New health inequalities system to help Dundee’s most deprived

Drug abuse was one of the key issues identified as affecting Dundee’s deprived communities.

Original Courier article here 


A revamped system to deal with health inequalities in Dundee has been launched after it emerged that the city has the second lowest life expectancy in Scotland.

Alcohol-related emergency admissions, substance-related deaths and suicides were identified by the Dundee Health and Social Care Partnership as some of the biggest health problems facing deprived communities.

The newly-streamlined system to tackle those issues aims to integrate health inequalities teams, budgets and management, which were previously separate.

Community groups and activities are also being actively targeted at vulnerable individuals, rather than having open access.

In addition, health checks are being offered on a locality basis and pathways between different components of the health inequalities team are being improved.

The new system will be discussed at a meeting of the Health and Social Care Partnership (HSCP) on Tuesday.

A report released in advance of the meeting explained: “The Dundee HSCP identified health inequalities a a priority theme.

“Dundee has the second lowest life expectancy in Scotland with a variation in gender and deprivation.

“The life expectancy of a female living in the most affluent part of Dundee is 10 years higher than a male living in the most deprived area.

“Dundee has a marked difference in lifestyle behaviours and resultant poor health across socio-economic groups.

“The patterns of some behaviours are not straightforward but the harm caused is disproportionate within disadvantaged populations.

“Drug misuse is concentrated within socio-deprived communities and is associated with other mental health and social problems.

“People with long-term conditions and mental health problems live disproportionately in Dundee’s disadvantaged communities.

“Alcohol related emergency admissions, drug and alcohol deaths and suicides are high in the city and are closely linked to deprivation.”

The re-designed system aims to target adults living in the 20% most deprived areas and who fit one of the following additional criteria: offenders, homeless, substance abusers, carers and people on low incomes, people with poor mental health.

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‘I have lost hope’: the people with mental health problems who are being stripped of their benefits

Personal Independence Payments – the points-based system for disability claims – only works for people with physical disabilities, say campaigners. We meet some of those who feel they have slipped through the net

Kloey Clarke at home in Devizes, with her son Seth.
 Kloey Clarke at home in Devizes, with her son Seth. 

Link to the original Guardian article here 



Kloey Clarke, 28, from Devizes in Wiltshire, has had severe anxiety and type II bipolar disorder for six years. “I’m scared to leave the house,” says Clarke, who does not feel emotionally or physically stable enough to hold down a job and relies on her husband for care and support. “I have a constant fear of dying. I can’t socialise and I can’t communicate outside [the house].” For four years, Clarke depended on a Disability Living Allowance (DLA). The DLA was replaced by Personal Independence Payments (PIPs) in 2012 – and phased in from 2013 – but she was receiving them for less than a year before she was reassessed by the Department for Work and Pensions (DWP) and told she no longer qualified.

Clarke believes that the assessment for PIP is aimed at people with physical disabilities and does not account for mental illness. “I was asked if I could walk 200 metres unaided. No, I don’t need a stick or an aid, but I do need my husband or someone with me. Can I talk to people face to face? I talk to my family when they visit, but can I speak to strangers? No.”

She has had panic attacks as a consequence of losing her benefits, she says, and her family is now struggling financially. They have had to visit food banks twice since being rejected for PIP, but Clarke’s pride has stopped her from going more frequently. “I just find it so degrading. I don’t feel as if I should be there. I feel that, if I just had what I deserve, then I wouldn’t need to be in that place; I wouldn’t need to take food from, say, homeless people.”

Clarke’s marriage and her relationship with her children are suffering. “I’m useless to them, I’m not half the mum that I could be. I haven’t got enough funds. The government has no idea what these types of assessments do to people with mental health [issues]; how much it takes to walk into that room and talk about something so personal and then be told you aren’t ill enough.”

The evidence is mounting that people with mental health problems in particular are being failed by PIPs, with claimants reporting that the new system takes no account of the needs of people with conditions ranging from schizophrenia to severe depression. Figures released by the DWP in October showed that complaints about the PIP assessment process increased by 880% last year. The number of complaints that were upheld rose similarly dramatically, by 713%.

