Mental Health: Assessment

Lisa Cameron Excerpts

Tuesday 22nd January 2019 Westminster Hall

[Angela Crawley]

I agree with the second part of the hon. Gentleman’s intervention, but I return to my original point, which is that we are talking about a tick-box exercise that does not recognise the fluctuating nature of mental ill health—I think that is the point he is trying to make. Why should someone have the fact that they put make-up on that day, or made the effort to turn up and be there for the assessment, marked against them? It seems completely arbitrary and unnecessary.

The constituent I mentioned earlier has a nervous compulsion and, as a result, she picks at her nails. She has chosen to wear acrylic nails so that she will not unconsciously pick at her hands due to her nervous disposition. That was taken by the healthcare professional as an indicator that she was well kept and therefore mentally stable. It did not seem to matter that it was a form of self-harming and that she had had suicidal thoughts, which she outlined to the person. Those are Victorian and antiquated measures through which to identify someone with mental ill health, and they come up time and again. My constituent Donna from Carluke recently had a personal independence assessment. She acknowledged that she had two options: she could present as someone who had a mental illness and

“Present as they expect someone who has a mental illness to i.e and I quote here from your own assessment documentation ‘rock, shake, sweat, unkempt, poor eye contact and look unwell and troubled’”,

or she could present as she was on the day,

“which was apparently none of the above.”

That does not negate the fact that she has a mental health condition; it simply does not tick the markers on that sheet. The DWP tick-box system does not seem to account for that at all, nor for people who live with long-term chronic health conditions that fluctuate between good days, bad days and unimaginable days.

Donna has faced an extremely difficult few years trying to cope with severe depression. She has outlined that on one day she can be great and on another she is simply not. I take the point that the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) made; I know it comes from a position of experience, and I greatly appreciate his expertise, but the fact is that Donna has been working in the mental health sector, so she has huge insight into her condition. She knew the only way she would get better would be by taking time and allowing herself to heal, which has taken longer than she had hoped, but now that she has returned to work, she has to fight to keep her personal independence payment, which has allowed her to stabilise her life.

I mentioned this case in a debate last week. Donna recently went back to work on very reduced hours, and through the personal independence payment, she was able to effectively self-manage her condition, meaning that she can lead a meaningful and purposeful life, return to work and provide for her family. Given the presence of her symptoms, that is only possible through the personal independence payment, which she is now being denied because the fact that she returned to work has been held against her. She exactly fits the purpose of those benefits and the criteria set out, but her claim was reassessed and, as a direct result of returning to work, she is no longer entitled to them.

It seems that all the valuable support Donna received over the last three years, combined with her self-determination, is now in jeopardy because, on the day of her PIP assessment, she was:

“well kempt, behaved normally, maintained eye contact and had good insight into my illness”.

Those are the assessor’s marks. They have decided against the criteria that she is no longer eligible for a personal independence payment, despite the fact that, as I am outlining, she relies on it and it has helped her to get back to work, which I believe is ultimately what the Government want. It is counter-intuitive. Healthcare professionals appear to be carrying out assessments without prior knowledge of how mental ill health works.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

My hon. Friend is making some extremely valid and excellent points, and I thank her for securing the debate. Does she agree that there is a real issue for people whose mental ill health, and perhaps some of the symptoms of it, such as paranoia or severe depression, mean that it is extremely difficult for them to even go to an assessment, because they feel the system might be against them, or they are just not well enough to get there? They are then penalised, and have their benefits taken away when they are very much in need of them, and have been very ill for a long time.

[Angela Crawley]

I could not agree more with my hon. Friend, and with the comments from the hon. Member for Ashfield (Gloria De Piero) about the individual who prepared themselves for an assessment, only for the assessor not to turn up. These assessments are really distressing, and they do not take into account the condition that the person being assessed has, or the impact that the assessment might have. Another of my constituents, Denise from Hamilton, was denied assistance for bipolar disorder because, as the report repeatedly stated, she is not manic all the time or on most days. How does one assessor even know that?

The idea of requiring assistance during periods of mania completely misses the point about the problems that Denise faces. The report ignores the depressive cycles that follow, and her struggles to find a measure of stability. That is a reckless approach, as she would be sent into a manic state if she were not supported, or if she tried to live the way many of us without a disability take for granted. Some of the things that have triggered a manic state in my constituent over the years would wash over most of us without her condition, but that is why the condition is extremely harrowing and distressing for those who have it. Simple things such as preparing for Christmas or a family wedding, stressful news events such as the Grenfell Tower incident, wider health issues such as the menopause, and changes to Denise’s medication for bipolar disorder are all things that have exacerbated her condition. Additionally, she has sometimes entered into mania for no apparent reason. In other words, the condition is out of her control.

