Disabled and ill benefit claimants overcharged for care due to DWP error

Botched transfer had knock-on effect on councils’ financial assessments

Disabled and chronically ill benefit claimants who were left thousands of pounds out of pocket by a government error may have also been overcharged by their local authorities for social care, it has emerged.

At least 110,000 benefit claimants were underpaid an average of £5,000 following a botched overhaul of incapacity benefits which began in 2011, according to the latest figures.

The error occurred when Department for Work and Pensions (DWP) officials transferred people from older benefits on to the wrong kind of employment support allowance (ESA), meaning they missed out on premium payments they were eligible for.

The Guardian understands that, as a knock-on effect, the error will have skewed financial assessments many councils undertake to determine how much these claimants should have contributed towards their social care costs.

Pat Sawh, 65, has received a refund of more than £2,000 from Enfield council, in north London, which is believed to be the first to begin addressing this issue. Her sons Stephen, 31, and Kris, 29, both have autism, while Stephen also has epilepsy and multiple allergies.

“Both my sons still live at home and my husband and I are pensioners,” she said. “This extra money is helping them a lot – without it they could not do as much.”

Wendy Berry, 75, helps run a group for carers of learning disabled adults in Enfield and helped Sawh bring her case to the attention of the council.

“The problem with this issue is that councils probably do not even realise that the DWP error had an impact on social care charging. It is very complicated. We suspect that very few councils have really thought about it,” she said.

“Charging for social care is always a difficult area because it takes money from the disability benefits paid to the most vulnerable people, who need support to live in their own homes. To ensure people are paying what they are supposed to be paying is critical.”

Enfield council has since sent letters to other residents it suspects have been affected by this issue, which could number as many as 200 people, according documents seen by the Guardian.

In 2014, local authorities gained the power to introduce charges to recoup costs they incur from contracting care and support services. These charges are typically deducted from the benefits of people receiving social care.

Councils who charge must conduct financial assessments to ensure that they do not cause a person’s income to drop below the statutory minimum set by the Department of Health (pdf), although they also have discretion to have more generous charging rules.

Many, though not all, councils now charge for adult social care. Among the factors considered when calculating a person’s minimum income guarantee is whether they are receiving a premium, such as the enhanced disability premium.

Those who, like the Sawhs, missed out on premiums because the DWP transferred them on to the wrong type of ESA, may have had a reduced minimum income guarantee. As a result, they may have been overcharged for care by their local authority.

While the DWP has compensated those who missed out on premiums – to the tune of £5,000 on average – there appears to have been no government effort to address this knock-on effect.

Marsha de Cordova, the Labour MP and disability rights campaigner, said: “This is a scandal. It is a responsibility of the DWP to ensure that all local authorities are compensating or refunding any ill or disabled persons affected.

“I would worry for the ill and disabled people that have fallen into debt, destitution or poverty because of this error by the DWP.”

Kamran Mallick, Disability Rights UK’s chief executive, said: “Now that the DWP have finally recognised the thousands of disabled people who have been underpaid ESA, we urge local authorities to refund the overpaid charges for social care that have been paid by many of these same disabled people.

“It’s monstrous that many of the poorest people in our society have faced a double whammy of not receiving their full entitlement and being hit by social care overcharging.”

A DWP spokesperson said: “We have worked hard to ensure that all those entitled to ESA receive the benefits they are entitled to.

“We urge anyone who believes their social care payments may have been affected by this issue to contact their local council.”

Figures released last month revealed that 5,000 people died before they could be reimbursed for the DWP’s ESA error.

Enfield council was contacted for comment.

https://www.theguardian.com/society/2020/feb/15/disabled-and-ill-benefit-claimants-overcharged-for-care-due-to-dwp-error

Welfare surveillance system violates human rights, Dutch court rules

Government told to halt use of AI to detect fraud in decision hailed by privacy campaigners

A Dutch court has ordered the immediate halt of an automated surveillance system for detecting welfare fraud because it violates human rights, in a judgment likely to resonate well beyond the Netherlands.

