Mental health is on all of our minds at the moment. From coping with isolation to supporting friends and relatives, the covid-19 pandemic has brought about social changes on a scale most people in the UK have not experienced before. Working conditions have shifted dramatically and for some this has included a rapid reduction in household income, adding significantly to existing levels of stress. Despite some easing of restrictions, many people who are older or who have pre-existing health conditions must continue to self-isolate at home as part of shielding measures to protect those who may be particularly susceptible to the virus. As households attempt to financially stabilise, there has been a sharp increase in the uptake of social security benefits such as Universal Credit, with over 1.8 million applications between 16th March and the end of April 2020. As these numbers continue to rise in the coming weeks and months, it is even more vital that the claims process works effectively.
In light of social distancing guidance and shielding measures, it is right that the Department for Work and Pensions has taken the decision to suspend all face to face eligibility assessments and reassessments for key benefits such as Universal Credit, Employment Support Allowance and Personal Independence Payment for three months from March onwards– measures that may need to be extended further as we understand more about the course of the pandemic. Eligibility for these benefits is ordinarily determined by a functional assessment, meaning that claimants are not awarded payment on the basis of having a particular health condition but on how far their health condition impacts on daily life and their ability to carry out particular tasks.
In our study, conducted between January and April 2017, we asked people with mental health conditions about their experiences of having their eligibility for key benefits such as Universal Credit, Employment Support Allowance and Personal Independence Payment assessed. We found that being asked to attend a face to face assessment caused considerable stress and anxiety, even where the assessment itself turned out to run smoothly. This has the potential not only to exacerbate existing mental health conditions, but also to increase the possibility of underclaiming. Our research further shows that face to face eligibility assessments are not only harmful to mental health, they risk creating misunderstanding of how mental health impacts on functioning. Although there is provision to discuss mental health within assessments for each of the key benefits, our participants felt that the focus remained very much on physical health. At best, some claimants reported limited opportunity to discuss the impact of their mental illness on functioning, but at worst felt their assessment was entirely irrelevant to their health condition. Indeed, eleven out of eighteen of our participants were turned down for one or more health-related income benefit.
At the time of writing, it seems that telephone or paper assessments may act as an interim replacement for some claimants who had already received a date for a health assessment prior to the lockdown, or who request a reassessment because they believe their financial award should be increased. A minority of claimants were already able to access this type of assessment prior to the pandemic but these are not usual circumstances and a number of issues need to be urgently clarified. Firstly, what evidence will be required from claimants for a paper or telephone-based assessment? Allowances may need to be made for difficulties accessing contextual information from potentially overstretched healthcare providers so that claims are not delayed or wrongly denied. Secondly, how will claimants be supported to complete application forms and articulate how they are affected by their health condition? In our study, support was a key factor in the success of claims, but this may be more difficult to obtain under current social distancing guidance. Finally, are alternative arrangements in place should significant numbers of assessors, who are registered healthcare professionals, return to front line work during the pandemic?
Provided these issues can be quickly addressed and assuming the new system works effectively, the changes to eligibility assessments made in response to the covid-19 crisis offer the potential for longer term improvements to the current system, by demonstrating that functional assessments can be completed without the need for a face to face interview. This would significantly reduce experiences of stress and anxiety associated with the current process. It would also place less demand on supporting agencies, since we found that a key part of their role during the claims process was to help individuals manage psychological difficulties associated with the eligibility assessment itself.
In our article, we call for removing the need for face to face assessments for all those claimants with mental health conditions who have undergone a psychiatric assessment by a mental health or social care professional in the preceding six months. Where this information is not available, we recommend that assessments are carried out by trained mental health professionals who have a good understanding of the functional impact of mental health conditions. Implementing a similar approach now would streamline the assessment process significantly in the face of rising demand by reducing the level of detail required in paper application forms and eradicating the need for some telephone assessments. Additionally, it would ensure that appropriate contingency plans are in place for claimants with mental health conditions, who may already be disadvantaged under the current system.
This pause may provide us with an important chance for reflection, to re-evaluate the effectiveness of the current functional approach and to consider how far it is really necessary to require claimants with health conditions and disabilities to attend a face to face assessment in order to determine eligibility for benefits. Taking this opportunity has the potential to bring about significant improvements for all those accessing social security in the UK.
About the authors
Katie Pybus is Research Fellow at the University of York.
Kate Pickett is Professor of Epidemiology at the University of York.
Charlie Lloyd is Professor of Social Policy and Criminology at the University of York.
Stephanie Prady is Senior Research Fellow at the University of York.
Richard Wilkinson is Professor Emeritus at the University of York.