The societal impact of individual placement and support implementation on employment outcomes for young adults receiving temporary health-related welfare benefits: a difference-in-differences study.

BACKGROUND: Individual placement and support (IPS) is an evidence-based practice that helps individuals with mental illness gain and retain employment. IPS was implemented for young adults at a municipality level through a cross-sectoral collaboration between specialist mental healthcare, primary mental healthcare, and the government funded employment service (NAV). We investigated whether IPS implementation had a causal effect on employment outcomes for all young adults in receipt of a temporary health-related rehabilitation (work assessment allowance, WAA) welfare benefit, measured at the societal level compared to municipalities that did not implement IPS. METHOD: We used a difference in differences design to estimate the effects of IPS implementation on the outcome of workdays per year using longitudinal registry data. We estimate the average effect of being exposed to IPS implementation during four-years of implementation compared to ten control municipalities without IPS for all WAA recipients. RESULTS: We found a significant, positive, causal effect on societal level employment outcomes of 5.6 (p = 0.001, 95% CI 2.7-8.4) increased workdays per year per individual, equivalent to 12.7 years of increased work in the municipality where IPS was implemented compared to municipalities without IPS. Three years after initial exposure to IPS implementation individuals worked, on average, 10.5 more days per year equating to 23.8 years of increased work. CONCLUSIONS: Implementing IPS as a cross sectoral collaboration at a municipality level has a significant, positive, causal, societal impact on employment outcomes for all young adults in receipt of a temporary health-related rehabilitation welfare benefit.

The impact of Disability Insurance reassessment on healthcare use.

Several Organisation for Economic Co-operation and Development countries have constrained Disability Income Insurance (DI) eligibility and reassessed those on DI to encourage workforce participation. But these policies can also have unintended consequences. While receiving less income can directly worsen physical and mental health, the stress related to reassessment and the possibility of losing DI may also adversely affect mental health. This paper uses Australian population-wide administrative data to explore how a 2014 policy - where DI recipients under 35 were reassessed under stricter criteria - affected healthcare use. We exploit this age targeting using a difference-in-difference regression design and find that the policy increased nervous system drug prescriptions (which includes antidepressants). Our findings suggest that the reassessment of DI recipients, even without income loss, may have had a significant negative impact on their mental health. DI reassessment policies may have the unintended consequence of worsening mental health and this needs be considered when deciding if reassessment is worthwhile.

The Impact of Temporary Assistance for Needy Families Benefit Requirements and Sanctions on Maternal Material Hardship, Mental Health, and Parental Aggravation.

INTRODUCTION: Temporary Assistance for Needy Families requirements can be stress-inducing, difficult for families to complete, and may be detrimental during early life. We assessed the impact of TANF requirements on primary caregiving mothers' experiences of material hardship, anxiety, depression, and parental aggravation in the first year of a child's life. METHODS: Survey responses were selected from mothers in the Future of Families and Childhood Wellbeing Study, who received TANF in the first year of their child's life (N = 1085). RESULTS: Survey-weighted regression models showed associations between: presence of any requirements and increased material hardship, work requirements and increased material hardship, requirement to name the father of their child and increased depression, benefit cuts and increased parental aggravation, and benefit cuts and increased material hardship. DISCUSSION: Federal and state policies should revise requirement programs to increase program accessibility and support the mental health and financial stability of mothers applying for TANF to facilitate sustainable movement into employment.

Justice perceptions of sanctions for unemployed welfare recipients.

Institutions of the welfare state are supposed to function in accordance with normative principles of redistributive justice, which should guide not only the allocation but also the withdrawal of resources. Our study examines justice assessments of sanctions for unemployed individuals receiving welfare benefits, a much-discussed variant of benefit withdrawal. We present results from a factorial survey that asked German citizens to indicate which sanction they would perceive as just under different scenarios. In particular, we look at different kinds of deviant behavior on the part of the unemployed job seeker, which allows for a broad picture concerning potential sanction-triggering events. The findings show that the extent of sanctions perceived as just varies considerably across scenarios. Respondents would impose more sanctions on men, repeaters, and young people. Moreover, they have a clear picture of the severity of the deviant behavior.

