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Out of the picture

26 April 2004

Health and social care evidence cover

Out of the picture [ 440 kb] - Citizens Advice evidence on mental health and social exclusion

Executive Summary

When people suffer mental health problems, they lose part of themselves, a way of being. For some, this may be like a bereavement. Their ability to work, to manage their everyday affairs and to look after themselves falters and sometimes fails completely.  

The scale of the problem is huge. The Office of National Statistics estimates one in six people suffer from a mental health problem at any one time , roughly over 7 million people between the ages of 16 and 74. The Sainsbury Centre recently estimated the economic and social costs of mental illness for England to be around £77 billion .  The most recent Welsh Health Survey indicated that 9.4 per cent of adults suffered from depression and 7.3 per cent had suffered from anxiety .  

Society’s response should be to support people through this difficult time. CAB evidence suggests that far from this happening, people with mental health problems often experience discrimination and are not adequately supported. These two themes run through the evidence from Citizens Advice Bureaux in this report. These issues create difficulties for people that reinforce the isolation their illness creates.

This report draws on evidence, views and experience from over 350 Citizens Advice Bureaux throughout England and Wales, 64 responses to a Social Exclusion Unit questionnaire on mental health and social exclusion and information from interviews and discussions with specialist workers from some of over 100 CAB mental health projects around the country.

Widespread discriminatory behaviour and failures to understand the difficulties people with mental health problems face makes raising awareness about mental illness a central issue.  This is not a new message. The Government has begun to take steps to educate young people and employers about mental illness but CAB evidence suggests this has not yet had real impact. This is a challenge for all of us. It calls for action across all sectors of society. All those who come into contact directly or indirectly with people with mental health problems need to be better equipped to identify and help them whether they be in the public, private or independent sectors.  Institutions need to review their procedures to avoid discriminatory outcomes. In addition, there is a need to break down the barriers of discrimination by raising awareness about mental health issues among the general population.

This report outlines CAB evidence on the stigma, discrimination and difficulties people with mental health problems face in the work  environment, the benefit system and dealing with consumer affairs such as financial services. These are just some of the areas in which people experience exclusion.  Working, welfare and personal finance are key to maintaining a regular income. When something goes wrong, security and the daily routine is lost. A large part of the work of Citizens Advice Bureaux involves helping these clients with employment, benefit and consumer problems as illustrated with case studies throughout the text.  

Many people with mental health problems want to work. We describe some of the barriers to their achieving this. The work environment too often seems to discard people who are ill, for lack of understanding and knowledge about the kind of help that people need. Sometimes there is overt discrimination. The Government is piloting changes to help people on incapacity benefit back into the workplace but we have yet to see how these will work out in practice.  

Loss of work and failure to get back into employment after illness means that mental health service users have the lowest employment rate of all disabled groups.  Only 18 per cent  are employed.  Most are dependent on benefit income and are some of the poorest people in the UK. Poverty is linked to poor health and people with mental health problems are trapped in poverty for longer periods than most. Persistent low incomes reduce people’s ability to afford to participate in activities and services that might help reduce their isolation.

Work is one avenue by which people with mental health problems may be made to feel less socially excluded but it is not the whole answer in addressing social exclusion.  A number of broader based issues need to be tackled if those with mental health problems are to be helped into a ‘work-ready’ state. Major changes in the benefit system and in consumer protection are urgently needed. Unfair discrimination in these sectors is undermining people’s confidence and their ability to cope financially and creates conditions in which they are least likely to get better.  

The benefit system should underpin people’s security but it often fails to recognise and make allowance for their illness. The forms that have to be completed and the procedures used for assessing capacity to work do not make appropriate provision for mental health problems. People with mental health problems have full responsibility for complying with procedures and time limits and failure to do so can mean benefits are stopped. When people are unwell, their capacity to function normally may be reduced, yet the benefit system makes no allowance for this.  

High pressure selling and the ease of obtaining credit are problems for many people. But those with mental health problems are particularly vulnerable when unwell. Many face difficulties in being effective consumers and understanding the full implications of consumer contracts or credit agreements they may not be able to afford. They are directly discriminated against when insurance providers apply blanket exclusions of people with mental illness and when payment protection insurance fails to cover breaks in their income.

Low income and illness make managing finances difficult and debt is common. The anxiety and stress that accompanies debt is known to impair health. Support and independent advice demonstrably contribute to reducing anxiety and health problems and debt needs to be addressed early if it is not to become insurmountable and make people’s condition worse.  

When unwell, large numbers of people with mental health problems are very much on their own. They need support to cope with their illness and advice and help to deal with the benefit system, debts, social activities and moves into work. Aside from the statutory agencies, a wide range of supportive work is undertaken by a number of voluntary organisations.  But these do not have the resources to cater for all needs.  

This report argues for a programme of action to tackle discrimination in behaviour and in institutional procedures across the public and private sectors. It calls for more support for people with mental health problems to help create positive experiences both in and outside work, building blocks that may help them to recover more quickly and prevent their domestic situation deteriorating. The report makes recommendations in the following key areas:

  • for action to improve awareness and understanding of mental health throughout the public, private and independent sectors.  This should be underpinned by monitoring and reviews of how services impinge on people with mental health problems and backed up by changes to the Disability Discrimination Act 1995.  The National Institute for Mental Health England should take responsibility for establishing a cross departmental programme to combat discrimination on grounds of mental health and promote social inclusion for people with mental health problems in the public, private and voluntary sectors.  The Welsh Assembly Government should build on the progress it has made for a multi-agency approach to address these issues
  • for a comprehensive review of the benefit system and its impact on people with mental health problems
  • for the National Institute for Mental Health England to work with the Department of Trade and Industry to raise awareness about mental health issues and achieve changes in working practices which reflects this awareness
  • for ready access to support for people with mental health problems when they are not well, where and when they need it
  • for statutory bodies, voluntary agencies and private companies to exercise due care and responsibility towards vulnerable people who may not be able to look after their own interests.  This should be underpinned with amendments to the Mental Incapacity Bill to improve consumer protection rights and remedies. Training on mental health awareness should be a requirement in industry codes of practice. The OFT should develop guidance on responsible lending and dealing with customers in financial difficulties.