The case was seen as an important legal challenge to the controversial but growing use by governments around the world of artificial intelligence (AI) and risk modelling in administering welfare benefits and other core services.

Campaigners say such “digital welfare states” – developed often without consultation, and operated secretively and without adequate oversight – amount to spying on the poor, breaching privacy and human rights norms and unfairly penalising the most vulnerable.

The UN special rapporteur on extreme poverty and human rights, Philip Alston, applauded the verdict and said it was “a clear victory for all those who are justifiably concerned about the serious threats digital welfare systems pose for human rights”.

The decision “sets a strong legal precedent for other courts to follow”, he added. “This is one of the first times a court anywhere has stopped the use of digital technologies and abundant digital information by welfare authorities on human rights grounds.”

The verdict will be watched closely by welfare rights campaigners in the UK, where the government is accelerating the development of robots in the benefits system in a digitisation drive that vulnerable claimants fear could plunge them further into hunger and debt.

A Guardian investigation in October found the Department for Work and Pensions (DWP) had increased spending to about £8m a year on a specialist “intelligent automation garage” where computer scientists were developing more than 100 welfare robots, deep learning and intelligent automation for use in the welfare system.

The Dutch government’s risk indication system (SyRI) is a risk calculation model developed over the past decade by the social affairs and employment ministry to predict the likelihood of an individual committing benefit or tax fraud or violating labour laws.

Deployed primarily in low-income neighbourhoods, it gathers government data previously held in separate silos, such as employment, personal debt and benefit records, and education and housing histories, then analyses it using a secret algorithm to identify which individuals might be at higher risk of committing benefit fraud.

A broad coalition of privacy and welfare rights groups, backed by the largest Dutch trade union, argued that poor neighbourhoods and their inhabitants were being spied on digitally without any concrete suspicion of individual wrongdoing. SyRI was disproportionately targeting poorer citizens, they said, violating human rights norms.

The court ruled that the SyRI legislation contained insufficient safeguards against privacy intrusions and criticised a “serious lack of transparency” about how it worked. It concluded in its ruling that, in the absence of more information, the system may, in targeting poor neighbourhoods, amount to discrimination on the basis of socioeconomic or migrant status.

The system did not pass the test required by the European convention on human rights of a “fair balance” between its objectives, namely to prevent and combat fraud in the interest of economic wellbeing, and the violation of privacy that its use entailed, the court added, declaring the legislation was therefore unlawful. The Dutch government can appeal against the decision.

Christiaan van Veen, director of the digital welfare state and human rights project at New York University School of Law, said it was “important to underline that SyRI is not a unique system; many other governments are experimenting with automated decision-making in the welfare state”.

Van Veen cited Australia and the UK as countries where such concerns were particularly acute. “This strong ruling will set a strong precedent globally that will encourage activists in other countries to challenge their governments,” he said.

Alston predicted the judgment would be “a wake-up call for politicians and others, not just in the Netherlands”. The special rapporteur presented a report to the UN general assembly in October on the emergence of the “digital welfare state” in countries around the globe, warning of the need “to alter course significantly and rapidly to avoid stumbling, zombie-like, into a digital welfare dystopia”.

In the UK, as well as contracts with the outsourcing multinationals IBM, Tata Consultancy and Capgemini, the DWP is also working with UiPath, a New York-based company co-founded by Daniel Dines, the world’s first “bot billionaire”, who last month said: “I want a robot for every person.”

His software is being deployed in an effort to introduce machine learning to check benefit claims, which suggests welfare computers will autonomously learn and alter the way they make decisions with minimum human intervention.

https://www.theguardian.com/technology/2020/feb/05/welfare-surveillance-system-violates-human-rights-dutch-court-rules

How the benefits clampdown is undermining the GP’s role

GPs warn the system for assessing whether people are too sick to work is becoming increasingly stringent, leaving severely unwell patients without benefits. Hiba Mahamadi investigates.

‘I’ve got patients with Parkinson’s disease who can’t speak and rely on carers for feeding being told they’re fit for work.’