COVID-19 and (mis)understanding public attitudes to social security: Re-setting debate.

The Covid-19 pandemic has seen emerging debate about a possible shift in 'anti-welfare commonsense' i.e. the orthodoxy previously described in this journal as solidifying negative public attitudes towards 'welfare'. While a shift in attitudes might be ascribed to the circumstances of the crisis it would still be remarkable for such a strongly established orthodoxy to have changed quite so rapidly. It is appropriate, therefore, to reflect on whether the 'anti-welfare' orthodoxy was in fact as unequivocal as claimed? To address this question, challenges to the established orthodoxy that were emerging pre-pandemic are examined along with the most recently available survey data. This leads to discussion of broader issues relating to understanding attitudes: methodology; 'messiness' and ambivalence of attitudes; attitudes and constructions of deservingness; and following or leading opinion. It is argued that the 'anti-welfare' orthodoxy has always been far more equivocal than claimed, with consequent implications for anti-poverty action and re-setting debate.

Have winter fuel payments reduced excess winter mortality in England and Wales?

BACKGROUND: The historical series of excess winter mortality (EWM) in England and Wales presents a negative trend. Winter fuel payments (WFPs) are the most important benefits for people aged 65 or over directly related to Winter Mortality in the UK. METHODS: This study presents a time series analysis of the direct effect of WFPs on EWM in England and Wales. RESULTS: We find a significant structural break in trend and volatility in the EWM series in England and Wales in 1999-2000. After controlling for a number of covariates, an ARIMA-X model finds that WFPs can account for almost half of the reduction in EWM in England and Wales since 1999/2000. CONCLUSIONS: Almost half of the reduction in EWM since 1999/2000 is attributable to WFPs.

The Sociodemographic Factors Related to Disability of Applicants of Welfare Benefits in Greece: A Cross-Sectional Survey Based on the World Health Organization Disability Assessment Schedule (WHODAS) 2.0.

INTRODUCTION: The aim of the present study was to report on the prevalence of disability and its association with sociodemographic factors among welfare benefit applicants in Greece. The study also compared the disability scores between different health conditions using the WHODAS 2.0 (12-item version), a biopsychosocial-model-based measure. METHODS: The Greek WHODAS 2.0, 12-item version, was administered by interview. A three-member medical committee assessed the medical records of the applicants and assigned a disability percentage based on the biomedical measure of disability percentage determination (Barema scale). RESULTS: The majority of the participants were female (56.65%). Certain health conditions were presented more frequently among welfare benefit applicants (mental health disorders and neoplasms). The domains with the highest rate of difficulty were the "participation" and "life activities" domains. Significant differences were found between WHODAS 2.0 and Barema scores for all eight different health condition categories. The factorial ANOVA (8x2) showed a significant interaction effect between health condition category and gender with respect to the WHODAS 2.0 score (F = 19.033, p <.001, η2 = 0.13). The WHODAS 2.0 score was negatively correlated to gender, years of studies, and marital status and positively correlated to age, working status, and the Barema score. The results revealed that male participants with a partner who were younger, had more studies, were actively working, and had a lower Barema score would have lower WHODAS scores. CONCLUSION: Sociodemographic characteristics of welfare benefit applicants are associated with disability levels based on WHODAS 2.0. Certain health conditions, like mental health or neuromusculoskeletal conditions, are associated with higher disability scores. There are differences between the biopsychosocial and the biomedical approaches to disability assessment. The implementation of WHODAS 2.0 may contribute to a better understanding of the lived experience of patients and is a feasible and efficient tool. Combining biomedical and biopsychosocial approaches may enhance the procedures of disability assessment and help in the development of policies that support people with disabilities.

