Work and Pensions Committee Inquiry into the impact
of the Work Programme on different user groups
Response from the Centre for Mental Health, Mind, and the
Scottish Association for Mental Health (SAMH)
1.
Introduction
1.1
The Work Programme works with an unprecedented number of benefit
claimants, with vastly different circumstances, barriers, prospects and
needs, within a single back-to-work scheme. It is therefore absolutely
vital that the programme is able to identify these circumstances,
recognise these barriers, and support these needs.
1.2
People with mental health problems make up a significant proportion of
people on the Work Programme. People with ‘mental and behavioural
disorders’ accounted for 44 per cent of claims for the old Incapacity
Benefit.1 For the new out-of-work disability benefit, Employment and
Support Allowance (ESA), 32 per cent of claims are primarily for mental
health problems. 2 Many people on Jobseekers Allowance (JSA) may
experience depression and anxiety, linked to their unemployment. It is
therefore essential that the Work Programme is able to adequately
cater for this user-group. We agree that returning to work can be an
important step in someone’s recovery from a mental health problem.
However, it is vital that any back-to-work programme does not
jeopardise this recovery through inappropriate conditionality or
insufficient support.
1.3
This submission is built upon information we have gathered from
people with mental health problems who have received back-to-work
support and from Work Programme providers.
2.
Key concerns
2.1
Work Capability Assessment (WCA): The WCA, which determines
the payment a provider receives when someone finds work, is an
insufficient assessment tool to determine levels of support needed.
2.2
Pricing Categories: The current pricing categories are too broad. As
a result there are people in the same group who have vastly different
1
DWP, Statistics tabulation tool (Benefit Caseload National Statistics (WPLS) data)
http://83.244.183.180/100pc/tabtool.html (statistics run up to February 2012)
2
DWP, Main health condition reported by Employment and Support Allowance
claimants, by employment situation immediately before claim ,
http://statistics.dwp.gov.uk/asd/asd1/adhoc_analysis/2012/ESA_claimants_health_fro
m_work_final_20121101.xls
needs. Those whose needs are less time intensive are prioritised. The
impact of contracting based on such broad categories is driving
providers to focus less on participants who face greater barriers to
work.
2.3
Focus on Outcomes: The exclusive focus on outcomes (finding
work) fails to recognise the importance of progress made by people on
the Work Programme. If payments were also made on progress,
specialist providers would be more incentivised, and have more
resources, to work with people facing the largest number of barriers to
getting back into the workplace.
2.4
Conditionality and Sanctions: The disproportionate emphasis on
conditionality and sanctions presupposes that people who are out
of work do not want to get back into work and fails to help build
people’s confidence.
2.5
Specialist training and Integrated services: The
Government must ensure that that all staff are appropriately trained in
mental health problems and that providers have more mental health
experts. The Government should also ensure that Work Programme
providers are given the financial incentives to work with health and
social care services to offer clients integrated health and employment
support.
3.
The Work Capability Assessment
3.1
The WCA decides which people are eligible for ESA, and if so whether
they are placed in the Work-Related Activity Group (WRAG), where they
are required to start preparing for a return to work, or placed in the
Support Group where any preparation would be voluntary.
3.2
It is therefore essential that the WCA works properly in assessing
needs.
3.3
However, overwhelming evidence from people who have undergone the
WCA shows that it is unfit for assessing people with mental health
problems. Between October 2008, when ESA was introduced, and May
2011 (the most recent figures available for condition-specific appeals
data), 43 per cent of ‘Fit for Work’ decisions for applicants with ‘mental
and behavioural disorders’ were appealed and 41 percent of these
appeals were successful. 3
3.4
We regularly hear from people who have received zero points on the
WCA and are declared ‘Fit for Work’ who then have the decision
overturned after a long and distressing appeals process:
DWP, Employment and Support Allowance: Appeal Outcomes (Tables)
http://statistics.dwp.gov.uk/asd/asd1/adhoc_analysis/2012/ESA_Appeal_Outcomes.xls
3
3.5
“I wasn’t asked any questions about my illness or how I was coping. Even
though I volunteered information none of my responses were documented
in the subsequent report. It was decided that I was completely fit for work
having scored O on the medical assessment.”
