Personal independence payments (PIP) among people who access mental health services

Earlier this year under the Conservative government a Green paper opened up a consultation on the future of Personal Independence Payment (PIP) - a welfare benefit claimed by many people with mental health and neurodivergent conditions as well as people with physical health conditions. Researchers from King’s College London investigated how this benefit is received by people who are accessing mental health services and, together with members of a patient and public involvement and engagement group who advise on the project, have written a blog to explain their latest findings.

The Personal Independence Payment (PIP) is a welfare benefit intended to provide financial support to people with long-term health conditions or disabilities.

In April 2024 the last Government released the Green paper on Modernising Support for Independent Living, opening up a consultation on the future of PIP. This paper considers changes to the assessment process, eligibility for PIP, what types of support should be provided through PIP, and explores alternative supports to cash payments (e.g. vouchers or therapy sessions).

The foreword to the consultation cited that ‘the clinical case mix has evolved in line with broader societal changes including many more people applying for disability benefits with mental health and neurodivergent conditions than when PIP was first introduced’ and there have been calls for more precision around the type and severity of mental health conditions that should be eligible for PIP. Although there has been a change in government since then, the consultation closed on July 22nd. It is unclear if the new government will consider changes to PIP, and how they will use the contributions to this consultation to inform the future of PIP.

Before this Green paper was launched our research group was already investigating the relationships between receipt of welfare benefits and different aspects of mental health and illness through an innovative linkage between data from mental health services and data from the Department for Work and Pensions. We now have our first set of results which is around PIP and provides insights into who is claiming this benefit and patterns over time.

What is PIP?

PIP was introduced in 2013, to replace Disability Living Allowance (DLA) as the new benefit intended to provide regular financial contributions to adults aged 16 to 64 with long-term health conditions or disability to help with some of the additional costs caused by their condition. PIP is a non-means tested benefit. This means that anyone with a long-term health condition or disability is eligible to apply for PIP regardless of their income or financial situation. PIP is not related to employment, and people are able to both work and receive PIP if they are able to do so. 3.3 million people across England and Wales claimed PIP in January 2024.

Our research on PIP receipt in mental health service users

Our team is interested in understanding how benefits are received in people who are accessing mental health services. We have successfully linked over 400,000 mental healthcare records from people accessing South London and Maudsley NHS Foundation Trust with benefits records from the Department of Work and Pensions. We will use this data to answer important research questions around work, benefits, and mental health. In our most recent study, we looked at how PIP is received among people who access mental health services.

What does our data tell us about PIP in people who access mental health services?

We included 143,714 adults who had linked mental healthcare and benefits data in our study. Everyone included was of working age (18-66 years) and had accessed South London and Maudsley mental health services between 2007 and 2019.

Approximately 1 in 4 people accessing mental health services received PIP

We found that 25.8 per cent of people who accessed South London and Maudsley mental health services had received PIP between 2013-2019. For our study, this totalled 37,120 people. In 2019, 23.6 per cent of our sample received PIP. We know that nationally around 6 per cent of all working-age adults receive disability benefits (either PIP or DLA). Our data indicates that people who access mental health services are four times more likely to receive these benefits.

Receipt of PIP increased over time

As expected, due to the rollout of PIP from 2013, we saw a sustained increase in amount of people accessing mental healthcare services who received PIP over time. In 2013 – the first year that PIP was introduced – only 1.4 per cent of our sample received PIP, and as can be seen in the graph below this continued to grow every year to 23.6% in 2019.

It should be noted that although people who received Disability Living Allowance are expected to all move to PIP, this process of changing people’s benefits from DLA to PIP (known as ‘migration’) is still ongoing. This means that on top of the people receiving PIP, there are also an extra 13,847 people in our sample who received DLA as a support for their long-term health condition or disability. The graph below shows the changes in both DLA and PIP receipt in our sample from 2007 to 2019.

^{Number of patients who received PIP (irrespective of type of PIP) or DLA (irrespective of type of DLA) by calendar year (N=143,714), data covering 2013-2019}

PIP receipt differed across psychiatric diagnosis groups

We also looked at differences in how PIP was received across different psychiatric diagnosis groups. This was done by considering all those people who received PIP and had used mental healthcare services and then comparing those who did have a psychiatric diagnosis to those with no psychiatric diagnosis on their record. We found that:

• People with an intellectual disability diagnosis were 5 times more likely to receive PIP than those without a psychiatric diagnosis.
• People with a personality disorder diagnosis were 3 times more likely to receive PIP.
• People with a diagnosis of schizophrenia or psychosis-related disorders were 2.8 times more likely to receive PIP.
• People with a severe mood disorder diagnosis, such as bipolar affective disorder or major depressive disorder, and people with anxiety-related diagnoses were 1.8 and 1.4 times more likely to receive PIP, respectively.
• People who had diagnoses classed as ‘other diagnosis’, including things like eating disorders, perinatal psychiatric disorders, and ‘unspecified mental illness’, were less likely to receive PIP.

We saw differences in PIP receipt for gender, age, ethnicity, and deprivation

• Women were slightly more likely to receive PIP than men.
• The likelihood of receiving PIP increased with age, particularly for those aged over 35 years.
• Compared to people from a White background, those from a Black background and mixed/multiple ethnic and racial group were slightly more likely to receive PIP. Those from an Asian/Asian British background were less likely to receive PIP compared to those from a White background.
• People living in more deprived areas were more likely to receive PIP than people living in areas with the lowest deprivation.

How our data can inform welfare reform and policy decisions

Many of the recent announcements about changes to the welfare system have explicitly discussed the increase of mental health related claims. Our data provides a unique and detailed insight into how the mental health and benefits system interact with one another, and can help identify which groups of people may be in most need of support. Any major changes to the benefits system that will affect people with mental health conditions should carefully consider the evidence around the impact of these decisions. We are using our data to further gain insights into PIP and other benefits claimed by people accessing mental healthcare services.

Stevelink SAM, Bakolis I, Dorrington S, et al. Personal independence payments among people who access mental health services: results from a novel data linkage. BJPsych Open. 2024;10(5):e150. doi:10.1192/bjo.2024.68