天美影院

The Social Agency: Dan Clay, Dan Lemmon, Deepa Ramanthan

Overview

Personal Independence Payment (PIP) is a benefit which can help with extra living costs where someone has both:

• a long-term physical or mental health condition or disability
• difficulty doing certain everyday tasks or getting around because of their condition

DWP commissioned The Social Agency (previously known as Basis Social), to conduct qualitative research, including a diary study, with people who applied for PIP and had mental health condition and/or neurodiversity to explore how the claim journey induces feelings of anxiety among this customer group in particular.

Research Context

As of July 2024, there were 3.6 million customers entitled to PIP in England and Wales^{[footnote 1]}. This represents a 29% increase in the volume of customers since July 2021 (where there were 2.8 million PIP customers^{[footnote 2]}). Mental health conditions and behavioural disorders have been a primary driver of the increase in the working age PIP caseload. The monthly average of new PIP awards where the primary medical condition was anxiety and depression has increased from 2,500 per month in 2019, to 8,800 per month in 2024^{[footnote 3]}.

In reporting on their inquiry into the assessment processes for health-related benefits^{[footnote 4]}, the Work and Pensions Select Committee acknowledged the prevalence of mental health conditions, and the increases in anxiety among disabled people in the past 10 years. They stated that the evidence suggests that health assessment processes used to inform decisions on health benefits can cause psychological distress and may help to precipitate mental health issues (though causation is difficult to determine).

Research conducted by the DWP in 2018^{[footnote 5]} explored customers鈥� experiences of the PIP claim journey and reported that certain aspects of the process were particularly stressful for people with mental health conditions.

This research was commissioned to gain an understanding of the ways in which the PIP application journey affects customers who are predisposed to experiencing anxiety. The Department will use these findings, alongside insights from wider research, to inform the development and delivery of the Department鈥檚 policy initiatives and the Health Transformation Programme.

Key Findings

The study found that anxiety is experienced in diverse ways, with many participants describing a feeling of 鈥渙verwhelm,鈥� while a few reported experiencing 鈥渕anic鈥� episodes^{[footnote 6]}. Anxiety often manifests in physical symptoms such as palpitations, rapid breathing, and difficulty sleeping.

Common triggers for feelings of anxiety include crowds and social interactions, formal interviews, changes in routine, loss of control, reflecting on past trauma, managing information, and specific activities that require individuals to step out of their comfort zone. Many participants reported 鈥渁nticipatory anxiety,鈥� experiencing anxiety weeks before a stressful event or activity.

The PIP claims journey itself is a significant source of anxiety, as it involves many of these common triggers. Several stages in the process were particularly anxiety-inducing:

• Starting a claim: Uncertainty about eligibility and the process, as well as the prospect of speaking to an unfamiliar person on the phone, can trigger anxiety.
• Completing the PIP application form (PIP2): The form鈥檚 length, complexity, and seemingly irrelevant questions, particularly those focused on mobility, cause stress. Participants expressed concerns about providing sufficient evidence, particularly for mental health conditions. Additionally, reflecting on traumatic experiences can be re-traumatising.
• The assessment: The prospect of being judged by an assessor who is unfamiliar with their condition, the possibility of not being believed, and uncertainty about the assessment format and timing all contribute to anxiety.

• Receiving a decision: While receiving a full award was met with relief, partial or nil awards often left applicants feeling disappointed and frustrated, particularly if they felt misunderstood or misrepresented. The research suggests a number of ways in which the PIP claims process, or support around the process, might be adapted to reduce anxiety^{[footnote 7]}, including:

• providing clear and accessible information about the process in various formats, including visual walkthroughs.
• raising awareness of flexibility in the application process, such as choice of the channel, date, and time of the assessment.
• recognising the importance of emotional and practical support by connecting applicants with support networks and facilitating access to support.
• implementing an online claim management system to enable applicants to track their claim鈥檚 progress and understand next steps. This might include access to a case manager for the most vulnerable.
• improving the communication of decisions by providing more transparency in the decision-making process and modifying the language used in decision letters to be less formal.

Methodology

This research involved 40 PIP applicants in England and Wales who self-reported being more predisposed to experiencing anxiety. It comprised qualitative interviews conducted at two different points in the claims process (once near the beginning, once toward the end) supplemented by entries to a digital diary in which people detailed their touchpoints with DWP through WhatsApp or text. The study took place between August 2024 and January 2025. To help inform the development of the research instruments, the research team also undertook a targeted review of posts on open-access social media sites.