Mental Health: Assessment

David Linden Excerpts

Tuesday 22nd January 2019 Westminster Hall

[David Linden (Glasgow East) (SNP)]

It is a great pleasure to serve under your chairmanship, Ms Ryan. I warmly congratulate my hon. Friend the Member for Lanark and Hamilton East (Angela Crawley) on securing the debate. It is also good to see the Minister in her place. She knows how much I respect and value the close working relationship that we have, particularly given my constituency caseload. I therefore hope that my remarks today, based on that constituency casework experience, are reflected upon in the Department for Work and Pensions and that action can be taken to build a social security system that is truly underpinned by respect, dignity and human rights.

At the weekend, and in anticipation of today’s debate, I asked constituents to share their thoughts with me. Indra from Tollcross said:

“I asked if they”—

the assessor—

“knew anything about my genetic condition—they didn’t but said it didn’t matter. I asked if they had worked in mental health treatment and again was dismissed.”

Indra went on to say:

“I left feeling worse off, and totally demoralised instead of supported.”

I guess that brings me to the first concern that I have about the assessment process, which was something I highlighted during my own debate on work capability assessments back in December 2017. It is a source of great regret that we are back today discussing the same issue a year or so on.

There is a concern, which is echoed by the Rethink Mental Illness report, that staff who perform assessments have an incredibly poor understanding of mental health. To illustrate the point, during the December 2017 debate I told the House how my constituent was asked if her son still had autism. That was an absolutely shocking thing to learn. The fact that that is something we can hear from a constituent should send an alarm signal to us. We have also seen examples where assessments have been carried out by physiotherapists for those with a mental health condition. That is like asking a chef to do the work of a car mechanic.

The second issue relates to vulnerable constituents who might have anxiety. Too often we ask people who struggle with the most basic tasks to complete long, convoluted forms riddled with jargon and difficult questions, a point made eloquently by the hon. Member for Morley and Outwood (Andrea Jenkyns). Just yesterday morning, while meeting the manager of Easterhouse CAB, I heard the story of a man who had started filling out his universal credit application over Christmas but found it so overwhelming that he did not complete it. The mess that that has caused the citizens advice bureau, which is now having to clear it up, is considerable.

We also know from experience that constituents who perhaps fail at the initial assessment and submit their mandatory reconsideration are left for weeks on end, worrying about the outcome of the appeal. That is simply not helpful for people with poor mental health.

[Hugh Gaffney (Coatbridge, Chryston and Bellshill) (Lab)]

Does the hon. Gentleman feel, as I do, that some of those people are being tested and tried before being given their benefits? That brings on anxiety. Last week’s Demos report is important in reviewing the issue. People should not be tested to get some money.

[David Linden]

I agree. The hon. Gentleman will have seen that in his constituency caseload and in surgeries. I am sure that all Members see it in surgeries.

I want to mention fibromyalgia. I attended the recent debate on the subject, as did my hon. Friend the Member for Lanark and Hamilton East (Angela Crawley) and the hon. Member for Morley and Outwood (Andrea Jenkyns). Fibro campaigners raise the legitimate concern that the DWP does not recognise the significance of mental health in fibromyalgia, which spans anxiety and depression. What work is under way in the Minister’s Department to explore what further training and support can be given in that area, including to work coaches?

There is much more to be done to ensure that the most vulnerable people can go about their lives in the knowledge that the process of assessing them for benefits will be underpinned by dignity, respect and human rights. The current system does not get that right, with the result that the British Government are failing the most vulnerable in society. I think we would all agree that we can and must do better.

Because of the respect I have for the Minister, I believe she is the Minister who can take the matter forward. We look to her for encouragement when she replies. There is strong cross-party consensus that we want to work together to protect our most vulnerable constituents. I look forward to supporting the Minister as she takes the matter forward.

--- Later in debate ---

[Chris Stephens (Glasgow South West) (SNP)]

It is a pleasure to see you in the Chair, Ms Ryan, and I join others in paying tribute to the tour de force that we heard at the beginning of the debate from my hon. Friend the Member for Lanark and Hamilton East (Angela Crawley). She was right to start by mentioning staff members, because one of her staff members—Mary Jane Douglas—is also one of mine, and she contacted me to make sure that I mentioned her name. I also wish to mention other members of the casework team: Dominique Ucbas, Tony McCue and my office manager, the great Roza Salih. They all deal with the benefits and assessment system and have delivered some success. Interestingly, when I interviewed recently for a caseworker, one of the successful candidates I mentioned today, and other candidates, explained how they had helped family members, and others acting on behalf of relatives, who were trying to navigate their way through the benefits process.