3.6
One of our local Minds in South East London, which runs a welfare
advice service, reported that they frequently receive referrals from the
Jobcentre. Referrals are made up of clients on the Work Programme,
but who the Jobcentre believes are currently unfit to participate in
back-to-work activities. The local Mind will help the client to appeal the
decision of the WCA. In the last three months they have received 1012 of these types of referrals.
3.7
We have also heard from Work Programme providers that they spend a
significant amount of time helping people appeal the decision of the
WCA rather than offering them back-to-work support because providers
felt the decision was incorrect.
3.8
For more details about our concerns about the WCA, please see our
joint submission to the third Harrington review, which was recently
passed onto the Clerk of the Committee.
3.9
As a result of these problems with the WCA, people are getting
inadequate support or being forced to undertake activities with which
they cannot cope.
3.10
For people placed in the WRAG, the point at which they are referred to
the Work Programme is largely set by the ‘functional prognosis’ from
their WCA. Initially people in the WRAG were referred to the Work
Programme three months before this date. This period was then
extended to six months and is now being extended to twelve. We are
concerned that there will be a lack of adequate assessments put in
place to ensure that people are actually well enough to properly engage
with back-to-work-support so far in advance of the date that the WCA
has decided that they will be better.
3.11
We have heard from significant numbers of people experiencing high
levels of stress and anxiety as a result of the WCA. This results in them
feeling much less positive about engaging in back-to-work support and
less likely to return to work sooner. We have also spoken with Work
Programme providers who described how negative experiences of the
WCA can make participants less likely to positively engage with back-towork support. They also told us that that information passed onto them
about someone’s health condition from the WCA offers little to no
insight into their mental health problems and the support they require.
4.
The Work Programme
4.1
Pricing
Work Programmes providers receive a higher level of payment for
securing work for people on ESA than those receiving JSA. A higher
payment is made for clients on ESA in the Support Group than those in
WRAG.
4.1.1
Given the complex and intangible nature of many mental health
problems and the tendency for conditions to fluctuate over time,
finding sustainable employment for a client in these groups is a huge
challenge. We therefore support the policy of paying providers more for
finding work for people in these groups in order to reflect the additional
costs associated with placing and supporting clients.
4.1.2
However, that there is one payment level for all ESA WRAG claimants
results in a very broad group of claimants within one price band. A
person’s mental health diagnosis is not a good predictor of their
employability or the barriers they face to getting work. We have spoken
with sub-providers, specialising in helping disabled people to find
sustained employment, who reported that such broad categorisation
and payment structures forces them to focus on clients whose needs
are less complex as payments do not cover the amount needed for
clients with more complex needs, despite that fact that this goes
against the values of their organisation.
4.1.3
The system needs to be better able to reward providers according to
their clients’ personal needs and barriers.
4.2
Greater Focus on Progression
4.2.1
Currently providers can claim a job outcome payment after a participant
has been in a job for three to six months. After receiving a job outcome
payment, providers can claim sustainment payments every four weeks
when a participant stays in work.
4.2.2
The current system fails to recognise the progress that specialist
providers are making with participants who have mental health
problems, but who may not yet have gained employment. These
participants face greater barriers to work and often need a considerable
amount of support in building work-skills. However, the current
payment structure fails to recognise this important work that specialist
providers are performing.
4.2.3
We welcome a payment structure which would reward, not simply the
outcome of employment, but also the progress made by clients with
more complex needs. This payment structure would make it much more
viable for small specialist providers to work with clients, who have
complex needs, over a longer period of time and better support their
return to work.
4.3
Conditionality and Sanctions
4.3.1
The majority of people with mental health problems on ESA are placed
in the WRAG and are required to participate in back-to-work support.
They face sanctioning if they do not participate. We are increasingly
concerned that the system is characterised more by coercion rather
than by a genuine attempt to support individuals into the workplace.
