Title: The interrelationships between receiving benefits, employment status and mental health: a data linkage project
Funder: Department of Health and Social Care

Abstract: Background Annually, 1.8 million people are on sickness absence for four weeks or longer, costing the UK 100 billion. Around 890,000 of these people claim unemployment or sickness related benefits with 32% of the successful benefit claims due to mental disorders. Therefore, promoting good mental health is a priority for the Government and the NHS. Over the last decade major changes have taken place in the benefits system, including the use of benefit sanctions and the introduction of Universal Credit. These have been met with concern about their impact on people's well-being, and particularly on patients with mental disorders. Aims and objectives Little is known about the interrelationships between benefit receipt, employment status, mental disorders, treatment, well-being and recovery. The proposed research aims to address this through three work packages. Work package 1 will investigate patterns of benefit receipt by socio-demographic, diagnostic, clinical and treatment factors among people attending mental health care services and explore how these vary over time and by psychiatric diagnosis. Work package 2 will investigate socio-demographic, diagnostic, clinical and treatment factors that predict return to work and how this varies by psychiatric diagnosis. Further, this work package will examine levels and types of benefit sanctions and their impact on psychiatric morbidity, adverse events or return to work. Work package 3 will explore the effectiveness of specific interventions (e.g. types of mental health treatment or a work support programme) on the likelihood and timeliness of return to work, and psychiatric recovery, thereby also exploring whether this differs by psychiatric diagnosis.Methods A novel data linkage will be established using electronic secondary mental health care records from the South London and Maudsley NHS Trust and employment, welfare and benefits records from the Department for Work and Pensions (n>400,000). This approved data linkage will be used to conduct retrospective clinical cohort studies and cross-sectional studies, using time to event analyses and generalised linear models to analyse the data, covering years 2007-2018 inclusive. Patient and public involvement The data linkage, and work packages, have been discussed with the Data Linkage Service User Advisory Group at the NIHR Maudsley Biomedical Research Centre, who were very supportive of the research. Two work placements for people with lived experiences will be offered to co-produce and deliver a detailed plan to engage with patients, the wider public and stakeholders. We will work together to run service user groups, and organise round table discussions to interpret and share findings. Dissemination and impact The findings will be summarised using accessible and understandable infographics and an innovative video that will be shared widely via social media, the University's press office and included in educational materials. The two people with lived experiences and I will attend conferences and events to disseminate the research findings. Papers will be published in scientific journals. Practical recommendations will be developed and leveraged to influence policies on benefit provision and the use of sanctions, and to inform and improve interventions to support people with mental disorders to enter, regain or remain in work.

Lay abstract: Annually, 1.8 million people are out of work due to sickness for a period of four weeks or longer, costing the UK 100 billion. About 890,000 of these people claim unemployment or sickness related benefits. Over one in three of those who successfully claim such benefits do so because they have a mental health difficulty. Therefore, promoting good mental health is a priority for the Government and the NHS. Over the last decade major changes have taken place in the benefits system, including the use of benefit sanctions and the introduction of Universal Credit. There have been concerns about the impact of these changes on people's well-being, and especially on patients with mental health difficulties. However, little is known about the interrelationships between receiving benefits, employment status, mental health difficulties, treatment, well-being and recovery. My research aims to answer important questions in this field through three work packages. Work package 1 will look at who is most likely to receive benefits among people attending mental health care services. I will explore factors such as age, gender, ethnicity, severity of mental health symptoms, type of mental health difficulties, type of treatment and mental health service use. Work package 2 will investigate whether the same factors can tell us who is most likely to return to work and how this may vary among people with different types of mental health difficulties. This work package will also examine how many people with mental health difficulties receive a benefit sanction, and if so, what type of sanction (for example their benefits being reduced or stopped), and how this impacts on their mental health, their use of mental health care services and how quickly they return to work. Work package 3 will explore how successful certain interventions (for example types of talking therapy or a support programme) are at getting people with mental health difficulties back to work, and if so, how quickly they can return and recover from their difficulties. I will investigate this by linking individual data from two datasets, namely electronic mental health care records from people who are receiving treatment from the South London and Maudsley NHS Trust, with employment, welfare and benefits records from the Department for Work and Pensions. This will result in a unique dataset of approximately 400,000 working age adults with mental health difficulties (covering years 2007-2018 inclusive). The data linkage, and work packages, have been discussed with the Data Linkage Service User Advisory Group at the NIHR Maudsley Biomedical Research Centre who were very supportive of the research. I will offer two work placements for people with lived experiences to co-produce and deliver a detailed plan to engage with patients, the Department for Work and Pensions, Department for Health and Social Care, NHS England, local charities and the wider public. With help of the two people with lived experiences, I will run service user groups and organise discussions to interpret and share findings. Findings will be summarised using accessible and understandable images that will be shared widely via social media, the University's press office and included in educational materials. An innovative video will also be produced. The two people with lived experiences and I will attend conferences and events to speak about the research. Findings will be published in scientific journals. Practical recommendations will be developed and used to influence policies on benefits and the use of sanctions, and to inform and improve interventions to support people with mental health difficulties to enter, regain or remain in work.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.2 HEALTH AND WELFARE ECONOMICS
Health categories: MENTAL HEALTH