I have heard many reports of assessors using very inappropriate language during assessments for people with mental health problems. Several people, including constituents I have mentioned, have told me that when discussing suicidal thoughts, they have been asked bluntly, “Why didn’t you kill yourself?” I do not know what that adds to the assessment, or what it does to a person to be asked that, but this point has been repeated by many of my constituents. When they have discussed suicidal ideation, they have been asked by the assessor, “Well, why didn’t you kill yourself?” I cannot say why they have been asked that.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in the debate, and to follow those who set the scene. The hon. Member for Lanark and Hamilton East (Angela Crawley) made a significant contribution, as did my colleagues and friends left and right. We may not agree on the constitutional position of Northern Ireland or the United Kingdom, or Scotland and Wales, but we agree on the important issue we are debating.

The Minister attending this debate is one who responds. Her comments to me in the Chamber, and whenever we meet, are soft-spoken words, which are always taken in the light in which they are meant. I thank her for her help and the interest she shows in the issues I bring to her attention. My comments today are not meant to be aggressive or harsh, but they are factual. Before I go on with those comments, I want to say how much I appreciate the Minister’s compassion and her interest in a job that she does extremely well.

We set up this social state to enable those in genuine difficulty to live, and not simply survive in poorhouses and the like. We determined that it was fair to ask those who could to help others, through tax and national insurance contributions. That has set us apart from many countries. I believe we are here to help the ill and the most vulnerable in society. Those suffering from mental health issues are more in need of our help today than ever before. The hon. Member for Glenrothes (Peter Grant) mentioned staff, and I have staff in my office who work on nothing but benefits—reviews, appeals, applications and advice. They work on those issues full time, to give the correct advice and assistance that it is our job to give as elected representatives. All my other staff are trained and, in fairness, the Government have set up training classes for our staff so that they can be versed in universal credit issues. I thank the Minister for that. We take advantage of it, and make sure our staff are trained.

In the UK, 20.3 million families receive a form of benefit, and 8.7 million of those are pensioners, which is about 30% of the population. For some families, the benefits they receive make up more than half their income. If an individual suffers with a mental health condition that has a long-term effect on their normal day-to-day life, it is considered a disability as defined under the Equality Act 2010. People with mental health conditions are less likely to receive any form of universal credit.

Between October 2013 and October 2016, 193,000 people with mental health conditions were reassessed, and of those 39% were awarded more money. However, 14% were given the same amount, 22% were awarded less money and 25% no longer received the benefits they once had. I say it very gently, but the benefits assessment process needs to be amended, as it is clearly not fitting for those who suffer with serious mental health problems that result in an inability to work. There was a debate in the Chamber on Thursday about mental health first aid in the workplace, with a good level of participation. In Northern Ireland, the legacy of the troubles is a considerably higher frequency of mental health problems than here on the mainland. The figures are extreme: 25% higher than on the mainland. That is the legacy of a 30-year terrorist campaign that affects not just those involved but the families—wives, daughters, sons, mums and dads.

[Dr Cameron]

The hon. Gentleman is making an excellent speech. Will he join me in commending the excellent work of psychologists in Northern Ireland who hosted a successful international trauma conference last year that is putting Northern Ireland on the map as a leader in international expertise on trauma?

[Jim Shannon]

I thank the hon. Lady for that intervention, and congratulate her on all she does, and on her interest in the issue.

Mental health issues have caused 300,000 people to lose their jobs because they cannot cope with the stress of their career. In Northern Ireland, one in five adults show signs of mental illnesses in their lifetime. We can see clearly that more funding needs to go towards helping those who cannot work because of mental health problems. People who cannot hold down a job owing to such problems must be treated with compassion and understanding. I have had several meetings with Capita. As the hon. Member for Glenrothes said, the staff are excellent and work hard. Frances, the manageress of the social security office in Newtownards, is extremely supportive and helpful, as are all the staff when anyone phones about an issue. However, that does not stop the problems that we are having. In my meeting with Capita, I outlined some cases where benefits were withdrawn, but in conjunction with its staff, we were able to overturn the decisions. I was glad that those constituents had come to see me and my staff, and that we could use medical evidence, supplied by doctors, to persuade Capita of the adverse effect on their mental health, wellbeing and, at times, physical safety. Things must change.