The success of Australia's 'No Jab, No Pay' policy at a local level; retrospective clinical audit of a single medical practice assessing incidence of catch-up vaccinations.

Vaccination is a vital health care initiative to prevent individual and population infection. To increase vaccination rates the federal government implemented the 'No Jab, No Pay' policy, where eligibility for several government benefits required children to be fully vaccinated by removing 'conscientious objections' and expanding the age range of children whose families receive benefits. This study assesses the impact of this policy at a local area within a single medical practice community in NSW, Australia. A retrospective clinical audit was performed between 2012 and 2017 on a single general practice's vaccination records for children ≤19 years. Catch-up vaccinations were assessed based on age at vaccination. Incidence of catch-up vaccinations was assessed for each of four years before and two years after the implementation of the 'No Jab, No Pay' policy in January 2016, along with the age of children and vaccination(s) given. Catch-up vaccinations were assessed temporally either side of implementation of 'No Jab, No Pay'. Comparing the average annual vaccination catch-up incidence rate of 6.2% pre-implementation (2012-2015), there was an increase to 9.2% in 2016 (p < .001) and 7.8% in 2017 (p = .027). Secondary outcome measurement of catch-up vaccination incidence rates before (2012-2015) and after (2016-2017) 'No Jab, No Pay' implementation showed statistically significant increases for children aged 8-11 years (3.2%-5.6%, p = .038), 12-15 years (7.5%-14.7%, p < .001) and 16-19 years (3.3%-10.2%, p < .001) along with a statistically significant reduction in children aged 1-3 years (11.4%-6.2%, p = .015). Also, catch-up rates for DTPa significantly increased after program implementation. This study demonstrates that the Australian federal government vaccination policy 'No Jab, No Pay' was coincident with an increase in catch-up vaccinations within a rural NSW community served by one medical practice, especially for older children.

The Role of Unemployment, Financial Hardship, and Economic Recession on Suicidal Behaviors and Interventions to Mitigate Their Impact: A Review.

Understanding the social determinants and risk factors for suicidal behaviors underlies the development of effective suicide prevention interventions. This review focused on recently published literature (2010 onwards), with the aim to determine the role of economic factors (at the individual and population level) on suicidal behaviors and ideation as well as the effectiveness of interventions addressing these factors in reducing suicidal behaviors and ideation. Where available, literature examining the economic impact of COVID-19 was highlighted. Economic recession and unemployment are associated with increased risk of suicidal behavior at the population and individual level. Additionally, personal financial problems such as debt and financial strain are associated with increased risk of suicidal behavior and ideation at the individual level. Regarding interventions, unemployment benefits, employment protection legislation, higher minimum wage and active labor market programs may reduce suicide at the population level. However, it is not clear what impact they have at the individual level, nor in relation to suicide attempts, self-harm, or suicidal ideation. There was a lack of evidence as to the effectiveness of financially focused suicide prevention interventions at either level. Current findings were contextualized within, and advance, prominent social theoretical models. Recommendations focused on future areas of research, including the unfolding economic impact of COVID-19, as well as the co-design and evaluation of tailored interventions and/or gatekeeper training for those in the financial and welfare sector, and enhanced early education aimed at increasing financial literacy in young people before onset or exacerbation of financial hardship.

The Effect of Psychological Anxiety Caused by COVID-19 on Job Self-Esteem and Job Satisfaction of Airline Flight Attendants.

This study aimed to investigate how psychological anxiety caused by COVID-19 has influenced airline cabin crew job self-esteem and job satisfaction. A questionnaire based on prior research was developed to identify factors of psychological anxiety among cabin crews as a result of COVID-19. The survey sample was limited to current cabin crews who experienced leave of absence due to COVID-19, and questionnaires were distributed to 201 crew members from 15 February to 15 April 2021. As a result of the analysis, the hypothesis that salary reduction, career stagnation, social perception, and employment insecurity have a significant effect on job self-esteem and job satisfaction was supported, while perceived infection risk and benefit reduction were rejected. This study found that psychological anxiety caused by COVID-19 affected cabin crew's self-esteem and job satisfaction. These findings could aid in the development of strategies for effective airline human resource management to prevent psychological anxiety from creating stress and negatively affecting work. Furthermore, since the alert for the emergence of new viruses will not be eased in the future, this study will prevent psychological anxiety among cabin crews to cause job self-esteem and job dissatisfaction.