Birmingham GP Dr MayJay Ali is not alone. More than half of the 645 GPs responding to a Pulse survey last year said their patients had been refused welfare benefits despite their GP’s opinion that they were unable to work. In other words, GPs’ expert opinions about their patients’ health are being ignored.

Official statistics back them up. Pulse’s analysis of figures from the Department for Work and Pensions reveals 68% of employment support allowance (ESA) claimants assessed as ‘fit for work’ at their initial assessment later successfully had the decision overturned. To put this into context, in 2010, only 36% of decisions were overturned.

GPs warn a small but key change this year is the latest in a series of moves by the DWP that serve to undermine GPs’ role as advocates for their patients – and as experts on their health.

Under the system, people off work long term undergo a DWP-run ‘workplace capability assessment’ to determine their eligibility for ESA. If this deems a person ‘fit for work’, the GP is informed by letter.

This year, this letter was changed to inform GPs that, as the DWP has declared the patient fit for work, the GP ‘does not need to provide any more fit notes’.

Detrimental impact on patients

GPs strongly criticised the change, pointing out that they are the medical experts and their view on a patient’s fitness for work has more validity than that of a non-medically trained assessor. They said the move undermined their role.

It also affects the GP-patient relationship. As then RCGP chair Professor Helen Stokes-Lampard put it at the time: ‘GPs are not benefits assessors and must never be used as barriers for patients to receive benefits when they are entitled to them, as ultimately, this can have a detrimental impact on their health.’

Following the criticism, the DWP made amendments. But even the revised letter says: ‘We no longer need [fit notes] for your patient as they are fit for work.’ The concession, in small print, says GPs can offer fit notes if the patient ‘asks you for evidence for a reconsideration or appeal’.

Dr Ali says ministers are taking an increasingly heavy-handed approach to financial support for sick people: ‘I’ve noticed the [Government’s] assessments don’t seem as fair as they used to be. A lot of my patients whom I would expect to be eligible for benefits are told they’re fit for work.’

And the latest DWP figures show one in three of the 250,000 initial ESA work assessments between April 2018 and March 2019 resulted in claimants being deemed fit to work and refused benefits.

Croydon GP Dr Adnan Siddiqui says: ‘The Government is using assessments as though there is some sort of objective way to assess these things. I usually tell patients the whole set-up is geared to be superficial, to make them fail. But I say, if you persevere, you will most likely win.’

While some patients’ claims may not be genuine, the large proportion of successful appeals indicates a problem with initial DWP assessments. Of almost 2,000 appeals by patients with mental health and behavioural disorders, 72% saw the DWP decision overturned, while 68% of some 1,700 patients with musculoskeletal conditions also appealed successfully.

But often damage has already been done. GPs say appeals can take anywhere from a few weeks to 12 months, bringing anxiety and financial distress for patients. Those suffering from mental health conditions often experience a worsening of symptoms.

Dr Siddiqui says the DWP wrote to him about three patients, telling him they were suicidal after the assessment. This came as no surprise, he said, given that one patient compared the assessment centre to a ‘police interrogation cell’.

All this means extra work for GPs. Dr Ali says: ‘I have to write to the DWP to ask why my patients’ benefits are being stopped and explain why I think they need them. That’s not really my role.’

The DWP assessments also mean GPs come under pressure from patients. Matthew Johnson, a lecturer in politics at Lancaster University spoke to 11 GPs in 2017 about this issue as part of research on deprivation in North East England.

He says: ‘There is evidence to suggest GPs with concern for the wellbeing of their patients often feel a duty to support them as they navigate the benefits system.

‘This can lead to practices in which GPs prescribe medication recognised by assessors as an indicator of serious pain or ill health. This is apparent in the use of opioid painkillers, which ought to be of serious concern and would be avoided were the benefits system different’.

