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Liz Main

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Liz is Australian, though grew up in India. A journalism career led to TV presenting and PR, which led to a five year spell of depression. Following this, Liz resumed her career working on government policy on mental health and social exclusion.

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Pyjama Girl and the hidden costs of going back to work

13th December 2007

So once again the Government has announced plans to overhaul the benefits system to get people on Incapacity Benefit (IB) back to work, this time through a move to "employment and support allowance" which positively focuses on "what people can do rather than what they can't".
Peter Hain MP, Secretary of State for Work and Pensions
But despite all the recent hoo haa about the 50 people with acne and those with nail disorders and the 400 people "too fat" to work, the group the Department of Work and Pensions really want to get off their books is people with mental health problems.

A glance at those books tells you why: mental health problems are costing the Government £2 billion a year in Incapacity Benefit, a hefty proportion of the total £12.5 billion they pay out.

It's not that those with mental health problems are shirking, campaigners insist. "People who have experienced severe mental illness have the highest want-to-work rate of any disability group, but have the lowest in-work rate," says Jane Harris, head of campaigns at Rethink. She points out there are two likely hurdles: the unwillingness of employers to take on people with mental health problems; and the hidden costs of going back to work.

In trying to gain support for the new changes to IB, government has been briefing that getting off benefits and back to work will swell your bank account as well as increase your sense of wellbeing. But we are unable to look at government profiling to see how they have worked these figures out and for whom it applies.

Other government figures are freely available to look at.

Harris says that though government publishes annual tax benefit model tables that show the relationship between incremental wage increases for lone parents, for example, they don't do this for people with disabilities.

We spoke to the Department of Work and Pensions (DWP). They told us that to publish model tables for people on disability benefits would be too complicated because of the number of scenarios that would need plotting.

The published tax benefit model illustrates the effect on net income of gross income, rent, marital status, number of children, tax credits, tax and National Insurance Contributions, they explained. "A model that looked at disability benefits would be a very complex table as there are so many factors involved in working out an individuals' entitlement. For example, not only would it have to take into account the information that is contained in the current model but it would also need additional information such as: type of disability, length of time on benefit, type of disability benefits customers are in receipt of, what rate of benefit they are in receipt of i.e. higher or lower."

While the DWP have pledged long-term Incapacity Benefit claimants will be at least £25 a week better off in work, this figure may cover little more than the travel costs that they will now incur through being off IB and in employment. But employment brings more costs than that, costs that could ultimately prove dangerous to people with mental health problems.
A typical office
We spoke to people with mental health problems who have gone back to work. They told us that they had been taken aback by some of the expenses they now had to pay as a working person such as exercise costs, school meals, talking therapies and prescriptions.


"When I came out of hospital I was on four different meds," says Kay, a woman with bipolar disorder. "Because I was seriously depressed, I was only given two days of some medications at a time. Everyone assumed that I would be on benefits, but I wasn't so I was paying a fortune for prescriptions."

Those in the know can buy a pre-paid prescription card for just under £100 a year or about £27 for three months, which covers unlimited prescriptions. But most people aren't aware of this, and continue to shell out £6.85 an item when they start paying for medication.

"Nobody told me that I could pay a set amount up front - not my psychiatrist, not the pharmacist," Kay told us. "I don't think the doctor knew. No one in the mental health system expects you to be paying, they blithely make the assumption that you can afford to keep taking the pills." She points out two ironies. If she hadn't taken the medication she would have been back in hospital where it would have been free, and if she had epilepsy, the other condition treated by the same medication, she wouldn't have paid for the pills.


This woman of 35 who also has bipolar and works full time despite a number of episodes in hospital, also paid for her prescriptions until she was diagnosed with a thyroid disorder. When the pharmacist told her she no longer had to pay for medication she was pleased but also furious. "Why should people pay for prescriptions for mental illness when you don't have to pay for other conditions? Why is something physical worth paying for, but mental health isn't?"

Sara is still doing the sums over what medication has cost her in the decade since she was diagnosed.
It is not surprising then, that some people throw the prescriptions away. Research carried out by the Citizens Advice Bureau in 2001 found that 50 of their clients paying prescription charges had difficulty affording them and 28% failed to get all or part of a prescription dispensed because of the cost.

Increasingly the Government will offer short-term talking therapies for people with minor mental health problems to enable a swift return to work. But those with ongoing mental health problems will often need longer-term therapy, and while this might be available on the NHS, it is almost exclusively within normal working hours. As it is difficult to take time out of the working day for ongoing talking therapy, people either quit or find themselves paying for private therapy out of hours at a ballpark £30-40 a session.


This was the case for Julian who was discharged by his Community Psychiatric Nurse when he returned to work. Once back, he found himself more vulnerable and in need of someone to talk to, so now pays £30 a week for counselling sessions. "I find I need more support now than ever before, but I'm more likely to skip appointments with my shrink as well, because if there's an important meeting at work it's easier to cancel the doctor than make an excuse to my boss about a therapy session," he says.

Julian swims and works out at a local leisure centre as he finds exercise helps to keep his depression at bay, but no longer gets a discount. "I pay about £30 a month more than when I was on benefits," he says. "It might have been less if I could use the gym off peak, but that's the thing about going back to work - every bit of help or discount is geared towards people who don't work."

he has a prescription card but calculates the price of going back to work will be around £2000 this year.

Andy Bell, head of public affairs at the Sainsbury Centre for Mental Health, says that services must stop being "predicated on the notion that you are out of work". "If you support someone when they are out of work and forget about them when they get back to work there's a chance they will fall out of work again," he warns.
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    • 1. At 10:10am on 13 Aug 2009, buffalobazza wrote:

      The government need to take a step backward and look at the things they are doing. Who dreams up these poorly thought out policies, David Ike?
      First of all, who came up with the support to employment benefit in place of Incapacity benefit at a time when there is no work. A situation created by government greed and incomepetency. Unemployment has just reached 2.4million and climbing, so just what jobs are they planning to find and support us into? Now we have another crackpot idea that people on incapacity benefit should take more exercise. The notion being that those suffering mental health problems will recover and be able to take up employment. What a load of cobblers. This is just desperation from ministers to find ways to reduce the benefits bill. Nothing wrong with that, but do it without picking on the most vunerable in society. And again tell us where the jobs are that these people are to take up. We are told that unemployment will continue to rise for some time to come.
      The real answer is to take the "Pretend sick" off benefit and stop picking on the genuine sick. Something that New Labour promised to do before they came to power and then dropped once in power. I think we all know of someone who has never worked and expects to live for free at our expence. Most could work, but have no intention of working. They are the ones that should now face a proper medical and taken off benefit. Leave the sick alone and instead look at the lazy.
      I personally have worked all my life and upon being made redundant took a degree to better my employment chances. I have now graduated with a degree in business but cannot even find menial work so what chance has someone with mental issues?
      The answer that the government must come up with is Jobs. Create employment first that the genuine unemployed can take up. These valued members of the community need work and are the ones who can generate real prosperity. then and only then can they look at getting the sick off benefit. but the lazy can be made to fend for themselves starting now.
      We must also bring immigration under control because as a small country we have become over populated. Whilst I am happy that many settlers in this country make a positive and welcome contribution to our society, we just don't have room for everyone. Other member states of the EU must accept these people instead of channeling them to the UK. Get the population down by encouraging immigrants to return home and lets help develope their homelands. We pay a high price for an open door policy that is not shared by the rest of the EU. We must look after our own before we look after the rest, and if thats not possible under EU legislation, we must ask if we should pull out of europe. We must also ditch this crackpot government that have lost the plot.

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