Barriers in Accessing Social Welfare Benefits for Families of Children With Intellectual and Developmental Disorders in Rural Karnataka: A Situation Analysis.

BACKGROUND: Several government schemes exist for the welfare of families having children with intellectual and developmental disorders (IDDs) in India. However, these schemes are often not utilized. An understanding of the barriers to access these social welfare benefits, especially in rural areas of India, can aid in planning social action toward the implementation of these schemes. METHODS: A situation analysis of the resources and potential barriers to access social welfare benefits for families of children with IDD was conducted in a rural community. Stakeholder interviews were conducted with families of children with IDD (n = 20), government officials responsible for implementing education at the state level (n = 5), local officials responsible for facilitating social welfare benefits (n = 5), and nongovernmental organization (NGO) working in the area of children with IDD (n = 3). Qualitative thematic analysis was used to understand the barriers to access social welfare benefits for the families of children with IDD. RESULTS: Barriers encountered by families of children with IDD, local officials, and NGOs included lack of awareness about the available welfare schemes, unavailability of social welfare facilities in the local areas, lack of social auditing in the provision of social welfare schemes to the needy, and stringent process of application and regulation for financial aid under the National Trust schemes. CONCLUSION: There are multiple barriers to access social welfare benefits for families having children with IDD in rural Karnataka. There is a strong need to empower families, sensitize local officials, and advocate for social policies to effectively implement National Trust schemes in rural areas of Karnataka.

The Long Shadow of Job Loss: Britain's Older Industrial Towns in the 21st Century.

This article takes a long view of economic change in Britain's older industrial towns, drawing on the authors' accumulated research into labor market trends in the places and communities most affected by deindustrialization. It begins by documenting the industrial job losses over the last 50 years and their impact on unemployment, economic inactivity and welfare benefit claims, highlighting the diversion onto incapacity benefits triggered by job loss that remains a major feature of the towns. It then looks at the evidence on the present-day labor market in the towns, identifying job growth at a slower pace than in the cities and continuing weaknesses in terms of earnings, qualifications and occupational mix. These are the on-going problems the authors describe as the 'long shadow of job loss'. The evidence also shows that despite years of job loss, industry remains a key component of the towns' economy and that the towns are increasingly connected to surrounding areas, including nearby cities, by strong commuting flows.

COVID-19: an opportunity for African governments to rethink social welfare benefits and protection.

The emergence of COVID-19 in December 2019 has highlighted several lessons about Public health emergencies. One important lesson is on the role of social welfare benefits and protection in the overall management of public health emergencies. The absence of a functional and digitalized social welfare system in Africa may render ineffective public health measures to mitigate the spread of COVID-19. The social determinant of disease illustrates the nexus between poverty and health outcomes. Therefore, COVID-19 is an opportunity for African governments to rethink their stance on social welfare benefits and protection; and adopt mechanisms that protect the most vulnerable.

Do welfare benefit reassessments of people with mental health conditions lead to worse mental health? A prospective cohort study.

