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.

这个定性的二次分析（QSA）项目旨在加深对与英国福利系统相关的人的心理困扰经历，以改善与健康相关的福利评估过程，并提高对经历精神健康问题的人们的福利到工作的有效性。英国运营基于条件性的福利制度，从而实现积极步骤的工作水平取决于对健康相关功能障碍的评估，即工作能力评估（WCA）。一个公认的问题是，用于确定功能障碍类型和程度的过程，工具和标准被广泛认为是它们反映和评估心理健康问题对人工作能力的影响的能力不足。尽管努力改善评估过程，但定性研究始终如一地报告说，进行WCA的人对心理健康问题的理解很少，并且索赔人很少发现的范围来传达波动和不可见力的状况的影响。当一些以前在评估过程中被遮盖，误解或拒绝了。在此QSA中，我们将使用叙事分析的方法，应用疾病代表模型（IRM）的理论框架，详细介绍较早的研究中的索赔人（主要集中于利益制裁）如何使他们感到困扰。 IRM提供了一个框架，用于识别感知的原因，表现，应对机制和困扰后果。通过提供对心理健康问题的生活经验的更详细和细微的说法，迄今为止以福利为中心的研究引起的，该项目将增强对福利评估过程的理解，以更好地识别并认识到在精神健康方面寻求索赔人支持的索赔人所经历的与工作相关的限制。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QSA，其中包括近500个定性纵向访谈，其中200多名经历了精神健康问题的福利索赔人。尽管最初的福利条件项目着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困扰叙事的新角度了解数据，重点是疾病表征和解释。调查结果将为有关福利评估系统如何变得更加以人以以人为本的当前讨论提供一条新的途径，从而为遇到心理健康问题的人们提供支持的目标。这一重点是及时的，是在英国政府对健康福利评估进行调查的情况下进行的，并进步了其健康转型计划，关键目标包括改善评估过程中的信任和透明度，改善索赔人的经验，改善索赔人的经验并提供更个性化的服务。探索这些发现，通过经验来探索范围的范围，我们将如何与范围内的范围融合各种范围，我们将如何努力地努力，我们将为范围提供良好的范围，并将其带入有价值的范围，并将其带入范围，并启用范围，并将其带入范围，并将其启用范围融合到范围内，并逐渐融入范围。在这种情况下的福利。调查结果将指向改进的询问方法，这些方法可以更敏感，更准确地捕捉索赔人的经验，从而更好地理解索赔人的精神痛苦经验及其与工作相关的影响，并为这些关键和长期存在的政策关注领域提供新的证据。