Universal Credit receipt among working-age patients who are accessing specialist mental health services: results from a novel data linkage study.

BACKGROUND: In 2013, Universal Credit (UC) was introduced by the UK Government. Understanding of how UC provision is allocated among people with mental disorders, and its intersection with protected characteristics is limited. This study aimed to explore (1) how UC receipt, including UC conditionality regime, varied among users of specialist mental health services between 2013 and 2019 and (2) associations between sociodemographic and diagnostic patient characteristics and UC receipt. METHODS: Working-age individuals who had accessed specialist mental health services were included if they had their mental health record data successfully linked with administrative benefits data. Associations between sociodemographic, diagnostic patient characteristics and UC receipt were explored using logistic regression models. RESULTS: Of the 143 715 patients, 26.9% had received UC between 2013 and 2019. Four in five patients were allocated to the searching for work conditionality regime during their time on UC. Females were less likely to have received UC (adjusted OR (AOR) 0.87, 95% CI 0.85 to 0.89) than males, and UC receipt decreased with age. Black patients (AOR 1.39, 95% CI 1.34 to 1.44) and patients from mixed and multiple ethnic backgrounds (AOR 1.27, 95% CI 1.18 to 1.38) had a higher likelihood of UC receipt than White patients. UC receipt was lower among patients diagnosed with severe mental illness compared with other psychiatric diagnoses (AOR 0.74, 95% CI 0.71 to 0.77). CONCLUSION: One in four specialist mental health service users had received UC and a large majority were subject to conditionality. The temporality of UC conditionality and mental health service presentation needs further exploration.

Disabled but not deserving? The perceived deservingness of disability welfare benefit claimants.

While disability benefits make up the largest group of claimants in high-income countries, we know surprisingly little about which disabled people are seen as 'deserving' benefits, nor whether different people in different countries judge deservingness-related characteristics similarly. This is surprising given they are increasingly the focus of retrenchment, which often affirms the deservingness of 'truly deserving' disabled people while focusing cuts and demands on those 'less deserving'. This article addresses this gap using two vignette-based factorial survey experiments: (i) the nine-country 'Stigma in Global Context - Mental Health Study' (SGC-MHS); (ii) a new YouGov survey in Norway/the UK, together with UK replication. I find a hierarchy of symptoms/impairments, from wheelchair use (perceived as most deserving), to schizophrenia and back pain, fibromyalgia, depression and finally asthma (least deserving). Direct manipulations of deservingness-related characteristics also influence judgements, including membership of ethnic/racial ingroups and particularly blameworthiness and medical legitimation. In contrast, the effects of work ability, age and work history are relatively weak, particularly when compared to the effects on unemployed claimants. Finally, for non-disabled unemployed claimants, I confirm previous findings that right-wingers respond more strongly to deservingness-related characteristics, but Norwegians and Britons respond similarly. For disabled claimants, however, the existing picture is challenged, with, for example, Britons responding more strongly to these characteristics than Norwegians. I conclude by drawing together the implications for policy, particularly the politics of disability benefits, the role of medical legitimation and the legitimacy challenges of the increasing role of mental health in disability benefit recipiency.

Has working-age morbidity been declining? Changes over time in survey measures of general health, chronic diseases, symptoms and biomarkers in England 1994-2014.

OBJECTIVES: As life expectancy has increased in high-income countries, there has been a global debate about whether additional years of life are free from ill-health/disability. However, little attention has been given to changes over time in morbidity in the working-age population, particularly outside the USA, despite its importance for health monitoring and social policy. This study therefore asks: what are the changes over time in working-age morbidity in England over two decades? DESIGN, SETTING AND PARTICIPANTS: We use a high-quality annual cross-sectional survey, the Health Survey for England (HSE) 1994-2014. HSE uses a random sample of the English household population, with a combined sample size of over 140 000 people. We produce a newly harmonised version of HSE that maximises comparability over time, including new non-response weights. While HSE is used for monitoring population health, it has hitherto not used for investigating morbidity as a whole. OUTCOME MEASURES: We analyse all 39 measures that are fully comparable over time-including chronic disease diagnoses, symptomatology and a number of biomarkers-adjusting for gender and age. RESULTS: We find a mixed picture: we see improving cardiovascular and respiratory health, but deteriorations in obesity, diabetes, some biomarkers and feelings of extreme anxiety/depression, alongside stability in moderate mental ill-health and musculoskeletal-related health. In several domains we also see stable or rising chronic disease diagnoses even where symptomatology has declined. While data limitations make it challenging to combine these measures into a single morbidity index, there is little systematic trend for declining morbidity to be seen in the measures that predict self-reported health most strongly. CONCLUSIONS: Despite considerable falls in working-age mortality-and the assumptions of many policy-makers that morbidity will follow mortality - there is no systematic improvement in overall working-age morbidity in England from 1994 to 2014.

