of
Universal Credit – conditionality – has left claimants lacking control and is not
tailored to support people with mental health problems. The conditionality regime
relies largely on the discretion of Work Coaches, who are not specialists in mental
health or disability. This is compounded by a regime of sanctioning and the threat
of sanctions where claimants do not comply with job searching and work related
conditions. It is essential that the level of uncertainty and reliance on discretion is
reduced in the system, while Work Coaches should be trained and empowered to
make genuinely supportive adjustments to claimants’ conditions to support their
mental health and wellbeing.'IT WAS A CONFUSION' 22
RECOMMENDATIONS
While the Universal Applying for
Universal Credit
Credit regime remains in SAMH recommends that the UK
government scrap Digital by Default and
its current form, SAMH permit people to use the most
appropriate contact channel for them.
recommends that no Being Assessed for
one is transferred to Limited Capacity to
Work
Universal Credit from SAMH recommends that the UK
Government use learning from the
legacy benefits, either
development of the Scottish Social
Security system, particularly on disability
assessments, to inform the development
through natural
of a replacement to the Work Capability
Assessment (WCA).
migration or the
SAMH recommends that no one should
have to undertake job searching or work
related activities while waiting for a WCA
forthcoming managed
and its outcome.
migration.UNIVERSAL CREDIT AND MENTAL HEALTH : RECOMMENDATIONS FOR CHANGE 23
Managing Universal Conditionality Support for People in
Credit SAMH recommends that DWP guidance receipt of Universal
to Work Coaches over setting
SAMH recommends the advanced
appropriate conditions is strengthened Credit
payment system should be replaced with
for vulnerable claimants, including people SAMH recommends that the ‘Universal
a non-repayable assessment grant for
with mental health problems Support’ service is funded to meet
new Universal Credit claimants.
demand with longer term support
SAMH recommends that Work Coaches
SAMH recommends the immediate provided, including debt advice.
should make full use of powers available
abolition of the unjustified five week
to them (easements) to ensure that SAMH recommends that the UK
waiting period for first payment.
conditionality is as flexible as possible. Government commit to ongoing funding
SAMH recommends that the UK Claimants should be fully informed about to the Community Partner programme
Government should replace the monthly their rights to easements. and additional Disability Employment
assessment period for Universal Credit Advisors (DEAs).
SAMH recommends that the DWP
with a system that looks at average
publish sanction statistics, disaggregated SAMH recommends that all Jobcentres
income over a longer period.
by disability and medical condition. have access to a mental health
Community Partner, with shared learning
and good practice between Community
Identifying Sanctions Partners facilitated.
Vulnerabilities SAMH recommends that the UK SAMH recommends that implicit consent
SAMH recommends the Jobcentre Government should end benefit to welfare advisors and other relevant
proactively gathers information about sanctions for people with mental health representatives is reinstated for Universal
the person’s health, prior to setting their problems. Credit
Claimant Commitment. Jobcentre staff
must explain, offer and apply reasonable
adjustments that are available. Scottish Flexibilities
SAMH recommends the DWP should SAMH recommends that the DWP and
routinely gather and publish data on Scottish Government work together to
claimant vulnerability, including urgently correct administrative issues
adjustments made to support vulnerable over the delivery of the Scottish Choices,
claimants. such as payment of the housing element
to social landlords, to provide assurance
to Universal Credit claimants and
landlords.You can also read
