Nothing to do with the NHS? Mental Health and Personal Independence Payments

Declaration of interest – I am chair of Citizens Advice Sheffield

The Health and Care system is so complex, the responsibilities so great, the budgets so big that it is often all too easy to think that it is the most important part of peoples lives – the glue that holds everything together. Of course it isn’t – it is really a set of services that are there as a last resort when we can no longer manage on our own.

So, the risk is that while we focus on the challenges faced by health services to meet the needs of people with mental health problems it is possible to lose focus on changes that are happening elsewhere that have the potential to make a grievous impact on the wellbeing of those same people.

Social Welfare Support and Mental Health

Just like the NHS, the social welfare system is meant to provide support to help people engage with society and take control of their own lives. One of these supportive elements is the mobility component of Personal Independence Payments (PIP) which is meant to provide funding to enable people who are unable to leave their home to do so – to go shopping, see their GP, socialise, go to training etc. Subject to assessment, people with mental health problems can either get nothing, the lower rate (£22 pw) or the higher rate (£58 pw). The Government says that people with mental health problems should only be considered for the lower rate.

In November 2016 the Government lost an Upper Tribunal ruling brought in part by Citizens Advice Sheffield which declared that in some cases people with mental health problems SHOULD be eligible for the higher rate because “overwhelming psychological distress” should be considered when assessing the descriptor.  This success led to the Government trying to rush a change to the regulations to block this judgement – claiming that this was an emergency! The Government claims that if it did not do this there would be an additional cost to the treasury of £3.7bn over the next five years.

Although the Government denies that changing the regulations in this way will adversely affect people with mental health problems the House of Commons Library Research Paper – Changes to Personal Independence Payment Eligibility Criteria notes that the Governments own Equality Impact Assessment says that this change to the regulations will:

“Affect 336,500 claimants of whom 282.5000 will no longer be entitled to any mobility changes.
These changes could affect people with a wide range of conditions including learning disability, autism schizophrenia, anxiety conditions, social phobias and early dementia.”

This table – also from the Equality Impact Assessment sets out the estimated impact:

Back to the NHS

These changes will affect not only the health and wellbeing of many people with mental health problems who will find it harder to get out of their homes, will become more isolated and less able to improve their wellbeing; it will also affect NHS mental health and primary care who will have more demands placed on already stretched services.

I am concerned at how quiet key players in the health system are with regard to this issue. Despite all the rhetoric associated with the Mental Health Five Year Forward View there appears to be little coherent thinking about the need for acton to address the parlous financial circumstances of many people with mental health programmes and instead a rather superficial take on parity of esteem that gives insufficient attention to health inequalities. Regrettably this (lack of) thinking is replicated in guidance on Sustainability and Transformation Plans and on Accountable Care Systems.

I think that:

• Public Health England need to develop clear models that describe the importance of the relationship between financial security and good mental health – and the actions that need to be taken locally and nationally.
• NHS England could produce guidance and appropriate tools that set out how NHS commissioners and care trusts should connect with key agencies such as Citizens Advice Bureau. Similarly, they could produce some guidance that supports CCGS develop good practice with their GP membership on this issue.
• Finally, NHS England, Public Health England plus professional bodies like the Royal Colleges of General Practice and Psychiatry and theFaculty of Public Health could publicly advise the Department of Work and Pensions on just how damaging these plans are.

What do you think?