BACKGROUND: There have been cases of suicide following the Work Capability Assessment (WCA), a questionnaire and interview for those claiming benefits due to ill health or disability in the United Kingdom. AIMS: To examine whether experiencing problems with welfare benefits, including WCA, among people with pre-existing mental health conditions was associated with poorer mental health and wellbeing and increased health service use and costs. METHODS: A prospective cohort study of an exposed group (n = 42) currently seeking help from a Benefits Advice Service in London and a control group (n = 45) who had recently received advice from the same service. Questionnaires at baseline and 3-, 6- and 12-month follow-ups. RESULTS: The exposed group had higher mean scores for anxiety (p = .008) and depression (p = .016) at baseline and the control group higher mean scores for wellbeing at baseline (p = .034) and 12 months (p = .035). However, loss to follow-up makes overall results difficult to interpret. The control group had higher incomes throughout the study, particularly at the 12-month follow-up (p = .004), but the differences could have been accounted for by other factors. Health service costs were skewed by a few participants who used day-care services intensively or had inpatient stays. Over the study period the proportion of exposed participants engaged in benefits reassessment ranged from 50% to 88%, and 40% to 76% of controls. CONCLUSION: The hardship of living with financial insecurity and a mental health condition made it difficult for our participants to sustain involvement in a 12-month study and the frequency of benefit reviews meant that the experiences of our controls were similar to our exposed group. These limitations limit interpretation but confirm the relevance of our research. The control data raise the question of whether people with mental health conditions are being disproportionately reassessed.

Adapting to a marketised system: Network analysis of a personalisation scheme in early implementation.

As governments worldwide turn to personalised budgets and market-based solutions for the distribution of care services, the care sector is challenged to adapt to new ways of working. The Australian National Disability Insurance Scheme (NDIS) is an example of a personalised funding scheme that began full implementation in July 2016. It is presented as providing greater choice and control for people with lifelong disability in Australia. It is argued that the changes to the disability care sector that result from the NDIS will have profound impacts for the care sector and also the quality of care and well-being of individuals with a disability. Once established, the NDIS will join similar schemes in the UK and Europe as one of the most extensive public service markets in the world in terms of numbers of clients, geographical spread, and potential for service innovation. This paper reports on a network analysis of service provider adaptation in two locations-providing early insight into the implementation challenges facing the NDIS and the reconstruction of the disability service market. It demonstrates that organisations are facing challenges in adapting to the new market context and seek advice about adaptation from a stratified set of sources.

Public expenditure costs of carers leaving employment in England, 2015/2016.

In the context of global population ageing, the reconciliation of employment and unpaid caring is becoming an important social issue. The estimation of the public expenditure costs of carers leaving employment is a valuable measure that is of considerable interest to policy makers. In 2012, the Personal Social Services Research Unit estimated that the public expenditure costs of unpaid carers leaving employment in England were approximately £1.3 billion a year, based on the costs of Carer's Allowance and lost tax revenues on forgone incomes. However, this figure was known to be an underestimate partly because it did not include other key benefits that carers who have given up work to care may receive. This paper presents a new estimate of the public expenditure costs of carers leaving employment. Key sources of information are the 2009/2010 Survey of Carers in Households, 2011 Census and 2015/2016 costs data. As well as Carer's Allowance, the estimate also now includes the costs of other benefits that carers leaving work may receive, namely, Income Support and Housing Benefit. The results show that the estimated numbers of carers who have left employment because of caring have increased from approximately 315,000 to 345,000. Due mainly to the inclusion of a wider range of benefits, the public expenditure costs of carers leaving employment in England are now estimated at £2.9 billion a year. The new estimate comprises £1.7 billion in social security benefits paid to people who have left their jobs because of unpaid caring, plus another £1.2 billion in taxes forgone on this group's lost earnings. The paper concludes that, if there was greater public investment in social care, such as "replacement care" to support carers in employment, and fewer carers then left employment, public spending on benefits would be lower and revenues from taxation would be higher.

Impact of the recent recession on self-harm: Longitudinal ecological and patient-level investigation from the Multicentre Study of Self-harm in England.