The DLA was first introduced in 1992 by John Major’s Conservative government and was paid to eligible claimants who had personal care or mobility needs as a consequence of a physical or mental disability. PIPs were introduced by the coalition government as part of the 2012 Welfare Reform Act, and have been steadily replacing the DLA since 8 April 2013. Some claimants who received indefinite DLA awards were not being reassessed, and the government then argued that it was necessary to have a system that frequently assessed people in order to determine if their needs had changed over time. In 2013, the then work and pensions secretary Iain Duncan Smith told the Daily Mail that “70% of people on it [DLA] have lifetime awards, which means no one sees you ever again. It doesn’t matter if you get better or your condition worsens – it’s quite ridiculous.”

The big differences between PIP and DLA claims arise from the assessment criteria. DLA is based on an individual’s condition and the needs arising from this, while entitlement to PIP is assessed using a points-based system. Claimants are typically invited to a face-to-face assessment in a private consultation room, but are sometimes assessed in their homes. People score points according to their ability to complete a number of everyday activities, such as washing and cooking, and whether they need aids and appliances or help from another person to do so. According to Full Fact, an independent factchecking charity, between October 2013 and October 2016, 22% of DLA claimants with mental health conditions had their benefits reduced when they were reassessed for PIP, and a further 25% lost them altogether.

Many of the people I speak to say the PIP assessments do not take into account the effect their mental health conditions have on their lives. Some say that, even though they are physically capable of preparing a meal, driving a car, or dressing and washing themselves, the ability to do these things changes all the time. This is especially the case with conditions such as clinical depression or bipolar disorder, when, on some days, a person may find it difficult to get out of bed.

Daniel O’Connor, 64, from Glasgow, has led a tough life. He has severe depression and adjustment disorder, and has twice attempted to end his life. O’Connor had been receiving DLA for nearly 22 years when, this year, his application for a PIP was rejected. Since then, he has experienced financial hardship and says his condition has worsened. O’Connor says he felt as if he wasn’t being listened to at his PIP assessment and recalls telling the assessor that on some days he struggles to get out of bed because his depression is so debilitating. However, his assessor dismissed his story, citing the fact that he could drive as evidence of his ability to carry out everyday tasks. “We got to discussing a previous suicide attempt I had [made],” he says. In the final moments of the interview, the assessor asked him seven times if he was going to go out of the door, there and then, and kill himself. O’Connor adds he found himself in the position of having to placate the assessor. “It seems to me that her concerns were not about me; her concerns were about what the reflection would be on her if I did go out of the door and kill myself.”

Rejected PIP applicants have the right to appeal the decisions made by the DWP, and statistics from the Ministry of Justice show that 65% of appeals are ruled in favour of the claimant. Campaigners say this demonstrates a systemic ineptitude in the way the assessment criteria are being interpreted.

Alison Smith with her husband, Mark, at home in Beverley.
 Alison Smith with her husband, Mark, at home in Beverley. 

Alison Smith, 55, from Beverley in Yorkshire, cares for her husband, Mark, who has bipolar disorder. Mark “is unable to go out without someone with him or socialise”, she says. He can go for days without washing, dressing or eating. He will neglect his medication if not reminded and has self-harmed. The couple have lost other benefits, including their housing benefit, since losing PIP and they have been relying on a lump sum from Alison’s pension to get by.

Alison had a difficult time at her husband’s appointment. “The woman who did the assessment was horrible. She wouldn’t let Mark speak. When he tried to say anything, she kept saying: ‘No, I’m not interested in that – I need to go through what’s on this computer.’ They don’t look at the mental illness side of things. Mark has the [physical] ability to make a sandwich, but he doesn’t have the mental ability to do it.”

