Understanding mental health in the UK welfare system: representations of distress among benefit claimants and implications for assessment and support
Lead Research Organisation:
King's College London
Department Name: Social Science, Health and Medicine
Abstract
This Qualitative Secondary Analysis (QSA) project aims to deepen understanding of the experience of psychological distress among people engaging with the UK welfare system, in order to improve the health-related benefits assessment process and enhance effectiveness of welfare-to-work support for people experiencing mental health problems. The UK operates a conditionality-based welfare system, whereby the level of expectation to undertake active steps towards work depends on an assessment of health-related functional impairment, known as the Work Capability Assessment (WCA). A recognised problem is that the processes, tools and criteria used to determine type and degree of functional impairment are widely perceived as inadequate in their ability to reflect and evaluate the impact of mental health problems on a person's capacity to work. Despite efforts to improve assessment processes, qualitative research consistently reports that mental health problems are poorly understood by those conducting the WCA, and that claimants find little scope to convey the impact of fluctuating and invisible conditions.
Whilst several prior studies have reported that the benefit system fails to comprehend the needs of claimants with mental health problems, research to date has not 'unpacked' claimant experiences of mental (ill) health to any great extent, meaning that the specific nature of the experiences that are obscured, misinterpreted or disavowed in the assessment process remain unclear. In this QSA, we will use methods of narrative analysis, applying the theoretical framework of the Illness Representational Model (IRM), to look in detail at how claimants in an earlier study (focused primarily on benefit sanctions), made sense of their distress. The IRM provides a framework for identifying perceived causes, manifestations, coping mechanisms and consequences of distress. By offering more detailed and nuanced accounts of the lived experience of mental health problems than has been elicited in welfare-focused research to date, the project will enhance understanding of how welfare assessment processes could be adapted to better identify and acknowledge the work-related limitations experienced by claimants seeking support on mental health grounds.
Our project comprises a QSA of archived material from the ESRC-funded Welfare Conditionality project (http://www.welfareconditionality.ac.uk/), which includes almost 500 qualitative longitudinal interviews with over 200 benefit claimants who had experienced mental health problems. While the original Welfare Conditionality project focused on claimants' perceptions of benefit sanctions and mandatory support, our analysis will approach the data from the novel perspective of analysing narratives of mental distress, with a focus on illness representations and interpretations. Findings will offer a new route into current discussions about how the welfare assessment system can become more person-centred and hence more effective in supporting work-related goals for people experiencing mental health problems. This focus is timely, taking place as the UK government conducts an inquiry into health benefits assessment, and progresses its Health Transformation Programme, key objectives of which include improving trust and transparency in the assessment process, improving claimant experience and delivering a more personalised service.
Exploring these findings with policy and practice stakeholders alongside experts by experience, we will provide valuable insights into the range of experiences underpinning claimant mental distress, and how people navigate work and welfare in this context. Findings will point towards to improved methods of enquiry that could more sensitively and accurately capture claimant experience, providing better understanding of claimants' experiences of mental distress and its work-related impacts, and contributing new evidence to these critical and longstanding areas of policy concern.
Whilst several prior studies have reported that the benefit system fails to comprehend the needs of claimants with mental health problems, research to date has not 'unpacked' claimant experiences of mental (ill) health to any great extent, meaning that the specific nature of the experiences that are obscured, misinterpreted or disavowed in the assessment process remain unclear. In this QSA, we will use methods of narrative analysis, applying the theoretical framework of the Illness Representational Model (IRM), to look in detail at how claimants in an earlier study (focused primarily on benefit sanctions), made sense of their distress. The IRM provides a framework for identifying perceived causes, manifestations, coping mechanisms and consequences of distress. By offering more detailed and nuanced accounts of the lived experience of mental health problems than has been elicited in welfare-focused research to date, the project will enhance understanding of how welfare assessment processes could be adapted to better identify and acknowledge the work-related limitations experienced by claimants seeking support on mental health grounds.