BACKGROUND: Economic recessions are associated with increases in suicide rates but there is little information for non-fatal self-harm. AIMS: To investigate the impact of the recent recession on rates of self-harm in England and problems faced by patients who self-harm. METHOD: Analysis of data from the Multicentre Study of Self-harm in England for 2001-2010 and local employment statistics for Oxford, Manchester and Derby, including interrupted time series analyses to estimate the effect of the recession on rates of self-harm. RESULTS: Rates of self-harm increased in both genders in Derby and in males in Manchester in 2008-2010, but not in either gender in Oxford, results which largely followed changes in general population unemployment. More patients who self-harm were unemployed in 2008-10 compared to before the recession. The proportion in receipt of sickness or disability allowances decreased. More patients of both genders had employment and financial problems in 2008-2010 and more females also had housing problems, changes which were also largely found in employed patients. LIMITATIONS: We have assumed that the recession began in 2008 and information on problems was only available for patients having a psychosocial assessment. CONCLUSIONS: Increased rates of self-harm were found in areas where there were greater rises in rates of unemployment. Work, financial and housing problems increased in people who self-harmed. Changes in welfare benefits may have contributed. DECLARATION OF INTEREST: None.

Exposing the impact of Citizens Advice Bureau services on health: a realist evaluation protocol.

INTRODUCTION: Welfare advice services can be used to address health inequalities, for example, through Citizens Advice Bureau (CAB). Recent reviews highlight evidence for the impact of advice services in improving people's financial position and improving mental health and well-being, daily living and social relationships. There is also some evidence for the impact of advice services in increasing accessibility of health services, and reducing general practitioner appointments and prescriptions. However, direct evidence for the impact of advice services on lifestyle behaviour and physical health is currently much less well established. There is a need for greater empirical testing of theories around the specific mechanisms through which advice services and associated financial or non-financial benefits may generate health improvements. METHODS AND ANALYSIS: A realist evaluation will be conducted, operationalised in 5 phases: building the explanatory framework; refining the explanatory framework; testing the explanatory framework through empirical data (mixed methods); development of a bespoke data recording template to capture longer term impact; and verification of findings with a range of CAB services. This research will therefore aim to build, refine and test an explanatory framework about how CAB services can be optimally implemented to achieve health improvement. ETHICS AND DISSEMINATION: The study was approved by the ethics committee at Northumbria University, UK. Project-related ethical issues are described and quality control aspects of the study are considered. A stakeholder mapping exercise will inform the dissemination of results in order to ensure all relevant institutions and organisations are targeted.

The ManVan: a mobile cancer support service for men with prostate, testicular and penile cancer in Wales.

The ManVan commenced service delivery on 1st April 2014 and is the United Kingdom's first dedicated mobile support service for men affected by prostate, testicular, and penile cancer. It is delivered in partnership with Prostate Cancer UK and Movember and fully funded by the Movember Foundation. It brings nursing care, counselling for individuals and couples, group support and welfare rights advice, directly to men living with prostate, testicular and penile cancer in communities across Wales. The ManVan has travelled extensively across Wales during its first year, visiting 94 different locations, across all seven Local Health Board areas. The first half of the year began with a Roadshow where we welcomed thousands of visitors on board, including men and women worried by all sorts of cancer symptoms; their family and friends; health and social care professionals and politicians. The variety of venues the ManVan has visited has included hospitals, supermarkets, social clubs, caravan fairs and rugby grounds to help raise awareness of the ManVan service and identify potential clients. As expected the greatest proportion of visitors are male, particularly older men. In the second half of the year, we focussed on our target audience - men diagnosed with prostate, testicular, or penile cancer and their families. Using a targeted approach to urology clinics across NHS Wales, as well as community-based activity encouraging men from ethnic minorities to visit, we have now taken on 161 clients, many of whom have received more than one ManVan service, and attended on more than one occasion. Most of our clients have prostate cancer, are over the age of 55 years, and are married. Analysis of the early data around the clinical and psychosocial benefits of the services offered on the ManVan is positive and the annualised value of the benefits obtained for ManVan clients equates to more than £300,000 in this first year. There were 3,319 visitors to the ManVan in total during the first year.