“Often, we hear from people with mental health problems who tell us that they dread the face-to-face assessments,” says Paul Spencer, policy and campaigns manager at the mental health charity Mind. Spencer adds that, as well as reforms to the Work Capability Assessment, used to determine one’s eligibility for Employment Support Allowance (ESA), “we also urgently need the government to overhaul the PIP assessment process to make sure it is fit for purpose – and delivered by people who really understand how someone’s mental health problem can affect their daily life”.

Lorna Crofta’s story illustrates this lack of understanding. Crofta, 53, from Worcester, has had severe mental health problems since childhood. She was awarded DLA for three years and then invited to apply for PIP this year. Her application was refused because she failed to attend her assessment – she had received a diagnosis of bowel cancer and the assessment was scheduled just before an operation to have a tumour removed. “I had come to a complete standstill physically, and that had an additional impact on my mental health. I hadn’t even opened my post for weeks and had gone beyond thinking in a rational manner about anything. I would not have been able to handle someone being in my house.” Crofta says she has been living in poverty all her life. Even before losing her DLA, she says, the benefit wasn’t allowing her to do much apart from securing basic subsistence. “My life is just existing between one appointment and the next. I have lost hope. I dread how much worse things will be if my appeal is turned down.”

Lorna Crofta in Worcester.
 Lorna Crofta in Worcester. 

The shadow work and pensions secretary, Debbie Abrahams, has seen first-hand some of the hardships disabled people are facing as a result of the government’s welfare reforms. “The number of cases I get, not just in my constituency but right across the country, is shameful – and shameful on the country as a whole,” she says, from her constituency office in Oldham. The system, she argues, is designed to put people off and to stop them claiming, “and, unfortunately, it’s working”. Abrahams adds that the assessors need to be held to account: “The fact that two-thirds of assessments are overturned on appeal just shows the fact that it is a warped system.”

The DWP responds: “PIP looks specifically at how someone’s life is affected by mental health, unlike the old system, which did not sufficiently recognise mental health problems.” They add that there are now more people with a mental health condition receiving the higher rates of PIP than their DLA equivalents. “PIP ensures that mental health conditions are given the same recognition as physical ones. It does this by considering how impairments affect a person’s life, rather than labelling individuals on the basis of a condition.”

In February, the DWP was advised by judges at the Tribunals Service (the branch of the Ministry of Justice that oversees tribunals and adjudications) to award more points on the mobility assessment of the claim if people suffer from “overwhelming psychological distress”. However, because of concerns that these changes would cost an extra £3.7bn by 2022, the government enacted legislation reversing the judgment: it altered the mobility criteria to exclude people who had psychological distress – specifically, psychological distress caused by following the route of a familiar or unfamiliar journey when travelling alone. The move will mean that 292,500 claimants will no longer be entitled to any mobility component, which could affect people with a wide range of conditions including learning disabilities, autism, schizophrenia, anxiety conditions, social phobias and early-stage dementia. The government argued that the judgment had “interpreted the assessment criteria for PIP in ways that are different to what was originally intended”.

In April, Valerie Grant, 73, killed herself after her severely autistic son was told he did not qualify for disability benefits. Her death came after a UN report, published in November 2016, concluded that the UK government has failed to uphold the rights of disabled people, a verdict the UN reached again this August. Areas of concern highlighted in the UN’s report are high levels of poverty for disabled people and their families and reduced standards of living as a result of multiple welfare reforms and benefit cuts. One of the welfare reforms highlighted for criticism is the criteria used to assess people for PIPs.

In response to the UN’s findings, the DWP said: “We’re disappointed that this report does not accurately reflect the evidence we gave to the UN, and fails to recognise all the progress we’ve made to empower disabled people in all aspects of their lives.” It added that the government spends over £50bn a year to support disabled people and those with health problems and that “it is encouraging that almost 600,000 disabled people have moved into work in the UK over the last four years”.

Abrahams says that Labour, if elected to government, would aim to scrap both the Work Capability Assessment, the ESA and the PIP assessment, and devise a system that doesn’t look for ways to stop someone’s support. She says: “First of all, we should recognise and value what our social security system is for, and I make it absolutely clear it should be like the NHS. It is there for everyone in their time of need and we should value it.” In the meantime, disabled people will have to continue to battle the DWP for access to benefits.

