Mental distress among people receiving benefits: new evidence

The majority of people receiving benefits report mental distress, many have recently thought about self-harm, and reported work limitations are considerable

It’s obviously impossible to understand benefits systems in the UK (or anywhere else) without looking at mental health - but there’s been surprisingly little recent, detailed evidence on the mental health of people receiving benefits.

In this post, I describe new research that provides a clearer picture - not just of the mental health labels that people apply to themselves, but also the distress that people experience and thoughts about self-harm, how this affects their capacity to work, and people’s experiences of conditionality.

The study behind the post

This is a follow-up to last week’s post on conditionality. It’s from the same people - I did this with the fab Welfare at a (Social) Distance team (co-authors are Lisa Scullion, Daniel Edmiston, Robert de Vries, Kate Summers, Jo Ingold, and David Young). And it uses the same YouGov survey of 3,800 UC/ESA/JSA claimants in May-June 2022 – so it refers to the situation 2½ years ago, though this was after the point that conditionality had been reintroduced after Covid-19, so is likely to be pretty similar to the position today.

One difference though - I’m blogging about a pre-print (that is, a working paper that’s publicly available, but which hasn’t been peer-reviewed). I don’t usually do this, but given that there’s an impending Green Paper, we thought it would be indefensible to work to the usual, slow academic timescales (a principle we applied to the WASD project throughout Covid-19). To reassure readers, we’ve tried to be as transparent as possible about everything - the full working paper is here, the supplementary material that explains the methods in more detail is here, and you can access the raw data from the UK Data Service.

Levels of mental distress

In short: levels of mental distress among people receiving benefits are very high.

One way of looking at this is by people self-reporting a current mental health condition - which is reported by 73% of people receiving benefits (vs. 37% of the working age public). Table 1 of the paper shows how this is split between different conditions, with depression & anxiety being most common, but many other mental health conditions are common - e.g. 14% of people receiving UC/ESA/JSA report PTSD. Personality disorders, bipolar disorder and psychosis are also all much, much more common among claimants than the wider public.

But given all the debates about how people label themselves, it’s useful to actually look at people’s experiences of distress - that is, how they report feeling over the past two weeks. We do this using two clinically-validated screening tools, PHQ-9 for depression and GAD-7 for anxiety - these are not perfect, and but wider research shows that they show people who are pretty likely to have clinical depression/anxiety. This is what we find:

Mental distress (symptoms of moderate/severe depression or anxiety) is very common among people receiving benefits - it’s reported by 61% of people receiving benefits. This is exactly the same number of people who say that they have depression/anxiety when asked about their current mental health conditions. This compares to 27% of the general public showing symptoms of depression/anxiety. (In fact the general public figure should be lower, because due to data limitations, it includes the 14% of the general public claiming UC/ESA/JSA and 6% of the public claiming other benefits).

Just to make this a bit more tangible, let’s look at the most severe measure - a question about whether people had had “thoughts that you would be better off dead or of hurting yourself in some way” in the past fortnight. As the chart shows, this was reported by 43% of people receiving benefits, compared to 21% of the working-age public. In fact, if we focus on the most severe answer to this question (having thoughts like this ‘nearly every day’), then the difference is even starker - it’s reported by 12% of people receiving benefits, vs. 2% of the working-age public.

Remember that this only covers symptoms relating to depression and anxiety - you can see from the best official survey on mental health (last done in 2014, more results later this year) that there’s a wide variety of experiences of distress that relate to other types of mental health conditions.

In summary: the majority of people receiving UC/ESA/JSA both report a mental health condition and show signs of current mental distress, and a substantial minority show signs of more severe distress.

Work limitations

It’s also useful to look at how mental ill-health relates to work limitations - which again there is strangely little evidence on¹. We here look at ‘mental health disabilities’ - that is, people who said that their mental health limited their day-to-day activities, which is roughly the same as the legal definition of ‘disability’. We further focus only on those people who report that their day-to-day activities were only limited by mental health - which is the minority of people with mental health disabilities, but helps clarify that the limitations relate to mental health rather than other health problems/disabilities.

The most common limitations are shown in the chart below. Some things are particularly common - not being able to do work with fixed hours, struggling in dealing with other people at work, and often just not being able to get anything done. But equally, it’s clear that the work limitations that people report are very varied. (And in the appendices to the paper, you can see the full list that shows an even more varied set of work limitations than the chart).

Conditionality

Finally, we looked at experiences of conditionality among claimants with mental health disabilities. Compared to those with a mental health disability, claimants without a mental health disability were at least twice as likely to be subject to conditionality. This is as it should be: the Government has created parts of the benefits system without conditionality deliberately for people with more limited capacity for work.

However, in out-of-work households², 7% of those with a mental health disability still said they were subject to intensive conditionality - so the conditionality-free space isn’t working perfectly, and we can’t assume that the WCA catches everyone. And of those with a mental health disability who were subject to conditionality, a quarter said that their Work Coach had not taken account of disclosed barriers to work, and that conditionality was unreasonable.

Remember too that conditionality works much worse for people with mental health problems (compared to other people receiving benefits), as I blogged about the other week.

What does this mean for policy?

Put simply: there is an ongoing narrative that many people receiving benefits do not really have mental health problems. In contrast, our study shows that their levels of mental distress are extremely high. And this is the main message we wanted to get out quickly.

While writing a press release for the paper, I also wanted to make sure that was a voice from someone with lived experience of welfare and mental ill-health. So I reached out to Rick Burgess, a disabled activist and member of the Lived Experience Advisory Board of the ESRC Centre for Society & Mental Health. He said:

“The experience of being under the DWP is like being under an oppressive police state, you feel despised, spied upon and in constant fear of being assessed, reviewed, investigated. Society is invited to turn against you by political and media narratives. A social security system has been turned into a shadow penal system by decades of a cruel policy direction.

“Real people are suffering real distress being made worse by the DWP, their contractors, and the government and media's messaging. Disbelieving people's distress and increasing conditionality is a recipe for even greater loss of life than there has been already. It is no mistake that the UN has found grave and systematic abuse of disabled people's human rights in multiple investigations.”

This is Rick’s view, rather than that of the research team - but it’s an important view to listen to, particularly as Rick is channelling many experiences other than just his own. On the blog I’ll be regularly returning to the experience of claiming benefits (beyond the amount of money you receive) - not just how it feels to claim, but what the consequences of this are, and how we get policymaking to properly take this into account.

1. There are questions in DWP and wider surveys, but personally I find these unhelpful, so we created our own questions…

2. As I said last week: UC is a household-level benefit where conditionality depends on both partners. In our results, we therefore often divide between ‘working households’ and ‘non-working households’ (those working 16+hrs/week or with a working partner are classified as ‘working’, as they are likely to be above the threshold which exempted people from conditionality) - see the paper for details.