4.3.2
Significant numbers of people have described to us the negative impact
threats of sanctioning have upon their return to work:
4.3.3 “I got a nasty letter which said my benefit was at risk because I didn’t
attend an appointment and I had to give a really good explanation
within a week or my benefit would be cut. It quoted all these
regulations I broke. I freaked out because I couldn’t understand what I
hadn’t done. …It turns out there was a mistake”
4.3.4
“I was made very anxious and sleepless by what I perceived as
threatening letters and terms from Jobcentre Plus and a4e. I
became depressed because I could see that my hopes to return to
work were being made unrealisable by this route”
4.3.4
These comments demonstrate how sanctioning is detrimental to
people’s mental health and weakens their ability to successfully engage
with back-to-work support. Supporting this evidence, the Employment
Related Services Association analysis of Work Programme statistics at
the end of November 2012 showed that there are better job outcomes
for people claiming ESA who voluntarily participate in the Work
Programme.4
4.3.5
The only international evidence on the impact of conditionality on
people with mental health problems found that the system does not
incentivise job searching or work-related activity; rather it leads to a
loss of income as sanctions are applied, with a consequent risk to the
person’s health: “Rather than creating behavioural change, sanctions
imposed on unresponsive groups are punitive.”5
4.3.6
We have also heard from Work Programme providers who find the
policy of sanctioning detrimental to their engagement with clients with
mental health problems. Currently sub-providers are required to report
to the Jobcentre if clients fail to engage with any element of back-towork support. They explained that often this means they are forced to
report clients for sanctioning whom they feel had a legitimate reason
for not fully engaging with back-to-work-support. Whilst they can
submit details of mitigating circumstances to the DWP, they felt that
this policy often weakened their relationship with clients.
The ERSA Analysis of Work Programme Job Start Data and Work Programme Briefing,
November 2012.
5 Meara E and Frank R, 2006, Welfare Reform, Work Requirements and Employment Barriers.
National Bureau of Economic Research, Cambridge MA
4
4.3.7
Furthermore, the focus on sanctions as a tool for ‘encouraging’ people
in the WRAG to engage with support presupposes that people with
disabilities do not want to work, and that the principal barrier in not
doing so is their motivation. Significant numbers of people have
described to us how this approach has led them to feel increasingly
stigmatised, further disengaging them from back-to-work support. One
person stated:
4.3.8
“I always feel that benefits treat me as if I am lying all the time,
they assume I’m like some others and trying to avoid work”
4.4
Barriers to Successful Employment Outcomes
4.4.1
Whilst people with mental health problems have one of the lowest
employment rates among disabled people (at 27 per cent for
depression and anxiety, and 14 per cent for more severe conditions,
compared to 46 per cent for disabled people as a whole), they have the
highest ‘want to work’ rate among benefit claimants.6 The Government
should therefore focus on external barriers that people with mental
health problems face in employment, including workplace
discrimination. One claimant we spoke to commented:
4.4.2
“My objective for the last 11 years in unemployment has been to find
appropriate work for my condition and qualifications that would make
claiming state benefit unnecessary. Such dictatorial and penalising
attitudes would increase my levels of anxiety and depression and
would be counterproductive, replicating what happened with my last
employer”
4.4.3
Fewer than four in ten employers would knowingly employ someone
with a mental health problem7 and 40 per cent of employers view
workers with mental health issues as a ‘significant risk’.8 A 2011
Populus poll of 2,006 adults in employment found that of those who
disclosed a mental health problem, 22 per cent were sacked or forced
out of their jobs,9 demonstrating that many of the fears that people
have about re-entering the workplace are well founded. The Work
Programme should therefore also consider external barriers and the
Government should focus on resolving workplace stigma and
discrimination.
4.4.4
People have also described to us how activities were focused on getting
people any form of work, rather than the most appropriate forms of
work:
6
Social Exclusion Unit (2004) Mental Health and Social Exclusion
DWP (2001) One Evaluation
8 Shaw Trust (2010) Mental Health: Still The Last Workplace Taboo?
9 Populus survey for Mind, in 2011, interviewed 2,006 adults in employment. Data have been
weighted to be representative of all GB adults in terms of gender, age, SEG and region. Of the
2,006 interviewed, 516 had experienced a mental health problem while in employment and 294
had told their boss. Press release retrieved from:
http://www.mind.org.uk/news/5053_workers_face_the_sack_for_admitting_they_feel_stressed
7
4.4.5
“Support was only really to get me into a job, however unsuitable, in order to
tick a box and provider to get money in and achieve targets”
4.4.6
Whilst we know that work based on a person’s preferences and
accessed with the right kind of support can be a vital part of recovery
from a mental health problem, we also know that inappropriate work
can be worse for someone’s mental health than not working at all.10
Often the Work Programme does not account for the skill and
experience that someone might have, and people are offered lower
paid roles which require less experience. This approach does not
support aspiration or wellbeing.
