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 have
UNIVERSAL 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: Assessment
UNIVERSAL 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.37
UNIVERSAL 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 related
UNIVERSAL 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 for
UNIVERSAL 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.91
UNIVERSAL 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.
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