O’Connor says he has experienced financial hardship since losing his benefit, but that has been mitigated by the fact that he is approaching state pension age, and the fact that he receives money from private pensions. “I’m very lucky that I’m in a situation where I will not be made homeless, but, even if I was, I still wouldn’t give up. They could sanction me to death, but I will not be doing their job for them; I will not be killing myself.”

In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at

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Calls for Dundee to have its own mental health ‘crisis centre’

A Courier article covering Phil, Lesley & Kirsty’s call for a crisis centre to be set up in Dundee.


The family of a Dundee man who took his own life have called for cross party talks to address what they see as political failure to address mental illness effectively.

Talented musician Lee Welsh died on August 8 this year.

Lee’s parents, Phil and Lesley, and sister Kirsty are campaigning for improved mental health care in Dundee and Tayside.

The family have already set up a website in Lee’s honour and are calling for cross party talks to be held on mental health provision.

Lee’s dad, Phil, has written to politicians and councillors throughout the region to urge them to put party differences to the side and address provision.

Phil would like to see a mental health crisis support centre, similar to a facility opened in Edinburgh, established in Dundee.

The centre in Edinburgh is funded by NHS Lothian, Edinburgh City Council and mental health charity Penumbra.

Phil said: “Something like that here would be fantastic. It simply isn’t good enough at the moment.

“The closure of the Mulberry unit in Angus is going to have a horrendous affect on Carseview.

“It’s disjointed as well, the GP doesn’t know what Carseview are doing, it’s all separate. Hopefully the politicians will begin to sit up and take notice.”

In his correspondence sent to politicians, Phil asks:  “Should we idly stand back while predominately young men and women needlessly take their own life?

“I urge you to work together to campaign and secure a resource such as the Edinburgh Crisis Centre here in our city.”

The move to host cross party talks has been welcomed by representatives from various political parties.

Scottish Conservative MP Kirstene Hair said Phil’s crisis centre idea deserves ‘”serious consideration”.

She said: “This is exactly what my Scottish Conservative colleagues and I have been warning about for some time now.

“The crisis centre idea deserves serious consideration, but it may not be necessary if we stop cutting local services.

“The closure of the Mulberry Unit not only prevents people with mental health problems in Angus from accessing help locally, it also puts huge pressure on staff and resources at Carseview in Dundee. ”

Scottish health secretary Shona Robison said: “I’ve replied to Mr Welsh offering to meet with him along with Council Leader, John Alexander and others to discuss his call for a local crisis centre. It’s important to hear what Mr Welsh has to say and to discuss what progress could be made to further improve local mental health services.”

Labour councillor Richard McCready said: “The Labour Group is going to look at the suggestions put forward.

“It’s very clear that all of us, councillors and members of the public, have a duty to do more to prevent suicide.

“For far too long mental health hasn’t been taken seriously enough.”

West End Liberal Democrat councillor Fraser Macpherson said: “The first point I would make is that this has been an absolute tragedy for the family.

“What I am anxious to see is that the best possible mental health provision is offered.

“To that end, I’m very keen to speak to other group leaders across the council.”

Scottish Health Secretary Shona Robison, said: “I’ve replied to Mr Welsh offering to meet with him along with council leader John Alexander and others to discuss his call for a local crisis centre.

“It’s important to hear what Mr Welsh has to say and to discuss what progress could be made to further improve local mental health services.”

Please visit the original article for links to other mental health stories.


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An email sent to Politicians by Phil

Dear all,

As I am sure you are all aware Sunday September 10th marks the start of Suicide Awareness Week.

With the proposed closure of the Mulberry unit in Angus, Tayside will be under extreme pressure to cope with mental health issues. That’s why I urge you to read over the attached document and consider offering support through your various parties and organisations in an attempt to bring something very similar here to Dundee .

Should we idly stand back while predominately young men and women needlessly take their own life.

I urge you to work together to campaign and secure a resource such as the Edinburgh Crisis Centre here in our city.


