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

这项定性二次分析(QSA)项目旨在加深参与英国福利制度的人对心理困境经历的理解，以改进与健康相关的福利评估程序，并提高对经历精神健康问题的人的福利到工作支持的有效性。英国实行以条件性为基础的福利制度，对工作采取积极步骤的期望程度取决于对与健康相关的功能损害的评估，即工作能力评估(WCA)。一个公认的问题是，人们普遍认为，用于确定功能损害类型和程度的程序、工具和标准不足以反映和评估精神健康问题对个人工作能力的影响。尽管努力改进评估过程，但定性研究一直报告说，进行WCA的人对精神健康问题的了解很少，索赔人发现几乎没有机会传达波动和无形条件的影响。尽管之前的几项研究报告称，福利制度未能理解有精神健康问题的索赔人的需求，但到目前为止，研究还没有在很大程度上拆开索赔人的精神(不健康)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。在此QSA中，我们将使用叙事分析方法，应用疾病代表性模型(IRM)的理论框架，详细查看早期研究(主要关注福利制裁)中的索赔人是如何理解他们的痛苦的。综合风险管理提供了一个框架，用于确定痛苦的感知原因、表现、应对机制和后果。与迄今以福利为重点的研究相比，该项目对精神健康问题的生活经历提供了更详细和更细致入微的描述，将加强对如何调整福利评估程序以更好地识别和承认基于精神健康理由寻求支持的索赔人所经历的与工作有关的限制的理解。我们的项目包括来自ESRC资助的福利条件项目(http://www.welfareconditionality.ac.uk/)，)的档案材料的QSA，其中包括对200多名经历过精神健康问题的福利申索人进行的近500次定性纵向访谈。虽然最初的福利附加条件项目侧重于索赔人对福利制裁和强制性支助的看法，但我们的分析将从分析精神痛苦的叙述的新角度处理数据，重点放在疾病陈述和解释上。研究结果将为当前的讨论提供一条新的途径，即福利评估系统如何变得更以人为中心，从而更有效地支持经历精神健康问题的人的与工作有关的目标。这种关注是及时的，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中的信任和透明度，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专家根据经验探索这些发现，我们将提供有价值的见解，了解支撑索赔人精神痛苦的一系列经验，以及人们如何在这种背景下驾驭工作和福利。调查结果将指向改进的调查方法，可以更敏感和准确地记录索赔人的经历，更好地了解索赔人的精神痛苦经历及其与工作有关的影响，并为这些关键和长期的政策关切领域提供新的证据。

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.