The DWP argues its assessments are carried out by health professionals given specific training in assessing people with a range of mental and physical health conditions. It says it works closely with its contractor to ensure assessments are of the ‘highest possible standard’.

http://www.pulsetoday.co.uk/views/analysis/how-the-benefits-clampdown-is-undermining-the-gps-role/20039773.article

Boycott Workfare Universal Credit Welfare Rights Advice

Boycott Workfare is the only independent campaign to successfully oppose all forms of ”conditionality” aka sanctions and workfare, no ifs, buts, political strings attached or punches pulled.  We are now stepping up to take on Universal Credit. The Conditionality of Universal Credit aka sanctions and workfare have received little attention in reports by campaigns, charities, mainstream media and alternative media outlets. Among other things, we will be exposing the realities of Universal Credit and those profiting from it, and challenging the current narrative of the Westminster Village political class. It’s time to reshape the discussion on Universal Credit to make a difference from the perspective of ordinary working class people living in the real world – not out-of-touch politicians, journalists, so-called industry professionals or policy wonks.

As of today, we are launching a new practical anti-conditionality resistance campaign focused on Universal Credit – the biggest change to social security for over 60 years – and as a starting point, we are now offering free welfare rights Universal Credit-related advice to claimants. Anyone needing help with Universal Credit is invited to contact us via email info@boycottworkfare.org.  We will also offer face-to-face Universal Credit advice for claimants (currently only available in central London). These advice sessions are by appointment only, please email us to book one, along with brief details of the help you need in advance. The first of these sessions will be held on Saturday the 10th November from 14:00 -17:00, kindly hosted at MayDay Rooms, 88 Fleet St, London EC4Y 1DH.

The areas we can help claimants with include:

How to avoid claiming UC in Full Service areas if already receiving any so-called ‘legacy benefits’ (JSA, ESA, Housing Benefit, Child Tax Credit, working Tax Credit) or on becoming unemployed

The possibility of returning to ‘legacy benefits’ in ‘Gateway/Live UC Service’ areas and when to withdraw a claim for UC in Live Service areas to avoid losing money for part of a monthly ‘assessment period’ – though please note these options are now much more difficult due to the rapid roll-out of Full Service UC.

Complaining if you’ve lost income after being wrongly advised to transfer to UC

Re-claiming Council Tax Reduction when transferring to UC

Making sure a 2-week Housing Benefit ‘run-on’ has been received along with a housing element in the first assessment period after transferring to UC

Changing ‘claimant commitments’ and moving to different UC conditionality groups

Understanding work search and work availability conditions in the ‘all work related requirements group’

Varying the general 35-hour a week work search and availability rule

Limiting or suspending work search and work availability requirements for claimants otherwise subject to ‘all work related’ conditions

Checking whether sanctions (reduced entitlements for alleged failures to comply) have been applied to UC claims and effectively challenging sanctions

Dealing with the conditionality regimes imposed by private and voluntary sector contractors on behalf of the DWP

Challenging Workfare-related sanctions

Appealing fines and penalties imposed under UC

Making ‘Mandatory Reconsiderations’ about UC decisions

Appealing to First Tier tribunals about UC decisions

Asking for compensation via the complaints systems

Dealing with practical problems in claiming UC, payment delays and claim closures

Claiming UC Advances and appealing recovery rate decisions

Overcoming some of the UC barriers set up for EEA migrants concerning ‘right to reside’ rules

Overcoming some of the problems for sick and disabled claimants on UC

How to be assessed as having limited capability for work under UC – even if working

Checking errors in UC monthly calculations

Complaining about DWP and 3rd party deductions from UC for overpayments/debts

Alternative Payment Arrangements’ (APA’s)

Understanding the ‘conditionality earnings threshold’ of the employed and the ‘minimum income floor’ of the self-employed claiming UC

Understanding how the timing of changes (e.g. to rent) and an earnings cycle (e.g. weekly) affect UC payments

Possible ways of claiming UC while studying

Possible ways of claiming UC if under 18

Overcoming housing element UC restrictions for single renters under 22

Applying for Discretionary Housing Payments

Applying for Discretionary Council Tax Hardship payments

If your problem isn’t in the list above, still get in touch and we’ll see if we can help but please remember, we are currently only able to offer welfare rights advice about Universal Credit, Sanctions and Workfare.