Phil Welsh

The following was included as an attachment to the email to highlight the work of the Edinburgh Crisis Centre



Edinburgh Crisis Centre


The Edinburgh Crisis Centre provides immediate support for people aged 16 years+ in Edinburgh who are experiencing intense and overwhelming mental health difficulties, such as extreme anxiety or depression, and who may be considering suicide.

The Centre is unique in Scotland in offering quick-access 1-1 and short-stay residential mental health crisis support, alongside a 24 hour a day, 365 days a year confidential freephone, text and email support service.

People initially contact the service by email, text or telephone. Centre staff then work with the person to support them through their distress. Where safety is an issue for people in distress, suicidal thoughts and feelings are openly discussed and staff support people to make safe plans.

Depending on the outcome of the discussion and review, a person may be offered a 1-1 session. Appointments for 1-1 meetings are made as quickly as possible – sometimes immediately and usually within the same day.

Depending on the outcome of the discussion and review at the 1-1, a person may also be offered an extended or overnight stay at the centre. Up to four people can stay at the centre at any one time.

Length of stay is discussed with individuals on an on-going basis during their support, however the maximum stay is seven days. The average stay for most centre users is two or three days. This period of time has been shown to be effective in allowing centre users to address their immediate anxieties and plan for on-going support after their stay. This can include, if required, follow up 1-1 and telephone support.

Leaflets about the service are available across Edinburgh in GP surgeries, student halls, CMHTs, counselling services and police stations. The Mental Health Assessment Service and Emergency Duty Social Work Team also signpost people to the Centre.

The service has 13 members of staff: a Service Manager, Deputy Manager, six Recovery Practitioners and five Recovery Workers. Five helpline volunteers regularly provide helpline cover in the evenings and at weekends.

People who use the service

The number of people who called, texted and emailed the service rose from 392 between April 2007 and March 2008 – when the service opened – to a peak of 1869 people for the year ending March 2014. This then fell to 1637 people in 2016/17, or around four people making contact with the Centre each day.

Even factoring in this slight fall, the Centre has experienced a rise of over 300% on the number of people calling, texting and emailing compared to when it opened in August 2006.

Reasons for contacting the service

When asked, the vast majority of people who contacted the service in 2016/17 said they did so because of anxiety, which was the same as in 2015/16. Depression and suicidal thoughts were also common reasons for contacting the service.

A 2016/17 survey of people who received support through the service found that 97% said they felt better prepared to deal with the issues that led to their crisis. 87% said the service was an alternative to a hospital admission.

Case study

Binal Lanakhi has used the Centre on several occasions, and says her life has been saved by the service.

Binal, now in her 50s, was 18 years old when she was diagnosed with schizophrenia. She has struggled for many years with mental health difficulties, insomnia and suicidal thoughts. She has been hospitalised because of her mental health several times, but says the Centre has made it easier for her to manage her mental health.

“I have been in and out of hospital so many times, but hardly ever in the last eight years, since I started going to the centre. When you are in hospital they usually treat your symptoms rather than the causes of the problem. At the centre they talk to you before things get really bad.”

Binal says having a 24/7 service is important for her.

“I don’t sleep very well and it is the only place you can call in the middle of the night and get someone to help you. Sometimes you don’t need much more than that but it is good having that safety net.

“It is definitely so much less stressful that being in hospital. You know these people and they know you. When you are really unwell, it is like coming out of the frying pan and into water.”

Binal’s story was published in the Edinburgh Evening News on 6 September 2016 as part of an article on the Crisis Centre’s 10 year anniversary.

Care Inspectorate

The Centre was last inspected by the Care Inspectorate in February 2016. Registered as a Support Service under the National Care Standards, the inspection focused on the Quality Themes of Care and Support, Environment, Staffing, and Management and Leadership.

The service received positive feedback about the quality of provision in each of these areas:
• Quality Themes of Care and Support – Very Good (5)
• Environment – Very Good (5)
• Staffing – Very Good (5)
• Management and Leadership – Very Good (5)

More information


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