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

了解英国福利体系中的心理健康：福利申请人的痛苦表现以及对评估和支持的影响

• 批准号: ES/X002101/2
• 负责人: Annie Irvine
• 金额: --
• 依托单位: University of York
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2024
• 资助国家: 英国
• 起止时间: 2024 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=ES%2FX002101%2F2
• 关键词: Understanding; mental; health; UK; welfare

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.

这个定性二级分析（QSA）项目旨在加深对英国福利系统参与者心理困扰经历的理解，以改善与健康相关的福利评估过程，并提高对经历心理健康问题的人的福利工作支持的有效性。联合王国实行一种以条件为基础的福利制度，根据这种制度，对采取积极工作步骤的期望程度取决于对与健康有关的功能损害的评估，即工作能力评估。一个公认的问题是，用于确定功能障碍类型和程度的程序、工具和标准被广泛认为不足以反映和评估心理健康问题对个人工作能力的影响。尽管为改进评估程序作出了努力，但定性研究一致报告说，进行WCA的人对精神健康问题了解甚少，申请人几乎没有机会传达波动和无形条件的影响。迄今为止的研究还没有在很大程度上“揭示”索赔人的精神（疾病）健康经历，这意味着在评估过程中被掩盖、误解或否认的经历的具体性质仍然不清楚。在这篇QSA中，我们将使用叙事分析的方法，应用疾病表征模型（Illness Representational Model，简称RDT）的理论框架，详细研究早期研究（主要关注福利制裁）中的索赔人如何理解他们的痛苦。该框架提供了一个框架，用于确定可感知的原因、表现、应对机制和痛苦的后果。通过提供比迄今为止以福利为重点的研究所得出的更详细和细致入微的心理健康问题的生活经历，该项目将提高对福利评估过程如何适应的理解，以更好地确定和承认寻求心理健康支持的索赔人所经历的与工作有关的限制。我们的项目包括来自ESRC资助的福利条件项目（http：//www.welfareconditionality.ac.uk/）的存档材料的QSA，其中包括对200多名经历过心理健康问题的福利申请人进行的近500次定性纵向访谈。虽然最初的福利条件项目侧重于索赔人对福利制裁和强制性支持的看法，但我们的分析将从分析精神痛苦叙述的新角度来处理数据，重点是疾病陈述和解释。调查结果将提供一个新的路线到目前的讨论如何福利评估系统可以变得更加以人为本，从而更有效地支持与工作相关的目标，为人们遇到心理健康问题。这一关注是及时的，因为英国政府正在对健康福利评估进行调查，并正在推进其健康转型计划，其主要目标包括提高评估过程的信任度和透明度，改善索赔人的体验，并提供更个性化的服务。与政策和实践利益相关者以及经验丰富的专家一起探讨这些发现，我们将提供宝贵的见解，以支持索赔人精神痛苦的经验范围，以及人们如何在这种情况下导航工作和福利。调查结果将指出改进的调查方法，可以更敏感和准确地捕捉索赔人的经验，提供更好的了解索赔人的精神痛苦的经验及其与工作有关的影响，并为这些关键和长期的政策关注领域提供新的证据。