Unlike state-funded welfare advice organisations like the Citizen’s Advice Bureau (CAB) with their ‘gagging clause’ restrictions, we will not hold back in our criticisms and demands for change while helping claimants. Much of the current focus of ‘UC support’ for claimants provided by charities and local authorities is on enforcing ”compliance”. Indeed, the DWP is paying CAB to concentrate on the IT skills needed to manage claims and on ‘budgeting skills’ – whilst the very same claimants are being plunged further into poverty via UC and ”conditionality”. CAB as an organisation has been paid off by the government to become a Universal Credit enforcer. Fail to attend a budgeting skills appointment with CAB? Then expect to be sanctioned as CAB will be contractually obliged to report it.

The only way to fight Universal Credit is to ensure that claimant’s know their rights and to actively challenge the narrative of punishment via conditionality. This is where you can come in to help. We plan to expand this part of our campaign and want you to get involved. We would love to hear from anyone and everyone interested in opposing conditionality and in working with claimants to help secure welfare rights. We’re especially keen on hearing from people with direct personal experience of the social security system. Why? We are claimants just like you, and the only way to win and get the welfare state you want is by coming together with like-minded people to actively expose and challenge the inadequacies of system we have. Work with us to help bring down Universal Credit.

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Boycott Workfare Universal Credit Welfare Rights Advice

DWP presentation on ESA plans ‘confirms worst fears’ about green paper

Ministers have been accused of ignoring a public consultation and ploughing ahead with plans that will make their “fitness for work” testing regime even more stressful and unfair for sick and disabled people.

A presentation delivered by two senior Department for Work and Pensions (DWP) civil servants earlier this month suggests that ministers have decided – as many disabled activists feared after the publication of last year’s green paper – to introduce new benefit sanctions for sick and disabled people with the highest support needs.

The presentation at a DWP “Operational Stakeholder Engagement Forum” appears to confirm that the government had decided how it would reform the system of out-of-work disability benefits before its “consultation” process had finished on 17 February.

The government had claimed that it wanted to make the work capability assessment (WCA) less of an ordeal for claimants, with work and pensions secretary Damian Green telling last October’s Conservative party conference he wanted to support those disabled people who cannot work, and “sweep away unnecessary stress and bureaucracy which weighs them down”.

But slides from the presentation appear to show that his new regime will be even harsher, and that many employment and support allowance (ESA) claimants with the highest support needs and barriers to work will for the first time face having their benefits sanctioned if they do not co-operate with the regime.

The slides show DWP has already begun introducing a compulsory, face-to-face “health and work conversation” (HWC) with a jobcentre work coach that will apply to nearly all new claimants of ESA, weeks or even months before they go through the WCA process to decide whether they are not fit for work and eligible for the benefit.

The presentation says that “vulnerable” claimants will not have to take part in the face-to-face HWC.

A DWP spokesman has told Disability News Service (DNS) that work coaches will be “issued clear guidance on who will be exempted from the HWC” and “will also be able to defer the HWC if the claimant cannot attend due to temporary circumstances”.

But disabled activists have warned that these decisions will be taken by non-medically trained civil servants.

The slides say: “Currently Jobcentre staff do not routinely engage with ESA claimants before the Work Capability Assessment (WCA) which can take place many months into the claim.

“We know that the start of the claim can be a challenging time for claimants and that the longer a claimant is on benefit, the more difficult it is for them to move into employment where appropriate.

“The Health and Work Conversation (HWC) will provide this early support to claimants.”

The presentation said the HWC – which it claimed was co-designed with some disabled people’s organisations – will draw on “behavioural insight techniques and research” to “develop voluntary action plans” and help claimants “move closer to the workplace”.

And it said that all new ESA claimants would have to sign a new “ESA Claimant Commitment”, which would “set out the expectations and legal requirements that claimants will be required to accept in order to receive ESA”.

http://www.disabilitynewsservice.com/dwp-presentation-on-esa-plans-confirms-worst-fears-about-green-paper/

I, Daniel Blake review – a battle cry for the dispossessed

Ken Loach crafts a Cathy Come Home for the 21st century, the raw anger of which resonates long after you leave the cinema.