Our project comprises a QSA of archived material from the ESRC-funded Welfare Conditionality project (http://www.welfareconditionality.ac.uk/), which includes almost 500 qualitative longitudinal interviews with over 200 benefit claimants who had experienced mental health problems. While the original Welfare Conditionality project focused on claimants' perceptions of benefit sanctions and mandatory support, our analysis will approach the data from the novel perspective of analysing narratives of mental distress, with a focus on illness representations and interpretations. Findings will offer a new route into current discussions about how the welfare assessment system can become more person-centred and hence more effective in supporting work-related goals for people experiencing mental health problems. This focus is timely, taking place as the UK government conducts an inquiry into health benefits assessment, and progresses its Health Transformation Programme, key objectives of which include improving trust and transparency in the assessment process, improving claimant experience and delivering a more personalised service.
Exploring these findings with policy and practice stakeholders alongside experts by experience, we will provide valuable insights into the range of experiences underpinning claimant mental distress, and how people navigate work and welfare in this context. Findings will point towards to improved methods of enquiry that could more sensitively and accurately capture claimant experience, providing better understanding of claimants' experiences of mental distress and its work-related impacts, and contributing new evidence to these critical and longstanding areas of policy concern.
Organisations
Publications
Irvine A
(2023)
First steps in qualitative secondary analysis: experiences of engaging with the primary research team
in International Journal of Social Research Methodology
Related Projects
| Project Reference | Relationship | Related To | Start | End | Award Value |
|---|---|---|---|---|---|
| ES/X002101/1 | 31/03/2023 | 04/02/2024 | £216,964 | ||
| ES/X002101/2 | Transfer | ES/X002101/1 | 05/02/2024 | 29/09/2024 | £82,772 |
| Description | This study sought to better understand the experience of benefit claimants who are affected by mental health problems, and has provided a novel perspective on how capacity for work might be reconceptualised within the UK welfare system. Our core finding and recommendation is that we need a more holistic approach to understanding and assessing capacity for work and, in turn, to determining how work-related conditionality is applied. Our in-depth narrative analysis revealed that a complex combination of psychological, social, structural, economic and interpersonal factors shape benefit claimants' capacity for work. All participants in this study had experience of mental health problems. However, our analysis revealed that the functional impacts of psychological distress were rarely the only thing constraining people's capacity for work. Considering employment experiences over time, it was evident that people's ability to sustain work had been shaped by factors including unstable housing and homelessness, relationship breakdown, violence and abuse, bereavement, lone parenthood, supporting children with additional needs, informal caring, debt and financial instability. When seeking to return to work, participants' opportunities continued to be shaped by many factors beyond the direct emotional and physical symptoms of mental distress. Local labour markets, employer flexibility, financial viability of work, transport availability, suitable childcare, aspirations and preferences, training opportunities, fit with prior skills and qualifications, citizenship status, digital exclusion, amongst many other things, also shaped and constrained people's capacity to return to work. However, these experiences were lived out within the context of a welfare system that takes a predominantly medicalised approach to conceptualising people's capacity for work. Our analysis starkly reflected the absence of opportunities within the current system for claimants to describe - and receive mitigations for - the wider range of work-related constraints that they faced. The consequence of this narrowly medicalised approach to understanding capacity for work is that claimants facing complex barriers must necessarily utilise a medicalised framing through which to convey what is often a much more multifaceted set of circumstances preventing their return to employment. We conclude that we need a more holistic approach to understanding and assessing capacity for work and that, within provisions already existing in the UK welfare system, more widespread and effective use should be made of conditionality easements for claimants facing non-health barriers to work. Fundamentally, our findings add to the call for a more person-centred and less punitive approach in the benefits system, where the emphasis shifts away from conditionality and surveillance to a system designed around compassionate and collaborative support to help people find appropriate employment at the appropriate time. A more holistic understanding of work-related barriers and contingencies could offer a more comprehensive, meaningful and compassionate approach to support for people who are facing numerous interrelated constraints on their capacity for work, which include but go beyond mental distress. Capacity building achievements alongside the above research outcomes include appointment to first permanent lectureships for both the PI and the Postdoctoral Research Associate. |
