Why your NHS Mental Health Trust should provide an independent in house Welfare Rights Service.

Every year approximately 70,000 people with a Psychosis are supported by the NHS. In most cases while they receive good consistent support from health and social care services the same cannot be said about access to support to address their socio-economic circumstances. Yet these can have a huge impact on their wellbeing and the likelihood of their being admitted to costly NHS services.

In 2013 Norman Lamb the Minister of State for Care and Support hosted a meeting in the House of Commons launching a report by the Centre for Mental Health on the importance of welfare rights provision for people with a psychosis. As well as many guests from the NHS and voluntary sector James Morris MP who was the Chair of the All Party Parliamentary Group on Mental Health was also there.

The report “Welfare advice for people who use mental health services – developing the business case” was by the Centre’s Chief Economist Michael Parsonage, it looked at the service provided by Sheffield Mental Health CAB (Now part of Sheffield Citizens Advice and Law Centre). SMHCAB provide a service in the Sheffield Health and Social Care NHS Foundation Trust. Here are some facts from the report:

Need

• Someone with a psychosis is 4 times more likely to be in problematic debt than some one without a psychosis.
• Of the 622 people seen by Sheffield Mental Health CAB in the period of the study 45% have an income of less than £4,800 a year

The Intervention

• 20% of the clients seen by the CAB had their income increased by an average of over £4,000
• On  average there were 8 contacts per client with a further 5 contacts per client with third parties such as benefits offices, housing etc.

The cost

• It costs the NHS £330 a day for every inpatient stay.
• The average cost of funding the Sheffield Mental Health CAB Service was £230 per client

The Issue

Sheffield Mental Health CAB have been campaigning on this issue because this sort of specialist independent, but in house service should be available across the country – not just in Sheffield. This is important is because:

• Welfare rights and advocacy is a specialist area – welfare systems change quickly and as we know are subject to policy changes and poor implementation that can easily disenfranchise those least able to stand up for themselves.
• In order to support people with a psychosis welfare rights advisors need to be skilled at working within the mental health system and have a good grasp of the specialist clinical and legal practices and constraints in this field.
• People with a psychosis even if they are not constrained from doing so are very unlikely to want or be able to access community provision. If the service is not brought to them when they are in greatest need the issues (indebtedness, low income, housing insecurity) that will have helped exacerbate their poor health will still be there to create anxiety and despair once they return to the community.

In 2010 SMHCAB began this campaign with a national survey conducted in partnership with the Sheffield Health and Social Care Foundation Trust and with support from Citizens Advice. This survey –  Specialist Advice Services in Mental Health Trusts was launched at a symposium in 2011 (summary of symposium proceedings). It showed that there is unacceptable variation across the country with regard to welfare rights provision for people with a psychosis:

• Welfare Advice was more likely to be given to community patients rather than inpatients
• A lot of trusts relied on highlighting services by posters and word of mouth rather than through building welfare rights access into assessments and care pathways.
• While a lot of trusts indicated they provided services they were not able to say how these services are funded or how they were embedded into mainstream services.

The NHS prides itself on its ability to ensure consistent provision across the country,  this sort of variation is unacceptable. Where examples exist they are usually provided by the voluntary sector who have the expertise and independence but there are other service models – for example Dr Jed Boardman who is Consultant at the South London and Maudsley NHS Trust came to the launch and told me that his trust have their own welfare rights staff working alongside their clinical teams – excellent! But we should not have to rely on chance meetings in committee rooms in the House of Parliament to find out about good practice. At the launch we also heard from another Trust Chief Executive who felt that it was quite possible to develop these services with comparatively little extra resource.

What actions are required next?

The Centre for Mental Health makes the following recommendations in its report:

• All Mental Health Trusts building access to welfare rights provision into the care pathway – including a recognition of the importance of welfare advice to recovery.
• Early Intervention – including a greater focus on improved access for young people
• Local Commissioners should ensure that the need for specialist welfare advice is included in planning and funding of mental health services
• JSNAs should capture information about welfare rights need and provision with regard to this client group.
• Key national agencies (Department of Health, NHS England, Public Health England, ADASS should promote awareness of this issue and promote good practice
• The Department of Health should incorporate relevant indicators on this issue in all outcome frameworks
• The Care Quality Commission should incorporate assessments on the availability and quality of welfare rights advice in its inspections of mental health services and in its annual surveys
• There should be more research on this issue by the NIHR

Also lets just note – If Michael Parsonage’s figures are correct and there are 70,000 people with a psychosis seen by NHS Mental Health Trusts every year that means that providing a targeted service to them would cost approximately £16 million to provide this service to all. There are about 50 Community Mental Health Trusts – so thats about £320,000 per trust. In the scheme of things thats peanuts.

What do you think?