How the Government’s Health and Disability White Paper Affects People Living with Mental Illness

It can be easy to take the ability to find and maintain a job for granted. Julia Aggio, Senior Policy Officer for Rethink Mental Illness, discusses the government’s recent Health and Disability White Paper and how it will affect people living with severe mental illness and their access to the benefit system.

In March 2023 the Department for Work and Pensions published the Health and Disability White Paper, outlining ways to help more disabled people, and people with health conditions to start, stay and succeed in work. 

While the paper offers hope for future improvements, we had some concerns that will affect people living with severe mental illness.  

Increasing the use of work coaches

Over the next three years, the Department for Work and Pensions will provide more work coaches to people living with health conditions or disabilities accessing Universal Credit and Employment and Support Allowance. 

A work coach is a Department for Work and Pensions employee who supports people through the process of making a claim, including: 

• People waiting for the decision of their Work Capability Assessment 
• People determined to have limited capability to work who may not be able to look for work now but can prepare with the aim of working at some time in the future 
• People deemed to have limited capacity for work-related activity who will not be asked to look for, or prepare for work 

The white paper states that work coaches will now be responsible for providing the new In-Work Progression Offer aimed at “helping people in work on Universal Credit to increase their earnings and move into better paid jobs”.  

We are concerned that case studies have shown this may be through increasing work hours or taking on more jobs, rather than focusing on training and developing skills.  

This service will be voluntary for everyone – except people claiming Universal Credit in the light touch conditionality group (people who have a commitment to find work but reviewed less regularly) from September 2023.  

But if someone is late or misses an appointment/phone call with their work coach, or are told they are not doing enough to look for work, they could be hit with sanctions such as a reduction or stopping of payments. We are worried an increase in work coach support will result in more sanctions.  

Improving communication in the benefits system

The white paper says people claiming benefits will have the chance to tell the Department for Work and Pensions what form of communication they prefer, and, in turn, they will share that information across the benefits services. They are also evaluating how well video and telephone assessments work when applying for Personal Independence Payment (PIP).  

This first, small step towards giving more communication choices is positive, but it is unclear when these actions will take place. There also remains a lack of detail on what forms of communication are being offered. A wide range is vital to support people’s needs and wellbeing.  

After a trial in Kent, the Enhanced Support Service – offering personalised support for people who find it most difficult to navigate the benefits system – has been extended to Birmingham, Blackpool, and King’s Lynn, and potentially other areas in the future.  

We have not received details of what this support entails or the criteria one needs to fulfill to access this support, however, in principle we support this.  

Improving medical evidence in health assessments

The Department for Work and Pensions is introducing the Health Impact Record, a chance for people to record their experiences over time to show how fluctuating health conditions can impact lives.  

For the new system to support people during the assessment process of claiming benefits, it is vital the approach and design are co-produced by people with lived experience of severe mental illness and the benefits system. 

The white paper also discusses the idea of including evidence from “people’s health and social care support networks”, but we would have liked to have seen them specifically state that clinical teams should be involved in collecting medical evidence.  

There has been a commitment to “test sharing health assessment reports with people making the claim before a decision is made, offering them the opportunity to clarify evidence so that we can make the right decision as early as possible”.  

This is being tested out in London and Birmingham and it is about time because it gives the opportunity for people to correct any mistakes that their assessor made and clear any miscommunication that may have happened during their conversation.  

Scrapping Work Capability Assessment 

This white paper saw the biggest reform to the welfare system in recent years. The government wants to scrap the Work Capability Assessment which would make PIP the only health and disability functional assessment.  

Please keep in mind that this reform would only happen if legislation is brought forward with the next government. If successful, the reforms would be rolled out no earlier than 2026/27. But while the Work Capability Assessment is fundamentally flawed and caused significant harm to people, simply scrapping it is not the solution. The next step should be to co-design a new approach to functional assessments.  

The Department for Work and Pensions wants work coaches to determine people’s capability for work and to what extent they can participate in work-related activities. While the current assessors are not suitable, despite being medically qualified, work coaches are also not qualified to make this decision and are under pressure to meet internal targets for getting people into work and assigning sanctions. 

A vaguely proposed new approach to conditionality which would provide personalised levels of conditionality and employment support, could result in an increase in sanctions and pressure to work.  

A new Universal Credit health element will replace the existing limited capability to work and limited capacity for work-related activity elements and will only be accessible to someone receiving both Universal Credit and PIP.  

However, this seems totally flawed as the eligibility criteria for PIP is far too narrow and it is difficult for many people living with a severe mental illness to access it.  

This means that under the new plans, many people currently eligible for the Universal Credit limited capability to work and limited capacity for work-related activity elements are at risk of not being eligible for the new scheme that will replace them. It also means that no one will be automatically protected from being required to do work-related activities (i.e., CV preparation, skills training).  

The Department for Work and Pensions seems to be aware that this would become an issue as they have committed to providing transitional protection, which is a top-up so that people who were in the limited capability to work and limited capacity for work-related activity groups will not lose out because of the introduction of the new Universal Credit health element. 

Ambiguities and support 

The Health and Disability White Paper comes with a lot of ambiguities. There are some hopeful opportunities that could make changes in our benefits system for people living with severe mental illness, but there are also points of concern that need to be addressed.  

Some of the changes are not immediate, but if you have any questions or need support with your benefits, check out our Mental Health and Money Advice service.