| Exploitation Route | The impact of our findings to date has been predominantly through sharing this novel reconceptualisation of 'capacity for work' - and the related policy implications - with stakeholder audiences including civil servants, policy thinktanks, third sector advocacy organisations and frontline employability practitioners. We have received feedback that our propositions around a more holistic conceptualisation of capacity for work are influencing stakeholders' thinking about these very 'live' welfare and employment policy issues. Over the coming months, we intend to engage with forthcoming government consultations on the reform of disability benefits and innovations in employment support for people with health problems and other vulnerabilities. |
| Sectors | Communities and Social Services/Policy Government Democracy and Justice |
| Description | CL appeared on a podcast for the Leonard Cheshire Foundation, speaking about the disability employment gap |
| Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | CL was interviewed for the podcast, drawing on her lived experience and the findings of our research project |
| Year(s) Of Engagement Activity | 2024 |
| URL | https://open.spotify.com/episode/4CaOV1P9mVWxS2X4eGeBKo?si=iHWAc8RwTiyOiffB2vqVNQ |
| Description | Deliberative Dialogue Workshop with stakeholders from policy, third sector and frontline employment support practice |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | As a planned stage of our project, we held a Deliberative Dialogue Workshop on 25 June 2024. Attendees included 16 professionals from across central DWP, policy think tanks, third sector employment support providers and mental health charities. Feedback on the event included: "I haven't really participated in anything like the session yesterday but found it hugely energizing We're always really open to finding new ways to make sure that our [clients'] voices are being heard and whilst I could appreciate there was a healthy tension in the session yesterday, I also found it helpful to understand the limitations too. We care deeply about improving the lives of the [clients] we support but I have a slightly better understanding now of the need for a scalable framework too Everyone [in the organization] was pumped at me attending yesterday as we are all desperate for greater fairness and understanding in how the welfare system works." (Third sector CEO) "It was great to hear more about your research and to have an opportunity to think about such an important issue with likeminded people. I hope that research findings and recommendations are carefully considered by government and that it moves them closer to understanding how counterproductive conditionality is." (Third sector frontline advisor) "It was a pleasure and also somewhat of a relief to know that what we do, is the right thing. Fingers crossed for national change!" (Third sector service manager) "I really enjoyed the workshop and having the opportunity to bring front line experience, research and policy together felt really powerful. It doesn't happen often enough!" (Third sector strategic manager) "I liked your model of work capacity that I don't think I'd seen in that form before, and people seemed so excited about the research in general. The discussion was really productive - I found the bits on Jobcentre culture particularly helpful. It was also a great group of people; fab to have a WCA assessor there, and people delivering frontline services alongside policy people." (Senior academic) LinkedIn post from a participant containing the following: "It's clear that mental health is just one part of a complex picture when we're supporting people into employment and we all need to be part of the solution in designing a support system that recognises and responds to this complexity, helping people where they need it most." (Third sector strategic manager) "I found the day reaffirming. It was so nice to be able to take the day to listen to other perspectives and to take stock, and then also to reflect on the conversation for the next day or so. It makes me believe that we are on the right path, but we are such a small organisation our impact is just a drop in the ocean." (Third sector CEO) "It was lovely to meet in person and the discussion generated was great to listen to and engage with." (Vocational Rehabilitation professional) "I think I'm ever more convinced by Annie's conceptualisation of the problem & am often stealing it! " |
| Year(s) Of Engagement Activity | 2024 |
| Description | Interview with Polly Toynbee for The Guardian Opinion column |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | Telephone interview with journalist Polly Toynbee (for The Guardian), leading to quotation and citation of the ESRC CSMH in Opinion column (appeared online Friday 12th Jan, 2024) |
| Year(s) Of Engagement Activity | 2024 |
| URL | https://www.theguardian.com/commentisfree/2024/jan/12/disability-claims-britain-rishi-sunak-governme... |
| Description | Invitation to Mind roundtable on in-work poverty and mental health (6 November 2023) |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Third sector organisations |
| Results and Impact | Annie attended Mind roundtable by invitation. Emphasized message that poor quality employment is a public mental health issue and needs to be framed as a political/policy problem, not an individualized mental health issue. |
| Year(s) Of Engagement Activity | 2023 |