Mark Kermode

Ken Loach’s latest Palme d’Or winner, his second after 2006’s The Wind that Shakes the Barley, packs a hefty punch, both personal and political. On one level, it is a polemical indictment of a faceless benefits bureaucracy that strips claimants of their humanity by reducing them to mere numbers – neoliberal 1984 meets uncaring, capitalist Catch-22. On another, it is a celebration of the decency and kinship of (extra)ordinary people who look out for each other when the state abandons its duty of care.

For all its raw anger at the impersonal mistreatment of a single mother and an ailing widower in depressed but resilient Newcastle, Paul Laverty’s brilliantly insightful script finds much that is moving (and often surprisingly funny) in the unbreakable social bonds of so-called “broken Britain”. Blessed with exceptional lead performances from Dave Johns and Hayley Squires, Loach crafts a gut-wrenching tragicomic drama (about “a monumental farce”) that blends the timeless humanity of the Dardenne brothers’ finest works with the contemporary urgency of Loach’s own 1966 masterpiece Cathy Come Home.

We open with the sound of 59-year-old Geordie joiner Daniel Blake (standup comic Johns) answering automaton-like questions from a “healthcare professional”. Having suffered a heart attack at work, Daniel has been instructed by doctors to rest. Yet since he is able to walk 50 metres and “raise either arm as if to put something in your top pocket”, he is deemed ineligible for employment and support allowance, scoring a meaningless 12 points rather than the requisite 15. Instead, he must apply for jobseeker’s allowance and perform the Sisyphean tasks of attending CV workshops and pounding the pavements in search of nonexistent jobs that he can’t take anyway.

Meanwhile, Squires’s mother-of-two Katie is similarly being given the runaround, rehoused hundreds of miles from her friends and family in London after spending two years in a hostel. “I’ll make this a home if it’s the last thing I do,” she tells Daniel, who takes her under his wing, fixing up her flat and impressed by her resolve to go “back to the books” with the Open University. Both are doing all they can to make the best of a bleak situation, retaining their hope and dignity in the face of insurmountable odds. Yet both are falling through the cracks of a cruel system that pushes those caught up in its cogs to breaking point.

“We’re digital by default” is the mantra of this impersonal new world, to which carpenter Daniel pointedly replies, “Yeah? Well I’m pencil by default.” Scenes of Blake struggling with a computer cursor (“fucking apt name for it!”) raise a wry chuckle, but there’s real outrage at the way this obligatory online form-filling has effectively written people like him out of existence. Yet still Daniel supports – and is supported by – those around him; from Kema Sikazwe’s street-smart China, a neighbour who is forging entrepreneurial links online (the internet may alienate Daniel, but it also unites young workers of the world), to Katie’s kids, Daisy and Dylan – the latter coaxed from habitual isolation (“no one listens to him so why should he listen to them?”) by the hands-on magic of woodwork. Having lost a wife who loved hearing Sailing By, the theme for Radio 4’s Shipping Forecast, and whose mind was “like the ocean”, Daniel carves beautiful fish mobiles that turn the kids’ rooms into an aquatic playground. Meanwhile, their mother is gradually going under.

A scene in a food bank in which the starving Katie, on the verge of collapse, finds herself grasping a meagre tin of beans is one of the most profoundly moving film sequences I have ever seen. Shot at a respectful distance by cinematographer Robbie Ryan, the scene displays both an exquisite empathy for Katie’s trembling plight and a pure rage that anyone should be reduced to such humiliation. Having seen I, Daniel Blake twice, I have both times been left a shivering wreck by this sequence, awash with tears, aghast with anger, overwhelmed by the sheer force of its all-but-silent scream.

“They’ll fuck you around,” China tells Daniel, “make it as miserable as possible – that’s the plan.” For Loach and Laverty, this is the dark heart of their drama, the use of what Loach calls the “intentional inefficiency of bureaucracy as a political weapon”, a way of intimidating people in a manner that is anything but accidental. “When you lose your self-respect you’re done for,” says Daniel, whose act of graffitied defiance becomes an “I’m Spartacus!” battle cry that resonates far beyond the confines of the movie theatre. Expect to see it spray-painted on the walls of a jobcentre near you soon.

https://www.theguardian.com/film/2016/oct/23/i-daniel-blake-ken-loach-review-mark-kermode

Why is poverty associated with mental health problems for some people, but not others?

