Understanding mental health in the UK welfare system: representations of distress among benefit claimants and implications for assessment and support

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This Qualitative Secondary Analysis (QSA) project aims to deepen understanding of the experience of psychological distress among people engaging with the UK welfare system, in order to improve the health-related benefits assessment process and enhance effectiveness of welfare-to-work support for people experiencing mental health problems. The UK operates a conditionality-based welfare system, whereby the level of expectation to undertake active steps towards work depends on an assessment of health-related functional impairment, known as the Work Capability Assessment (WCA). A recognised problem is that the processes, tools and criteria used to determine type and degree of functional impairment are widely perceived as inadequate in their ability to reflect and evaluate the impact of mental health problems on a person's capacity to work. Despite efforts to improve assessment processes, qualitative research consistently reports that mental health problems are poorly understood by those conducting the WCA, and that claimants find little scope to convey the impact of fluctuating and invisible conditions.Whilst several prior studies have reported that the benefit system fails to comprehend the needs of claimants with mental health problems, research to date has not 'unpacked' claimant experiences of mental (ill) health to any great extent, meaning that the specific nature of the experiences that are obscured, misinterpreted or disavowed in the assessment process remain unclear. In this QSA, we will use methods of narrative analysis, applying the theoretical framework of the Illness Representational Model (IRM), to look in detail at how claimants in an earlier study (focused primarily on benefit sanctions), made sense of their distress. The IRM provides a framework for identifying perceived causes, manifestations, coping mechanisms and consequences of distress. By offering more detailed and nuanced accounts of the lived experience of mental health problems than has been elicited in welfare-focused research to date, the project will enhance understanding of how welfare assessment processes could be adapted to better identify and acknowledge the work-related limitations experienced by claimants seeking support on mental health grounds. Our project comprises a QSA of archived material from the ESRC-funded Welfare Conditionality project (http://www.welfareconditionality.ac.uk/), which includes almost 500 qualitative longitudinal interviews with over 200 benefit claimants who had experienced mental health problems. While the original Welfare Conditionality project focused on claimants' perceptions of benefit sanctions and mandatory support, our analysis will approach the data from the novel perspective of analysing narratives of mental distress, with a focus on illness representations and interpretations. Findings will offer a new route into current discussions about how the welfare assessment system can become more person-centred and hence more effective in supporting work-related goals for people experiencing mental health problems. This focus is timely, taking place as the UK government conducts an inquiry into health benefits assessment, and progresses its Health Transformation Programme, key objectives of which include improving trust and transparency in the assessment process, improving claimant experience and delivering a more personalised service.Exploring these findings with policy and practice stakeholders alongside experts by experience, we will provide valuable insights into the range of experiences underpinning claimant mental distress, and how people navigate work and welfare in this context. Findings will point towards to improved methods of enquiry that could more sensitively and accurately capture claimant experience, providing better understanding of claimants' experiences of mental distress and its work-related impacts, and contributing new evidence to these critical and longstanding areas of policy concern.