The UK Government’s tick-box exercises for disability assessment are woefully inadequate when it comes to mental health conditions. The Work and Pensions Committee, on which I sit, considered a report from last year that contained a damning indictment of the Government’s assessments for the personal independence payment and employment and support allowance. It highlighted that assessments can be emotionally draining for people, and that is doubly awful for those who have mental health conditions. Indeed, such conditions can sometimes be exacerbated by the process and the stress of undergoing an assessment, or by a feeling that the health professional making the assessment is not accurately recording the impact of a condition.

The Government’s follow-up on the report’s criticisms were described by the Committee as “regrettably slow”. One example of their attitude was the contempt that they showed towards people with psychological conditions who require additional support under PIP. As has been said, in 2016 the Government introduced regulations that specifically excluded people with psychological conditions from receiving higher points in their disability assessment for PIP, until the Department was defeated in the courts for what was described as “blatantly discriminatory” legislation. That shows that the Government have absolutely no regard for the impact of psychological conditions, and it completely flies in the face of the commitment made by the Prime Minister on the steps of No.10 to create parity between physical and mental health conditions. We urgently need a complete overhaul of the PIP and ESA assessment process, to ensure that individuals with mental health conditions are treated with respect and dignity.

A huge amount of evidence from both claimants and stakeholder groups suggests that the system of disability assessment is failing people with mental health conditions. The Committee pointed out that there was an “unprecedented response” from claimants to its inquiry into PIP and ESA assessments. Rethink Mental Illness has said that many assessors do not have the necessary expertise in mental health conditions to carry out assessments, and that is exacerbated by the fact that ESA and PIP assessments are not designed to take account of the full impact of someone’s condition on their day-to-day life.

Mencap is

“concerned that assessors often do not have a full understanding of learning disability as exemplified in the stories we hear from individuals and their families.”

Mind and the Scottish Association for Mental Health have said that they hear

“frequently from people with mental health problems who have been assessed by healthcare professionals who lack a basic understanding of mental health. Often in these cases the problem is not that assessors lack specific clinical knowledge, but that they do not have good understanding of what it’s like to have a mental health problem or do not ask sensitive questions about how someone’s mental health affects them.”

That point came across clearly in the inquiry. We asked the contractors Atos and Capita how many qualified doctors they had in their organisations to carry out assessments. Atos said that it had two, as did Capita, and they described the rest of their assessors as “occupational health practitioners”.

I remember specifically asking a senior figure from Atos—this became one of those videos that are widely shared within minutes on social media—who someone with multiple sclerosis and depression would see in their organisation, and I was advised that they would see an occupational health practitioner. When I asked that senior figure whether he understood why people are cynical about the process, he nodded his head.

One recommendation in the Committee’s report was for audio and visual recording, because around 80% of successful appeals are based on verbal information that was provided at the original assessment. Will the Minister update Members on that recommendation?

[David Linden]

My hon. Friend is spot on. Does he, like me, believe that this issue is such a problem partly because it has been contracted out to private companies that cut corners in all ways, meaning that our constituents get such a bad service? It comes down to the issue of privatisation; that is why the service is so poor.

[Chris Stephens]

My hon. Friend makes an excellent point. My next question to the Minister is about acceptable reports. The contractors have never hit Government targets for acceptable reports. If any other contractor were to conduct its business in such a way and failed to meet Government targets, it would no longer have its contract. How are the contractors now performing with regards to acceptable reports?

Will the Minister explain the mandatory reconsideration process, and confirm the rule that eight out of 10 mandatory reconsiderations—80% of them—should result in failure? That instruction was given to staff. I think the Government said it was guidance, but some of us believe it was an instruction. Will the Minister say whether it has been rescinded, so that mandatory reconsiderations can be dealt with in a fairer way? Will she provide statistics on the number of successful appeals made by those with mental health conditions? I recently wrote to her about people who are blind or have a visual impairment, as that issue has had some press scrutiny in Scotland, but can she provide similar figures for individuals with mental health conditions?

The removal of implied consent under universal credit will have a particularly detrimental impact on those with psychological disorders or learning difficulties. Under the legacy system, implied consent allowed family members, support services and benefits advisers easily to represent claimants when making claims to the DWP. That seems to be changing under universal credit, because a claimant now has to give explicit consent for such representation. For claimants who are severely sick or disabled, and especially those with mental health conditions or learning difficulties, the ability to rely on implied consent was important. The stress and pressure of having to interact with the benefits system and provide explicit consent is a real concern, as it may force claimants to jump through new hoops to get support in making their claim or resolving any problems with it.

I will conclude with the Scottish Government’s approach to the social security system. The Scottish Government will have some devolved power over the PIP process, and they are building the necessary infrastructure to deliver that. Disability benefit assessments will be carried out not by the private sector, but by Scotland’s public sector healthcare professionals. The approach taken by the Scottish Government will mean that the system is evidence-based and uses healthcare professionals, and that important step has been welcomed by many third-sector organisations in Scotland. It is vital to put the needs of the individual at the centre of the social security system by providing choice, flexibility and control. I thank you, Ms Ryan, and I look forward to the Minister’s response.