Warnings over mental impact of benefit changes must be heeded | Letters

For every 10,000 people assessed for employment and support allowance (Benefit changes fuel demand for mental health care, warns NHS, 8 March) there are, in addition to existing mental health morbidity, an extra 2,700 cases of reported mental health problems, an increase of 7,020 antidepressant prescriptions and six more suicides than expected.

The public health department of Liverpool University studied 1.03 million claimants from 149 local authorities, who between 2010-13 had been reassessed for ESA. Across England as a whole for this period there were thus an additional 279,000 cases of reported mental health problems (11% of the total), 725,000 antidepressant prescriptions (0.5% of the total) and 590 suicides (5% of the total). There is open access to the department’s report.

For both ESA and personal independence payments (PIPs), sources of distress include the reporting of the effects of medical illness by “health professionals”. The government’s own appraisal stated: “During visits to both Capita and Atos (the health professionals’ employers), the review observed that the requirement to gather evidence was not always being fully considered … In some cases, it was clear that insufficient evidence had been gathered … Claimants have also expressed a lack of trust in the ability of health professionals to record what has been said during face-to-face assessments. Some assert that the health professional had misinterpreted or even deliberately misrepresented what was discussed during the assessment”.
Morris Bernadt

It’s not just the secondary mental health services being put under pressure, but also GPs, IAPT (the community based primary care mental health service) and advice organisations such as Citizens Advice. As a GP, I receive almost daily requests for supporting letters in benefit appeal processes. In many cases I dig out the one written a year before and update it with increasingly terse statements about the futility of this process. People are being repeatedly subjected to reassessment by the Department for Work and Pensions, leading to severe mental distress. GPs “hold” many patients with long-term mental ill health, people who are not accepted into secondary care mental health services. Even worse, under pressure we prescribe yet more antidepressants and painkillers trying to relieve this distress.
Dr Charles Heatley
GP, Sheffield

Last week’s NHS Providers report shows that any attempt to improve mental health that focuses only on what the NHS can do will fail. People must get the right treatment at the right time, but to keep people well, wider society must play its part. In April, the cross-ministerial committee on mental health will meet for the first time in 12 months. We need to see substantial progress in how mental illness is understood and acted on across government, including welfare, housing and supporting councils to provide services. Without that change, we risk making the laudable aims of the NHS long-term plan impossible to deliver.
Mark Winstanley
CEO of Rethink Mental Illness

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