The growing American health penalty: International trends in the employment of older workers with poor health.

Many countries have reduced the generosity of sickness and disability programs while making them more activating - yet few studies have examined how employment rates have subsequently changed. We present estimates of how employment rates of older workers with poor health in 13 high-income countries changed 2004-7 to 2012-15 using HRS/SHARE/ELSA data. We find that those in poor health in the USA have experienced a unique deterioration: they have not only seen a widening gap to the employment rates of those with good health, but their employment rates fell per se. We find only for Sweden (and possibly England) signs that the health employment gap shrank, with rising employment but stable gaps elsewhere. We then examine possible explanations for the development in the USA: we find no evidence it links to labor market trends, but possible links to the USA's lack of disability benefit reform and wider economic trends.

Assessing work disability for social security benefits: international models for the direct assessment of work capacity.

PURPOSE: It has been argued that social security disability assessments should directly assess claimants' work capacity, rather than relying on proxies such as on functioning. However, there is little academic discussion of how such assessments could be conducted. METHOD: The article presents an account of different models of direct disability assessments based on case studies of the Netherlands, Germany, Denmark, Norway, the United States of America, Canada, Australia, and New Zealand, utilising over 150 documents and 40 expert interviews. RESULTS: Three models of direct work disability assessments can be observed: (i) structured assessment, which measures the functional demands of jobs across the national economy and compares these to claimants' functional capacities; (ii) demonstrated assessment, which looks at claimants' actual experiences in the labour market and infers a lack of work capacity from the failure of a concerned rehabilitation attempt; and (iii) expert assessment, based on the judgement of skilled professionals. CONCLUSIONS: Direct disability assessment within social security is not just theoretically desirable, but can be implemented in practice. We have shown that there are three distinct ways that this can be done, each with different strengths and weaknesses. Further research is needed to clarify the costs, validity/legitimacy, and consequences of these different models. Implications for rehabilitation It has recently been argued that social security disability assessments should directly assess work capacity rather than simply assessing functioning - but we have no understanding about how this can be done in practice. Based on case studies of nine countries, we show that direct disability assessment can be implemented, and argue that there are three different ways of doing it. These are "demonstrated assessment" (using claimants' experiences in the labour market), "structured assessment" (matching functional requirements to workplace demands), and "expert assessment" (the judgement of skilled professionals). While it is possible to implement a direct assessment of work capacity for social security benefits, further research is necessary to understand how best to maximise validity, legitimacy, and cost-effectiveness.

Success and failure in narrowing the disability employment gap: comparing levels and trends across Europe 2002-2014.

BACKGROUND: International comparisons of the disability employment gap are an important driver of policy change. However, previous comparisons have used the European Union Statistics on Income and Living Conditions (EU-SILC), despite known comparability issues. We present new results from the higher-quality European Social Survey (ESS), compare these to EU-SILC and the EU Labour Force Survey (EU-LFS), and also examine trends in the disability employment gap in Europe over the financial crisis for the first time. METHODS: For cross-sectional comparisons of 25 countries, we use micro-data for ESS and EU-SILC for 2012 and compare these to published EU-LFS 2011 estimates. For trend analyses, we use seven biannual waves of ESS (2002-2014) with a total sample size of 182,195, and annual waves of EU-SILC (2004-2014) with a total sample size of 2,412,791. RESULTS: (i) Cross-sectional: countries that have smaller disability employment gaps in one survey tend to have smaller gaps in the other surveys. Nevertheless, there are some countries that perform badly on the lower-quality surveys but better in the higher-quality ESS. (ii) Trends: the disability employment gap appears to have declined in ESS by 4.9%, while no trend is observed in EU-SILC - but this has come alongside a rise in disability in ESS. CONCLUSIONS: There is a need for investment in disability measures that are more comparable over time/space. Nevertheless, it is clear to policymakers there are some countries that do consistently well across surveys and measures (Switzerland), and others that do badly (Hungary).

