Do welfare benefit reassessments of people with mental health conditions lead to worse mental health? A prospective cohort study.

BACKGROUND: There have been cases of suicide following the Work Capability Assessment (WCA), a questionnaire and interview for those claiming benefits due to ill health or disability in the United Kingdom. AIMS: To examine whether experiencing problems with welfare benefits, including WCA, among people with pre-existing mental health conditions was associated with poorer mental health and wellbeing and increased health service use and costs. METHODS: A prospective cohort study of an exposed group (n = 42) currently seeking help from a Benefits Advice Service in London and a control group (n = 45) who had recently received advice from the same service. Questionnaires at baseline and 3-, 6- and 12-month follow-ups. RESULTS: The exposed group had higher mean scores for anxiety (p = .008) and depression (p = .016) at baseline and the control group higher mean scores for wellbeing at baseline (p = .034) and 12 months (p = .035). However, loss to follow-up makes overall results difficult to interpret. The control group had higher incomes throughout the study, particularly at the 12-month follow-up (p = .004), but the differences could have been accounted for by other factors. Health service costs were skewed by a few participants who used day-care services intensively or had inpatient stays. Over the study period the proportion of exposed participants engaged in benefits reassessment ranged from 50% to 88%, and 40% to 76% of controls. CONCLUSION: The hardship of living with financial insecurity and a mental health condition made it difficult for our participants to sustain involvement in a 12-month study and the frequency of benefit reviews meant that the experiences of our controls were similar to our exposed group. These limitations limit interpretation but confirm the relevance of our research. The control data raise the question of whether people with mental health conditions are being disproportionately reassessed.

Only Making Things Worse: A Qualitative Study of the Impact of Wrongly Removing Disability Benefits from People with Mental Illness.

Many countries belonging to the Organisation for Economic Co-operation and Development (OECD) have seen a considerable increase in the number of disability benefits recipients (DBRs), in addition to an increase in the proportion of people with mental illness. As in other countries, changes to the welfare benefits system in England were made in order to reduce the number of DBRs. Many people lost their benefit payments, although a considerable number had them reinstated after appeal. Our aim was to investigate the impact of the process on DBRs whose disability was related to mental health and who won their appeal. Seventeen DBRs were interviewed. The participants reported three main types of impact. Beyond the practical reduction of income and the related anxiety, interviewees reported considerable stress when coping with the 'never-ending' cycle of bureaucracy. They also expressed anger, frustration and demoralisation at mistrust on the part of the authorities partly due to the 'invisibility' of their disability.

A welfare benefits outreach project to users of community mental health services.

BACKGROUND: Many psychiatric service users are entitled to welfare benefits, but work from the UK and the USA suggests many are either unaware of their entitlements or find the benefits system difficult to access. AIMS: This study has four aims: 1) to assess the extent to which people using a range of community mental health services receive the welfare benefits to which they are entitled; 2) to calculate the impact on income of receiving help from specialist benefits advisors; 3) to ascertain sociodemographic risk factors for under-claiming; and 4) to identify reasons for under-claiming related to the claims system itself, in order to make recommendations for routine practice. METHODS: This report makes use of data collected during a welfare benefit uptake project by Mind in Croydon staff (MF-G, RO, RP). Benefit assessments were offered to a total of 153 people attending any Croydon resource centre (run by the Health Service) other than the pilot site, or day centre (run by Social Services) for people with mental health problems. All those who were identified as under-claiming were offered help pursuing claims through to conclusion. We used quantitative methods to address the first three aims; qualitative methods in the form of case studies were used to address the fourth. RESULTS: One-third (34%) of people seen were getting their correct entitlement and two-thirds (66%) were under-claiming. All those found to be under-claiming who accepted all the help offered (87 out of 99 underclaimants) did gain additional benefits as a result, of a mean annual amount of pound 3079 each. Under-claiming was more frequent in those under 65 years of age, but having had previous advice or having a care manager did not protect against under-claiming. A number of reasons for under-claiming were identified. CONCLUSIONS: For a large and possibly increasing proportion of people using community mental health services, the current benefits system necessitates frequent advice and help by expert advisers to avoid poverty due to underclaiming. The adverse effects on quality of life and mental health may be significant, as are the economic implications of correcting this level of under-claiming.