Liz Main | ukwatch.net

The Hidden Costs of Going Back to Work

Tim Holmes — Sat, 22 Dec 2007 09:04:01 +0000

So once again the Government has announced plans to overhaul the benefits system to get people on Incapacity Benefit (IB) back to work, this time through a move to “employment and support allowance” which positively focuses on “what people can do rather than what they can’t”. But despite all the recent hoo haa about the 50 people with acne and those with nail disorders and the 400 people “too fat” to work, the group the Department of Work and Pensions really want to get off their books is people with mental health problems.

A glance at those books tells you why: mental health problems are costing the Government £2 billion a year in Incapacity Benefit, a hefty proportion of the total £12.5 billion they pay out.

It’s not that those with mental health problems are shirking, campaigners insist. “People who have experienced severe mental illness have the highest want-to-work rate of any disability group, but have the lowest in-work rate,” says Jane Harris, head of campaigns at Rethink. She points out there are two likely hurdles: the unwillingness of employers to take on people with mental health problems; and the hidden costs of going back to work.

In trying to gain support for the new changes to IB, government has been briefing that getting off benefits and back to work will swell your bank account as well as increase your sense of wellbeing. But we are unable to look at government profiling to see how they have worked these figures out and for whom it applies.

Other government figures are freely available to look at.

Harris says that though government publishes annual tax benefit model tables that show the relationship between incremental wage increases for lone parents, for example, they don’t do this for people with disabilities.

We spoke to the Department of Work and Pensions (DWP). They told us that to publish model tables for people on disability benefits would be too complicated because of the number of scenarios that would need plotting.

The published tax benefit model illustrates the effect on net income of gross income, rent, marital status, number of children, tax credits, tax and National Insurance Contributions, they explained. “A model that looked at disability benefits would be a very complex table as there are so many factors involved in working out an individuals’ entitlement. For example, not only would it have to take into account the information that is contained in the current model but it would also need additional information such as: type of disability, length of time on benefit, type of disability benefits customers are in receipt of, what rate of benefit they are in receipt of i.e. higher or lower.”

While the DWP have pledged long-term Incapacity Benefit claimants will be at least £25 a week better off in work, this figure may cover little more than the travel costs that they will now incur through being off IB and in employment. But employment brings more costs than that, costs that could ultimately prove dangerous to people with mental health problems.

We spoke to people with mental health problems who have gone back to work. They told us that they had been taken aback by some of the expenses they now had to pay as a working person such as exercise costs, school meals, talking therapies and prescriptions.

Kay

“When I came out of hospital I was on four different meds,” says Kay, a woman with bipolar disorder. “Because I was seriously depressed, I was only given two days of some medications at a time. Everyone assumed that I would be on benefits, but I wasn’t so I was paying a fortune for prescriptions.”

Those in the know can buy a pre-paid prescription card for just under £100 a year or about £27 for three months, which covers unlimited prescriptions. But most people aren’t aware of this, and continue to shell out £6.85 an item when they start paying for medication.

“Nobody told me that I could pay a set amount up front – not my psychiatrist, not the pharmacist,” Kay told us. “I don’t think the doctor knew. No one in the mental health system expects you to be paying, they blithely make the assumption that you can afford to keep taking the pills.” She points out two ironies. If she hadn’t taken the medication she would have been back in hospital where it would have been free, and if she had epilepsy, the other condition treated by the same medication, she wouldn’t have paid for the pills.

Sara

This woman of 35 who also has bipolar and works full time despite a number of episodes in hospital, also paid for her prescriptions until she was diagnosed with a thyroid disorder. When the pharmacist told her she no longer had to pay for medication she was pleased but also furious. “Why should people pay for prescriptions for mental illness when you don’t have to pay for other conditions? Why is something physical worth paying for, but mental health isn’t?”

Sara is still doing the sums over what medication has cost her in the decade since she was diagnosed.

It is not surprising then, that some people throw the prescriptions away. Research carried out by the Citizens Advice Bureau in 2001 found that 50 of their clients paying prescription charges had difficulty affording them and 28% failed to get all or part of a prescription dispensed because of the cost.

Increasingly the Government will offer short-term talking therapies for people with minor mental health problems to enable a swift return to work. But those with ongoing mental health problems will often need longer-term therapy, and while this might be available on the NHS, it is almost exclusively within normal working hours. As it is difficult to take time out of the working day for ongoing talking therapy, people either quit or find themselves paying for private therapy out of hours at a ballpark £30-40 a session.

Julian

This was the case for Julian who was discharged by his Community Psychiatric Nurse when he returned to work. Once back, he found himself more vulnerable and in need of someone to talk to, so now pays £30 a week for counselling sessions. “I find I need more support now than ever before, but I’m more likely to skip appointments with my shrink as well, because if there’s an important meeting at work it’s easier to cancel the doctor than make an excuse to my boss about a therapy session,” he says.

