Nikki Bond, Research Officer, Money and Mental Health

Making the benefits system accessible to people with severe mental illness

15 March 2019

Accessing the benefits system can be tricky for anyone, but as our new report shows, for people experiencing severe and enduring mental health problems such as psychotic illnesses and bipolar disorder, or those in mental health crisis, this can be impossible.

Symptoms of acute mental illness can include delusions, suicidality, mania or depressive lows. Contending with these frightening and debilitating symptoms can make even everyday activities like washing, preparing a meal or popping to the shops a real struggle. Under these circumstances, jumping through the hurdles presented by the benefits system, such as advocating for yourself on application forms, or remembering and attending appointments can present an impossible challenge.

“I was sectioned. I had not been in a fit state to be in charge of my finances for weeks beforehand. I was not fit for work, but also not fit to claim any benefits. My income was nil until [someone] explained ESA to me and filled the forms in for me.” – Research Community member

The current system has made efforts to meet the needs of people who are unwell, such as facilitating home visits for assessments, or accepting fit notes for retrospective missed appointments. However, even the process of securing these adjustments can be difficult to navigate, particularly for people who are struggling with the effects of severe mental illness or crisis.

Devastating consequences

Before working at Money and Mental Health I worked in financial services supporting customers experiencing mental health problems to manage their accounts. Daily, I spoke to customers who were reliant on benefits yet too unwell to access them. Difficulties complying with the conditions required to receive benefits – such as submitting paperwork within strict timescales, evidencing extensive work search efforts or attending meetings with work coaches – often meant people had claims denied or faced sanctions. As a result, people were often left penniless and forced to live in desperate circumstances with no heating, electricity or food.

“Benefits staff often have no clear understanding of mental illness. When a service user is late or does not appear for an interview regarding benefits, staff think they’re working on the side but in real life, the patient has had or is experiencing a psychotic episode.” – Mental health practitioner

These issues have been echoed by the hundreds of members of our Research Community who shared their experiences as part of our latest research looking at access to the current benefits system. Here we propose two key adjustments to existing processes to ensure people with severe mental illness or in crisis are able to gain equal access to their entitlements.

Making assessments more accessible

The process of attending benefits assessments, including work capability and medical assessments, can be difficult in itself, often requiring people to revisit their past traumas and dwell on the things they are unable to do. But this is exacerbated by inadequately trained staff and unsuitable assessment environments, which can prove particularly difficult for people with severe mental illness.

Adjusting the assessment processes could help to remove some of these barriers to accessing the system. One way of doing this is to draw upon parallels in the Health and Social Care Assessment guidelines of assessing people by automatically offering people with a severe and enduring mental illness:  

  • A choice of venues for assessments
  • Flexibility around dates and times of assessments
  • Specialist assessors with experience and knowledge of mental health.

Introduce a mental health crisis ‘easement’

There are processes in place to offer people a temporary break from meeting the requirements associated with certain benefits during a period of illness. However, these are difficult for people in crisis to access and navigate. Currently, people are required to follow an arduous process of obtaining a fit note in order to be exempt from benefits conditionality for up to two weeks, before potentially being expected to attend a face-to-face interview. This system is ill-suited to the needs of people in crisis. People who are acutely unwell, who may be delusional or suicidal, cannot be expected to request an exemption, obtain a fit note, and present for an interview after just two weeks respite.

The government has already recognised that this process is inadequate for a person fleeing domestic abuse or receiving treatment for drug or alcohol dependence, and has introduced a temporary ‘easement’ from conditionality for these groups – meaning they don’t have to look for jobs or attend assessments, and won’t face sanctions as a result. We propose introducing a similar mental health ‘easement’, to ensure that the tens of thousands of people who experience a mental health crisis each year are protected from sanctions.

Improving the system for people with severe mental illness

Requiring people in an acute phase of mental illness to navigate the benefit assault course risks exposing them to harm and detriment. However, this is avoidable. These proposed changes would go far in ensuring people with severe and enduring mental illness, and those in crisis, are not disadvantaged when accessing the benefits system.