Meeting the needs of vulnerable clients in the Borough of Richmond
This project started in 2018 as a result of a campaign launched by Citizens Advice nationally in England and Wales that showed how mental health problems make it harder for clients to cope with practical issues such as claiming benefits or dealing with debts, housing or employment, and how these issues can aggravate their mental health problems. A national survey of GPs also led to a report showing that many GPs did not know where to refer their mentally ill patients to help them deal with the practical problems that concerned them. This research strengthened the case for better co-ordination of mental health services with agencies that provide advice and support to tackle these practical issues. Locally we decided to follow up the national campaign by examining the impact of our clients’ mental health problems on their ability to cope with their day to day lives and on the obstacles that get in the way of us providing them with effective support.
What are the problems?
As a result of this examination we produced a short report with case summaries of our clients’ experience to illustrate four main problems that we identified :
- Clients needing professional help to improve their mental health before they can cope with practical problems
- Clients receiving treatment for their mental health problems not being referred, or signposted, to advice agencies such as ours for help with practical problems
- Organisations failing to accept that people with mental health problems are vulnerable
- Organisations requiring claims for benefits or services to be made online
What are the solutions?
We presented our report to the Advice Forum, a body established and chaired by Citizens Advice Richmond whose membership includes Richmond Council and a wide range of local advice agencies. In discussions at meetings of the Forum between December 2018 and June 2019 solutions were developed to the problems that we had identified.
Signposting clients to appropriate local mental health services
Healthwatch Richmond, which champions the interests of patients in the borough, produced a comprehensive directory of all the services in the borough, including mental health services. This indicates that patients looking for help to improve their mental health can apply direct to Richmond Wellbeing Service to find the most appropriate mental health service to meet their needs locally.
Signposting patients with mental health problems to other local services
Several solutions were considered. It was hoped that GPs in the borough would benefit from national funds that NHS has now provided to encourage “social prescribing” initiatives for GPs and other health professionals to refer patients to local services other than medical services to help them take part in activities that would improve their mental health. Funds were also offered by competitive tender for an organisation to develop a single publicly accessible Information Hub to cover all the services available in the borough. The funds were awarded to RUILS, a local organisation run by and for local residents with disabilities and health conditions. From April 2019 RUILS developed a service to provide 9 Link officers to work with all the GP practices in the borough that are affiliated to the Richmond GP Alliance to help patients referred by GPs consider what non-medical services might enrich their lives. You can read more about this initiative here.
Persuading organisations to change their procedures for people who have mental health problems or are vulnerable for other reasons
It was agreed that it was important to provide convincing evidence to organisations providing benefits and services that our clients’ mental health problems make it difficult for them to meet normal requirements to qualify for these benefits and services. There was already a Debt and Mental Health Evidence form that had been developed by the Royal College of Psychiatrists and the Money Advice Liaison Group that was designed to provide evidence for creditors to persuade them to modify their approach to debt recovery from debtors with mental health problems.
Using this form as our starting point we drafted a series of forms for the next meeting of the Advice Forum in June 2019 to ask health professionals who have been working with our clients to complete to confirm the difficulties caused by their mental health problems to send to organisations other than creditors that were providing benefits or services that our clients needed. At this meeting the general approach adopted in preparing the forms was accepted, but we were asked to discuss the detailed drafts further with Richmond MIND. You can view the drafts here: Mental health evidence client consent form, Covering letter on mental health evidence form, General Mental Health Evidence Form.
However it was clear that organisations like the DWP, Richmond Council and local Housing Associations all accept that people may be vulnerable and need special treatment for a variety of reasons apart from just mental illness; but it was necessary to find out what criteria they each used to define vulnerability. To illustrate this we circulated the guidance that Richmond Council staff are expected to use to identify vulnerable residents when they are recovering Council Tax arrears. The DWP’s local partnership manager shared on a confidential basis the guidance given to staff on how to identify benefit claimants with “complex needs” who were likely to need additional help. We also agreed to investigate the various ways in which local Housing Associations identify vulnerable tenants who may need additional help. Our aim is to help advice agencies in the Forum to see what further evidence may be needed to support other reasons for their clients to be considered vulnerable and offered special treatment.
Persuading organisations to provide alternatives to communication online
Locally, and then nationally, the DWP accepted that some Universal Credit(UC) claimants either need extra help to make their applications online or need to apply by phone and have their claim processed without a personal online account s that from
April 2019 Citizens Advice Richmond received government funding to recruit a special group of Help to Claim advisers dedicated to helping these claimants apply for UC up to the point where they receive their first UC payment as well as alerting DWP staff to UC claimants with complex needs who should be considered vulnerable for other reasons – see Improving Universal Credit.
Secondly we updated our handout How to Get Online (see Recent Campaigns – How to help people in the Borough learn how to get online) for Help to Claim advisers to give to clients who want to learn how to get online or to improve their digital skills.