When governments are making decisions about the policies they should make and where they should invest public money, savings in social security (so-called ‘welfare’) spending are often sought. “If you put money into x, you’ll spend less on benefits”, we’re often told by advocates of certain policies or interventions. This has become such ingrained behaviour, it’s almost always unnoticed, and seldom questioned.
Yet from a mental health perspective, or indeed one of social justice or even common sense, spending on social security is not necessarily a bad thing or (as sometimes stated) the ‘cost of failure’. Very often, it is quite the opposite. It’s a cornerstone of a decent and just society that cash transfers are offered to those who, for whatever reason, do not have other means to have a decent standard of living.
Social security was the first element of the modern welfare state to be implemented in Britain – stretching back to the Liberal Governments of the very early twentieth century. Before then, and indeed during its first thirty years, that system was accompanied by the workhouse – the last vestige of the cruel system of ‘indoor relief’, making it so unpleasant that no one would ever choose to seek help unless they were desperate. Notably, the workhouses were mirrored by the long-stay asylums, and for many people, stays in both were commonplace.
Since the 1940s, a wide range of social security benefits has been created, and frequently changed as political fashions have evolved, meeting a wide range of needs – from pensions and child benefits to payments for those facing unemployment, disability, or caring responsibilities. All have been in the form of cash transfers – money paid to individuals to ensure they have enough to live on, and to create a social safety net from ‘want’ (caused by poverty), one of Beveridge’s ‘five giants’.
From a mental health perspective, social security has many important benefits. Poverty and income inequality are known risk factors for mental ill health. So keeping people and families out of poverty, and reducing the gap between the most and least well-off, benefits the public’s mental health. There is compelling evidence from a wealth of international research that benefit rates, and the ways they are administered, directly affect rates of depression and anxiety: where benefit rates are cut, or eligibility is reduced, or systems are made harsher, levels of depression and anxiety rise. Do the opposite, and they get lower. That’s why we welcomed the Government’s decision to end the two-child limit for Universal Credit, potentially lifting almost half a million children out of poverty in one move.
Disability and incapacity benefits play an important role in the lives of people with a range of mental health difficulties. While there are many very serious shortcomings in the ways that the Universal Credit health elements and Personal Independence Payment (PIP) are administered, and the amounts on offer after years of cuts, the presence of these benefits is essential to ensure that disabled people (including those living with mental health problems) can get by day to day. Without them, people’s lives are made almost impossible – as those who are unable to get the benefits they are entitled to can attest.
That’s one reason why welfare advice services embedded within mental health services make such a difference. By ensuring people get benefits they’re entitled to, these services improve people’s living standards, and their health, reducing the costs of health care at the same time. What follows from this is that if these benefits were to be taken away or squeezed further, people with mental health problems would face more crises, more relapses, and a lot more need for health care. That’s potentially devastating for people and families, and incredibly costly for the NHS and social services.
Despite all this evidence, spending on benefits is still denigrated and seen (by those who don’t need them to live) as a drain on public finances. We’re told that disabled people are ‘stuck on benefits’, because payments are supposedly too generous to incentivise people to work. Yet we know that with the right help, through Individual Placement and Support (IPS), people with mental health difficulties (among many others) can get and keep jobs that are right for them and enjoy better living standards as a result. It’s not benefits that are stopping people working, but fears of being discriminated against and left destitute by a system built on distrust. Expanding IPS while rebuilding social security, not cutting it, will give more people the best chance of a better life.
The business case for a range of mental health interventions will often include savings in social security – if fewer people require, say, PIP, as a result of having better mental health. Similarly, some mental or physical health interventions might also reduce the need for hospital beds if people need fewer or shorter admissions. But no one would argue that a person’s right to a hospital bed should be restricted as an ‘incentive’ to get or stay well. Yet such arguments are often advanced in relation to benefits.
Myths about benefits, and stereotypes about the people who receive them, drive discriminatory discourses and dangerous decisions at every level of our social security system. In the process, its purpose and founding values are clouded. A mentally healthier society must have a place for social security: a place that values its role in building a just and fair society.
