| Information component |
Pg 4 Health Summary: Indicator No 25 |
| Subject category / domain(s) |
Health and ill health in our community |
| Indicator name (* Indicator title in health profile) |
Claimants / beneficiaries of Incapacity benefit / severe disablement allowance with mental or behavioural disorders (*Mental Health) |
| PHO with lead responsibility |
NEPHO |
| Date of PHO dataset creation |
December 2007 |
| Indicator definition |
Claimants / beneficiaries of Incapacity benefit / severe disablement allowance with mental or behavioural disorders, crude rate, males and females, working age, 2005, Per 1000 working age population |
| Geography |
England, GOR, Local Authority: Counties, County Districts, Metropolitan County Districts, Unitary Authorities, London Boroughs |
| Timeliness |
Ad hoc special request.This indicator is potentially suitable for time-series analysis. |
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Rationale:What this indicator purports to measure
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Prevalence of working age people with severe mental illness who are in receipt of benefits for mental health conditions |
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Rationale:Public Health Importance
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This is a proxy measure of levels of severe mental illness in the community, and a direct measure of socio-economic disadvantage in those ‘not in work’ because of mental illness. Severe mental illness severely restricts the capacity to fully participate in society and in particular the employment market. Unemployment rates are high amongst people with severe mental illness. In the UK unemployment rates of 60 – 100% have been reported. These high rates reflect the disability caused by severe mental illness, but they also reflect discrimination (unemployment rates are higher than in other disabled group) and the low priority given to employment by psychiatric services. People with long-term psychiatric disabilities are even less likely to be in employment than those with long-term physical disabilities. Despite high unemployment rates amongst the severely mentally ill, surveys have consistently shown that most want to work. These low rates of employment should be considered against the facts that at least 30-40% of people who are significantly disabled by enduring mental illness are capable of holding down a job.More than 900,000 adults in England claim sickness and disability benefits for mental health conditions. This group is now larger than the total number of unemployed people claiming Jobseeker’s Allowance in England. Vocational rehabilitation services can help mentally ill people find work. See: Crowther R, Marshall M, Bond G, Huxley P. Vocational rehabilitation for people with severe mental illness. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD003080. DOI: 10.1002/14651858.CD003080See Royal College of Psychiatrists Memorandum to Select Committee on Work and Pensions available at: http://www.publications.parliament.uk/pa/ cm200506/cmselect/cmworpen/616/6022719.htm |
| Rationale: Purpose behind the inclusion of the indicator |
To estimate the prevalence of those with severe mental illness who are not in work because of their mental ill healthTo help improve the provision of services for helping mentally ill people find work |
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Rationale:Policy relevance
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In June 2004 the Social Exclusion Unit of the Office of the Deputy Prime Minister (ODPM) published the ‘Mental Health and Social Exclusion’ report. This report highlights the large number of adults in England claiming sickness and disability benefits for mental health conditions (approximately 40% of all claims) with the statistics showing that more adults now fall into this group than the total number of unemployed people claiming Jobseeker’s Allowance. The report draws attention to the fact that adults with long-term mental health problems are one of the most excluded groups in society facing numerous barriers that only serve to stop them from achieving their full potential as individuals and members of the community as a whole. Current government policy is focusing on finding ways of returning people to work via initiatives such as Pathways to Work, New Deal for Disabled People, and Disability Employment Brokers.Mental Health National Service Framework |
| Interpretation: What a high / low level of indicator value means |
A high indicator value (red blob in health summary chart) represents a statistically significant higher rate of benefit claimants for mental and behavioural disorders for that local authority when compared to the national value.A low indicator value (amber blob in health summary chart) represents a statistically significant lower rate of benefit claimants for mental and behavioural disorders for that local authority when compared to the national value. |
| Interpretation: Potential for error due to type of measurement method |
