City Research Online

Abstract

Aims
This report presents a health, social and economic profile of a sample of Employment and Support Allowance (ESA) claimants living in England in 2014. ESA is a benefit aimed at people with a health condition or disability that affects how much they can work. It is designed to help with living costs if you are unable to work and to provide support to get back into work for those who are able to. This analysis was carried out in order to understand more about the specific barriers and challenges ESA claimants face, which may help inform the provision of appropriate support to help with moving towards or into employment.

Methods
The data analysed in this report are from a general population survey funded by the Department for Health and Social Care (DHSC) called the Adult Psychiatric Morbidity Survey (APMS). The survey was conducted in 2014/5 with a random probability sample of 7,546 people aged 16 and over. It included detailed assessments of a range of mental health conditions, as well as questions about wider circumstances. In this report participants who were in receipt of ESA around the time of the interview are compared with people who were in paid employment. Rates are also presented for participants in receipt of Jobseeker’s Allowance (JSA) and for those with any other economic status, including students who were not in paid work. Analyses in this report are weighted, descriptive and based on participants aged 18 to 64, 4.2% of whom were ESA recipients.

While this draws on a high-quality random sample of the population, people with the most complex needs (including those who were ESA claimants) were likely to be underrepresented. The profile produced, therefore, may underestimate the challenges and adversity this group faced. The sample of ESA claimants (N=287) is also not large and is even smaller for JSA claimants (N=122), and when the sample is small this can mean there is greater uncertainty about the precise estimates. Information about statistical significance, including the confidence intervals around the survey estimates, are provided in the tables[footnote 1]. A further limitation is that the data were collected in 2014, therefore the impact of any subsequent changes to the social security system, mental health services, or other aspects of society are not captured.

Key findings
ESA claimants surveyed were somewhat more likely than the rest of the sample to be male (56.7%), older (26.5% were aged 55 to 64), and lack educational qualifications (33.7%). Their health, social, and economic circumstances were worse - often much worse - than those of employed people on almost every indicator examined.

High levels of multimorbidity: Given ESA is aimed at people with a health condition or impairment, it was not surprising that claimants were much more likely than Jobseeker’s Allowance (JSA) claimants or others in the population to experience having multiple health conditions at the same time. Over half (55.1%) struggled with being able to perform three or more activities of daily living, such as being able to wash and dress, take medications, deal with paperwork and money, and get out and about. Nearly a third (30.9%) experienced the combined burden of having both a physical health condition that limited them ‘a lot’ and a mental health condition that limited them ‘a lot’. They were also more likely than the rest of the working age population to experience limiting sensory impairments (16.9% sight; 8.3% hearing), borderline intellectual impairment (24.2%), and traits linked to autism (6.4%) and attention-deficit/hyperactivity disorder (38.2%).

Majority anxious and depressed: Two-thirds (65.2%) of ESA recipients experienced depressive or anxiety disorders at levels at which mental health intervention, such as counselling or medication, might be considered warranted. This is twice the rate in JSA claimants (28.1%), and four times that among employed people (14.6%). High rates of severe mental illness and trauma: One in six were identified with probable psychosis (16.7%), a serious and disabling mental health condition characterised by hallucinations, delusions and confused or disturbed thoughts: the prevalence in employed people was one in a thousand (0.1%). Many had experience of trauma in their lives, with nearly one in three (29.6%) screened positive for possible post-traumatic stress disorder. This was more than twice the prevalence in JSA claimants (12.2%) and ten times that in employed people (2.7%). ESA claimants were more likely than other groups to report signs of drug dependence (12.8%) but were not found to be more likely to show signs of having an alcohol problem.

Struggling to access treatment: One in ten (11.2%) ESA recipients had requested a particular mental health treatment but not received it the past year. This figure was higher than that for other groups in the population. The higher rate of treatment requests is not unexpected given the higher prevalence of mental health conditions in this group, but the fact that there were many who had requested but not received a specific treatment indicates that unmet needs for mental health treatment, certainly around the time the survey was conducted in 2014, could have been a particular barrier for this group.

Living alone and feeling alone: ESA claimants were more likely to live alone (37.5%), feel lonely and isolated from other people (56.0%), and have perceived lower levels of social support. Around half of ESA (55.9%) and JSA (55.4%) claimants reported that they generally trusted other people, demonstrating lower levels of trust than among the rest of the working age population.

Lower wellbeing, higher weariness and stress: ESA claimants had lower mental wellbeing, as measured by the Warwick Edinburgh Mental Wellbeing Scale: they were far less likely than the rest of the working age population to feel confident (48.2%), useful (61.5%), like they had energy to spare (32.7%) or were able to think clearly (71.9%).

Poverty and financial strain: Most ESA claimants were living in the lowest-income households (62.7%) and were unable to save £10 a month (64.8%); over a quarter (28.6%) were facing serious debt arrears. They tended to rent their home (77.9%) and were less likely than people in employment to be able to afford to keep it warm in winter (20.7%). While the great majority of ESA claimants had experience of paid employment (88.9%), nearly half (48.3%) had been made redundant at some point.

Conclusions
This analysis describes ESA claimants in 2014; the social security system has undergone a substantial programme of transformation since then so there may potentially be some changes to the profile of claimants. Mental health services have also undergone significant transformation since 2014, so access to treatment may also differ. Furthermore, this sample is likely to have underrepresented people, including ESA claimants, with the most complex impairments, and thus may underestimate the true extent of adversity faced by this group.

Despite these limitations, this survey dataset presents a clear opportunity to gain valuable insights into the mental health and life circumstances of this group of people. It also allows comparisons to be made between their experiences and those of the rest of the working age population, drawing on a national, high quality, probability sample. The survey dataset also presents the chance to gain a greater understanding of topics that are not available in the administrative datasets or other sources.

In this study, ESA claimants were worse off than people in employment across almost every aspect of life examined. While it was to be expected that rates of poor health or limiting impairment would be near universal in this group, given the nature of the benefit, these analyses demonstrate the multiplicity of health burdens faced. Many ESA claimants grapple with multimorbidity: combining more than one condition across physical, mental, sensory, and other impairments. This analysis is not able to say to what extent these are additive in their effects, and to what extent they interact. Managing paperwork, money, and being able to get out and use public transport were all aspects of daily life that this group were much more likely than other groups in this study to struggle with. This potentially has implications for the completion of complex forms and using public transport to reach appointments and employment. Alongside tending to have fewer educational qualifications, their lower levels of energy and self-confidence are further barriers to change.

The findings highlight the importance of awareness among Jobcentre Plus staff that this is a population reporting high levels of stress, in which confidence was low and anxiety high. This understanding is relevant to staff working across government and local government, or in any public-facing roles. ESA claimants, and those in receipt of JSA, were more likely to have had negative experiences in the past, such as facing a redundancy process, and their current circumstances were characterised by uncertainty and insecurity. Compared to those in employment, few owned their own home and many faced serious debt arrears: factors likely to contribute to their higher rates of struggle with concentration and difficulty with task completion.

Opportunities for face-to-face social contact are likely to be both important and complex for this group. ESA claimants were more likely to live by themselves, have a small network, and feel isolated and lonely. Their levels of trust in others was also low, and they often felt that support could not be relied on.

Publication Type:	Report
Additional Information:	Crown copyright 2024.
Subjects:	B Philosophy. Psychology. Religion > BF Psychology H Social Sciences > HC Economic History and Conditions R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments:	School of Policy & Global Affairs School of Policy & Global Affairs > Violence and Society Centre
SWORD Depositor:	Symplectic Administrator

Export

Downloads