Do welfare benefit reassessments of people with mental health conditions lead to worse mental health? - King's College London

[MSEsperanza]

Stuart, R., Campbell, S., Osumili, B., Robinson, E. J., Frost-Gaskin, M., Pacitti, R., ... Henderson, C. (2020). Do welfare benefit reassessments of people with mental health conditions lead to worse mental health? A prospective cohort study. The International journal of social psychiatry, 66(2), 136-149. https://doi.org/10.1177/0020764019888955

https://kclpure.kcl.ac.uk/portal/en...th(7b9da7b0-4de9-4b43-83fd-280823e468f0).html

https://kclpure.kcl.ac.uk/portal/fi...ts_STUART_Accepted25October2019_GREEN_AAM.pdf

Abstract

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.

 

[Sly Saint]

Applies to a lot of claimants, not just people with mental health conditions.

Although having said that, I suspect that on many occasions ME patients are treated by the assessment people (eg Maximus) as having a mental health condition.

I came across this bit of info a while back and it's worth noting (altho its from 2015)

Regular readers will be aware that Benefits and Work has been investigating why some ESA claimants are not being sent ESA50 forms prior to a face-to-face medical assessment.

ESA50 forms give a claimant the opportunity to explain how their condition affects them and ensure that accurate evidence is available to the health professional carrying out a face-to-face assessment.

They are a vital part of the work capability assessment and not completing one puts a claimant at a serious disadvantage, as the decision maker is then likely to be obliged to rely primarily on the evidence from the Maximus health professional.

We contacted Maximus – trading as the Centre for Health and Disability Assessment (CDHA) - about this and they informed us in an email that:

“An ESA50 is automatically issued once a referral is made. This needs to be completed and returned, along with any medical evidence, prior to an assessment taking place. If a person’s medical condition changes after the form is submitted, these changes can be discussed during the assessment. There is no need to fill in another form. We ask everyone to bring any additional medical evidence along with them, when they attend.”

However, they went on to say that:

“The only people that would be asked to attend an assessment without completing an ESA50 are those who a doctor has recorded on the referral, have a diagnosed mental health condition.”

https://www.benefitsandwork.co.uk/n...ng-denied-chance-to-complete-vital-esa50-form

 

[Wits_End]

My immediate response to the title question: Why would they not, when benefit reassessments of people not claiming on grounds of mental health lead to worse mental health?

 

[Invisible Woman]

Although having said that, I suspect that on many occasions ME patients are treated by the assessment people (eg Maximus) as having a mental health condition.

I'm pretty sure they do. I fill in the mental health section of the questionnaire in some detail to record the effects of impaired cognitive dysfunction. Although I make it clear these are a symptom of ME rather than a comorbidity because they are and the form is rubbish for eliciting information about cognitive impairment.

“The only people that would be asked to attend an assessment without completing an ESA50 are those who a doctor has recorded on the referral, have a diagnosed mental health condition.”

This would certainly put me at a serious disadvantage. Written communication is easier for me & probably many others with some form of cognitive impairment or fluctuating disease. It also means that if someone has multiple people who care for them can't seek input from all of them. Let's say one person helps in the morning but another helps getting them to bed in the evening - there might be different aspects of the impairments that become more noticeable as the day wears on.

I can understand if the logic was to reduce stress in the claimant but denying them the same opportunity to explain how their illness affects them is discriminatory. Also, there a many, many better ways the system could be changed to tackle that.