Julian swims and works out at a local leisure centre as he finds exercise helps to keep his depression at bay, but no longer gets a discount. “I pay about £30 a month more than when I was on benefits,” he says. “It might have been less if I could use the gym off peak, but that’s the thing about going back to work – every bit of help or discount is geared towards people who don’t work.”

he has a prescription card but calculates the price of going back to work will be around £2000 this year.

Andy Bell, head of public affairs at the Sainsbury Centre for Mental Health, says that services must stop being “predicated on the notion that you are out of work”. “If you support someone when they are out of work and forget about them when they get back to work there’s a chance they will fall out of work again,” he warns.

A Bill Too Far

christian — Thu, 13 Oct 2005 09:04:47 +0000

I was on a train in Northern Ireland with my loved one a couple of weekends ago, coming back from a delightful few days by the seaside at Portrush. We were watching the countryside go by when a six or seven year old girl next to us started to sing.

Annoying as it was, we tuned out until a lyric about “lunatics” made us both look up. We exchanged secret smiles – how amusing that she had no idea she was sitting next to two of them.

Sticking to her theme, she then segued into the next rhyme: “Make the loonies take their pills, take their pills, take their pills … Lock them up in Holywell, Holywell, Holywell”. No prizes for guessing that Holywell was a local asylum, now a psychiatric hospital.

There was no malice in her song – it could have been Ring-A-Ring-O-Roses (that other great illness-related nursery rhyme). It must be some sort of school playground number, and her parents were oblivious to the lyrics – until I walked over to speak to them.

“I have a mental health problem and I’m finding your daughter’s song offensive,” I said politely.

“What?” they said … so I raised my voice and repeated it.

The kid shut up and the parents looked at the floor. They got off at the next station, but I like to think they were going to anyway.

Two days later I had to debate with Health Minister Rosie Winterton at a fringe meeting at the Labour Party conference. I was there to draw attention to the Mental Health Bill that we all abhor. The Bill is all about forcing people to take medication while living in the community, and indefinitely locking up people who, it is considered, MIGHT commit a crime.

I started scrawling pre-conference notes on the train down to Brighton, and thought how clever it would be to start with this story. And so I did, with great passion and to a spontaneous round of applause. It’s just a shame that the Minister wasn’t actually there to hear it; Gordon Brown had decided to launch his leadership bid at the same time as our meeting.

The Minister did arrive an hour and a half late (amazingly the audience endured), but by then my energy was spent and it was too late to use the other line I’d been saving up. The government keeps acknowledging that mental health is the ‘Cinderella’ of the NHS. I’ve had enough of that statement, I was prepared to rage, because this Bill ain’t Prince Charming’s glass slipper and there is no fairytale ending.

What we’ve got instead is the makings of a mental health system that is about coercion, not about care, and decent health staff won’t work in that environment.

At the moment it takes two doctors and an approved social worker to ‘section’ a person, i.e. detain them against their will. Under the new legislation, there is a marked difference. There will be what they call ‘approved clinicians’, who can be just about anyone who has worked in mental health – psychologists, occupational therapists, nurses as well as social workers and doctors. Herein lies the detail that is making many of us very anxious.

I went to a party on Saturday night to farewell the wonderful woman who was ward manager in the days when I was in and out of the loony bin. Marva has become a great friend – she’s retiring to Trinidad, so I think it’s safe to leak the fact that ‘boundaries’ were overstepped a little – and she invited me along with a few other former patients, old staff and dozens of friends.

I got there early and went up to talk to a beautiful young woman in gorgeous blue and gold African garments who was sitting on her own. “Hello Liz,” she said, and suddenly I realised that it was my favourite former consultant looking absolutely fantastic, but unrecognisable out of context. Which was how I must have appeared to many of the nurses who emerged a bit later.

I’d spent a lot of time with most of them, not least because they’d had the joy of guarding me one-on-one when I had been at my most unwell and consequently my most unglamorous. When the penny dropped it was hugs and kisses all round, because we were there on equal terms. I saw them as people not guards, and they saw me as a person, and I think were proud of their roles in helping me back to life. Also present were the Occupational Therapists who I’ve always had a special relationship with, because they really did play a huge role in my recovery.

Under the new Bill, they could all be playing a part in deciding whether to section people. So I asked them all – if they’d had to section me, would they have wanted to make the decision?

“No way,” they said. They don’t see their job as being about depriving people of their liberty. They consider themselves to have caring roles. They said that if it becomes part of their job description they would be forced to quit.

This is a scary prospect for me, because the Mental Health Bill is going to weed out the people who really care and leave us with the people who want to make the loonies take their pills and lock us up. Maybe that six year old girl on the train knows more than I do.