By guest blogger Peter Kinderman

“I’ve been rich and I’ve been poor. Believe me, rich is better” (Mae West).

Critiques of the rather discredited “disease-model” of mental illness are commonplace, but we also need to articulate the alternative. New research by Sophie Wickham and colleagues helps do that, by providing support for the idea that we learn, as a consequence of our experiences in life, a framework of appraising, understanding and responding to new challenges. This psychological schema then shapes our emotional and behavioural responses to future events.

Wickham and her colleagues used data from over 7000 people and, based on a composite measure of each person’s neighbourhood (including data on income, health, education, and crime), they found that participants living in more deprived neighbourhoods had much higher levels of both depression and paranoia.

But the researchers did not merely correlate social deprivation with mental health. They also looked at a range of psychological mediators. They found that, if people reported low levels of stress, high levels of trust in others and high levels of social support, then social deprivation was no longer associated with more depression. The same was partially true in the case of paranoia – when people reported low levels of stress and high levels of trust, social deprivation had a greatly reduced association with levels of paranoia.

In one sense this is a relatively conventional correlational study using secondary data (the Adult Psychiatric Morbidity Survey) to look at a rather well-established link between social factors and mental health. But I think there’s more to it than that.

There are many ways to be overly simplistic about mental health issues. A simple “disease-model” of mental health problems doesn’t really help us much, but an equally simplistic model of social causation is equally reductionist – reducing people to mechanistic pawns, pushed around by social pressures. Instead, a more elegant psychosocial model might suggest that the emotional (and behavioural) impact of life events is at least in part a consequence of how we appraise and respond to those events… and in turn that our appraisals and responses have been learned over time as a consequence of the events to which we have been exposed.

Wickham and colleagues have gone some way in exploring that hypothesis. Their data suggest that people’s appraisals of their circumstances – their perceived stress, perceived trust and perceived social support – mediate the impact of social deprivation on depression and paranoia. It is also interesting to note that these relationships appeared specific to depression and paranoia; they did not apply to auditory hallucinations or hypomania, the rates of which were not associated with poverty in this study.

If these kinds of findings are replicated in future research, the implications could be important and far-reaching. But first, it seems important to replicate this work, exploring the specific combinations of social circumstances, and mediating psychological processes, that lead to different emotional and behavioural outcomes. Wickham and colleagues speculate about what some of these may be – for example, whereas the combination of deprivation and a person’s appraisal of their situation was associated with more depression and paranoia, perhaps a combination of childhood trauma and a perceptual source monitoring problem (e.g. misattributing one’s own thoughts to a third party) might be associated with auditory hallucinations.

The researchers also speculate about the implications of their findings – how we might intervene at a population level, with social and psychological interventions targeted at specific risk factors and psychological mechanisms. Long term political and social policies could address issues of population-level social disadvantage, deprivation and inequity. Similarly, social interventions and targeted welfare packages might be effective in addressing social risk factors at an individual or family level. And, unsurprisingly given that they are psychologists, Wickham and her colleagues also point out that psychological interventions such as cognitive-behaviour therapy (CBT) and interpersonal psychotherapy could help individuals develop more effective psychological responses to the inevitable social stressors that accompany social deprivation.

One study cannot possibly explore all these issues. But, by examining both the social deprivation that is known to contribute to mental health problems and the psychological mechanisms that mediate the impact of this social stress on the individual, Wickham and colleagues offer a model for an elegant approach to understanding and, ultimately, intervening to improve psychological health and well-being. These ideas are important, and new, but are also evidence of the growing maturity and power of psychosocial explanations in mental health. I discuss these ideas further in my book, A Prescription for Psychiatry: Why We Need a Whole New Approach to Mental Health and Wellbeing
and in my new, free, online course.

http://digest.bps.org.uk/2014/09/why-is-poverty-associated-with-mental.html