Page created by Amy Carlson
for Scotland’s mental health

'IT WAS A CONFUSION'                                                           2


                        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


          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


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


                             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
                             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

                             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


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

                                                                                               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
                                              Universal Credit on behalf of his son who        highlighted in his 2018 statement on the

                                              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

                                              “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


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
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


                                                          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

     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
                                                          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

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-
                                             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
(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
'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

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


                               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


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
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
UNIVERSAL CREDIT AND MENTAL HEALTH : RECOMMENDATIONS FOR CHANGE                                                         21


                               UNIVERSAL CREDIT IS
                               NOT WORKING FOR
                               PEOPLE WITH
                               MENTAL HEALTH
                               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


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
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.

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
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