4.4.7
Work Programme providers also reported to us that at present, due to
cuts to other services, they spend significant amounts of time assisting
people with issues such as housing and health. These issues should also
be recognised as key in helping someone re-enter the workplace, and
greater focus and resources should be allocated by government to help
providers address multiple needs.
4.5
Work Choice
4.5.1
We would also recommend that more people with mental health
problems are referred to Work Choice, the Government’s specialist
employment programme. Participation in Work Choice is voluntary,
which we believe, and is reflected in the ERSA recent analysis of Work
Programme statistics, is a basis through which to successfully work
with people facing multiple barriers and ensure their sustain return to
the workforce.11 Work Choice however, is limited to 115,000
placements over the lifetime of a five year contract and only 14 per
cent of all referrals to Work Choice so far have been ESA claimants.12
5.
Mental Health Expertise and Integrated Support
5.1
Specialist Mental Health Training
Many of our supporters have commented that there is a lack of
understanding of mental health among Work Programme providers:
Comments include:
5.1.1
“She said of depression things like if I felt a bit down then I should really just
make more of an effort to do stuff even if it is a chore. It’s lovely having
your feelings being made light of”
5.1.2
“When I eventually got to see a disability specialist the first thing he said
was he didn’t understand my diagnosis and was going to get an
occupational therapist to reassess me… when I turn up to an appointment it
10
Butterworth, P, Leach, L, Strazdins, L et al 2011, 'The psychosocial quality of work determines
whether employment has benefits for mental health: Results from a longitudinal national
household panel survey', Occupational and Environmental Medicine, vol. 68, no. 11, pp. 806-812.
11 The ERSA Analysis of Work Programme Job Start Data and Work Programme Briefing,
November 2012.
12 See November 2012 data: http://statistics.dwp.gov.uk/asd/workingage/wchoice/wc_nov12.pdf
seems pretty clear that no thought has been given to me between
appointments or even before the appt as the advisor … [had] look on her
computer to refresh her memory of what my diagnosis [was]”
5.1.3
We also heard from providers who described how, with greater funding
could recruit extra staff to coordinate health and social care with backto-work support. They described that this approach would be more
sensitive to the multiple needs people with mental health problems face
and better support their transition into the workplace.
5.2
Individual Placement Support (IPS) Model
5.2.1
There is clear evidence that employment support is most effective for
people with mental health problems if it is integrated with health care.
The IPS approach, which is used in secondary mental health care, is
twice as likely to enable people with severe mental health problems to
enter competitive work than any other type of work programme.13
Advisers who understand mental health help the person to identify what
barriers they face, how they might overcome them, and what work they
would like to do. The adviser proactively seeks out employers who
might be well suited to the person’s abilities and needs. The individual
and their employer are then supported within the workplace for as long
as required.
5.2.2
Participation in IPS is voluntary, so conditions and sanctions are not
necessary. As already discussed recently published DWP figures show
that there are better job outcomes for people claiming ESA who
voluntarily participate in the Work Programme. We believe that
voluntary participation coupled with specialist support for people with
mental health problems, demonstrating to people that the system was
genuinely designed to help them, would result getting far larger
numbers of people back into sustained employment.
6.
Recommendations
6.1
The Government should ensure that the WCA is fit to properly identify
the needs and barriers that people with mental health problems face in
the workplace.
6.2
The principle focus of Work Programme providers should be on
demonstrating to clients that the back-to-work process is a positive
one, rather than using sanctions to enforce involvement. Discussions
about sanctioning should not take place until it is clear that the client
does not want to engage with back-to-work support.
6.3
Any conditionality should take account of the individual client’s
circumstances and needs, and should not result in any negative impact
13
The Centre for Mental Health, ‘The Work Programme, supporting individuals with severe
mental health conditions into work’,
http://www.centreformentalhealth.org.uk/pdfs/work_programme_providers_briefing2.pdf,
(accessed 19/11/2012)
on the clients’ mental health.
6.4
The ambitions and expectations of the client should be central to any
programme designed to help them back to work.
6.5
The Work Programme should function to ensure that providers are
properly incentivised to cater for the needs of all clients, including those
with greater levels of need and barriers to the workforce.
6.6
The Government should ensure that external barriers including
workplace discrimination are tackled in order to guarantee successful
long-term employment of people with mental health problems.