Corporate social responsibility and conflicts of interest in the alcohol and gambling industries: a post-political discourse?

The corporate pursuit of social goals - known as Corporate Social Responsibility or 'CSR' - has been subject to critique on a number of grounds. However, a hitherto underexplored potential consequence of CSR has been suggested in a recent paper by C. Garsten and K. Jacobsson ('Post-Political Regulation: Soft Power and Post-political Visions in Global Governance' (2013), Critical Sociology 39: 421-37). They suggest that CSR is part of an international trend towards 'post-political' governance discourses, where an emphasis on different actors' common goals obscures conflicts of interest, subverting the open political conflict necessary for a well-functioning democracy. This paper examines whether such post-political discourses - including an outright denial of conflict of interest - can be found within the alcohol and gambling industries, where conflicts of interest are likely to be particularly acute given the addictive nature of the goods/services in question. Based on interviews with CSR professionals in these industries in Italy, the UK, and at EU-level, we do indeed find evidence of a post-political discourse. In these discourses, alcohol/gambling industry staff deny potential conflicts of interest on the basis that any small benefits from sales to a small number of addicts are seen to be outweighed by the reputational damage that addicts cause. Crucially, however, this coexists with another, less post-political discourse, where addictions CSR professionals emphasize 'common ground' as a basis for CSR, while accepting some instances of possible conflict of interest. Here interviewees make considerable efforts to differentiate good (sustainable) from bad (short-term) self-interest in order to stress the genuineness of their own actions. We conclude the paper by considering whether CSR embedded within a 'common ground' discourse still hides conflicts of interests and subverts democratic debate, or overcomes the problems identified by Garsten and Jacobsson.

Can alcohol make you happy? A subjective wellbeing approach.

There are surprisingly few discussions of the link between wellbeing and alcohol, and few empirical studies to underpin them. Policymakers have therefore typically considered negative wellbeing impacts while ignoring positive ones, used gross overestimates of positive impacts via a naïve 'consumer surplus' approach, or ignored wellbeing completely. We examine an alternative subjective wellbeing method for investigating alcohol and wellbeing, using fixed effects analyses of the associations between drinking and wellbeing within two different types of data. Study 1 examines wave-to-wave changes in life satisfaction and past-week alcohol consumption/alcohol problems (CAGE) from a representative cohort of people born in Britain in 1970, utilising responses at ages 30, 34 and 42 (a sample size of 29,145 observations from 10,107 individuals). Study 2 examines moment-to-moment changes in happiness and drinking from an iPhone-based data set in Britain 2010-13, which is innovative and large (2,049,120 observations from 31,302 individuals) but unrepresentative. In Study 1 we find no significant relationship between changing drinking levels and changing life satisfaction (p = 0.20), but a negative association with developing drinking problems (-0.18 points on a 0-10 scale; p = 0.003). In contrast, Study 2 shows a strong and consistent moment-to-moment relationship between happiness and drinking events (+3.88 points on a 0-100 scale; p < 0.001), although associations beyond the moment in question are smaller and more inconsistent. In conclusion, while iPhone users are happier at the moment of drinking, there are only small overspills to other moments, and among the wider population, changing drinking levels across several years are not associated with changing life satisfaction. Furthermore, drinking problems are associated with lower life satisfaction. Simple accounts of the wellbeing impacts of alcohol policies are therefore likely to be misleading. Policymakers must consider the complexity of different policy impacts on different conceptions of 'wellbeing', over different time periods, and among different types of drinkers.