The first 28 weeks of incapacity are assessed under the “own occupation test” which looks at a person’s ability to do their usual job and is based on medical certificates from a GP. After this time, the personal capability assessment (PCA) applies which involves completing an incapacity questionnaire (IB50) that assesses ability to do any work.Forms are difficult to understand and complete. There may be an “institutional bias” against people with mental health problems in the incapacity benefit questionnaire which does not establish information about fluctuating conditions. The DWP uses a system that allocates points to certain activities and tasks, with 10 points needed to determine a person’s eligibility on grounds of mental incapacity. Mental health descriptors are not itemised in the same detail as physical descriptors and a client is therefore less likely to answer in the way most helpful to a successful outcome in their case.Problems those with severe mental illness face with personal capability assessments conducted by Medical Services include:— doctors not listening to clients;— poor recording of clinical findings;— incorrect assumptions based on information from the client and from the medical examination;— effects of mental illness not appropriately taken into account by the scoring system employed; and— difficulties in arranging home visits for some clients.The assessment process may lead to underestimation of unemployment due to severe mental illness.See Royal College of Psychiatrists Memorandum to Select Committee on Work and Pensions available at:http://www.publications.parliament.uk/pa/ cm200506/cmselect/cmworpen/616/6022719.htm
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| Interpretation: Potential for error due to bias and confounding |
There may be disincentives to return to work: These include:— Medical review process: There are concerns that engagement in voluntary work, education and training—which can help get back to work—may trigger the medical review process.— Permitted work rules: These may deter people, who will be at risk of losing incapacity benefit and associated benefits.— Transition to work may disrupt income: People returning to work will lose housing benefit. Should the return to work fail they will be at risk of losing their home. — Fear of drop in income.— 52-week linking rule: The time period may not be long enough for people whose illness has a relapsing and remitting course. (For example the average time to clinical relapse for people being treated for schizophrenia is approximately two years.) — Difficulties in getting financial support for practical needs at work.— Lack of expert, independent benefits advice on return to work.Therefore severe mental illness as a cause of inability to participate in the labour market may be overestimated due to these disincentives to return to work.See Royal College of Psychiatrists Memorandum to Select Committee on Work and Pensions available at:http://www.publications.parliament.uk/pa/ cm200506/cmselect/cmworpen/616/6022719.htmThere are groups of people who may be less likely to engage with or be able to benefit from the benefit system eg certain ethnic minorities, married women, those with functional illiteracy, rough sleepers. This may underestimate the problem. |
| Confidence Intervals: Definition and purpose |
A confidence interval is a range of values that is normally used to describe the uncertainty around a point estimate of a quantity, for example, a mortality rate. This uncertainty arises as factors influencing the indicator are subject to chance occurrences that are inherent in the world around us. These occurrences result in random fluctuations in the indicator value between different areas and time periods. In the case of indicators based on a sample of the population, uncertainty also arises from random differences between the sample and the population itself.The stated value should therefore be considered as only an estimate of the true or ‘underlying’ value. Confidence intervals quantify the uncertainty in this estimate and, generally speaking, describe how much different the point estimate could have been if the underlying conditions stayed the same, but chance had led to a different set of data. The wider is the confidence interval the greater is the uncertainty in the estimate.Confidence intervals are given with a stated probability level. In Health Profiles 2007 this is 95%, and so we say that there is a 95% probability that the interval covers the true value. The use of 95% is arbitrary but is conventional practice in medicine and public health. The confidence intervals have also been used to make comparisons against the national value. For this purpose the national value has been treated as an exact reference value rather than as an estimate and, under these conditions, the interval can be used to test whether the value is statistically significantly different to the national. If the interval includes the national value, the difference is not statistically significant and the value is shown on the health summary chart with a white symbol. If the interval does not include the national value, the difference is statistically significant and the value is shown on the health summary chart with a red or amber symbol depending on whether it is worse or better than the national value respectively. |
; and C=2(n+z2),where z is the appropriate value, z1-α/2, from the standard Normal distribution. Then the confidence interval for the population proportion is given by (A-B)/C to (A+B)/CThis method has the considerable advantage that it can be used for any data. When there are no observed events, r and hence p are both zero, and the recommended confidence interval simplifies to 0 to z2/(n+z2). When r = n so that p = 1, the interval becomes n/(n+z2) to 1.Wilson EB. J Am Stat Assoc 1927, 22, 209-212 Newcombe, RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 1998;17:857-72.