Access to Social Security Benefits for People who are Unable to Work because of Mental Illness

This thesis examines the difficulties which people with mental health conditions may experience in establishing and maintaining entitlement to the social security benefits which underwrite incapacity for work. Two regimes are currently operating simultaneously, the incapacity benefits regime, introduced in 1995, and employment and support allowance (ESA), introduced in October 2008. The thesis identifies the main barriers to incapacity for work benefits for people with mental health problems as the symptoms of mental illness, administrative procedures, national insurance contribution conditions, assessment, conditionality, appeals and complexity of the welfare system. It compares the two regimes and concludes that although problems arise with both incapacity benefits and ESA, problems with ESA are greater. The ESA scheme and ongoing reforms appear to have worked well for people who are at the most severe end of the spectrum of mental illness, since they receive more money and are relieved of conditionality. For claimants with lesser mental health problems the situation has worsened. The thesis makes a number of recommendations for change. It suggests that mental health teams should include welfare benefits advisers, recommends better training in mental health issues for DWP staff, and improved communication between the DWP and claimants, in particular lesser reliance on telephony. Consideration should also be given to removal of national insurance contribution conditions for incapacity for work benefits, and replacement by a universal benefit. The thesis points out that assessment of incapacity is the most significant obstacle to entitlement and suggests a return to the informal procedure used pre-1995, as well as payment for partial capacity. It also recommends voluntary, rather than mandatory participation in work-related activity by claimants with mental health problems, and questions whether it is appropriate to use the welfare system to coerce claimants, particularly those with mental health problems, into employment.