Universal Credit: how people who have accessed mental health services journey through the welfare system

Researchers from King's IoPPN are linking data from electronic health records to data from benefits records to understand how people with mental health problems move through the welfare system. A new study has focussed on Universal Credit which is a welfare benefit to help with living costs, available to people who are on a low income, out of work, or unable to get work. In this blog Dr Sarah Ledden discusses the findings and what they suggest for welfare reform going forwards.

Universal Credit (UC) was announced in 2012 in a major shake-up of how the welfare system works. Designed as a “one-stop shop” for benefits, UC aimed to simplify the welfare system by replacing six common benefits (including job seeker’s allowance, housing benefit, and tax credits) with a single application and payment. UC is paid per household and is a means-based benefit, meaning that household earnings and savings need to be under a certain level to receive UC.

Although UC was designed to simplify the welfare system, summarising how UC works feels far from simple. When receiving UC, claimants are allocated to one of six UC regimes. These regimes are largely tied to someone’s ability to work or seek work. When in these work-based regimes, recipients are expected to meet requirements to receive their payment, for example meet regularly with a work coach or provide evidence of work searching and these are summarised in box 1.

Box 1: Universal Credit regimes 

Our research on UC trajectories in mental health service users

We have been researching how people who are accessing mental health services receive benefits. To do this we have successfully linked over 400,000 mental healthcare records from people receiving care from South London and Maudsley NHS Foundation Trust with benefits records from the Department of Work and Pensions. Healthcare records are accessed through the NIHR Maudsley BRC Clinical Record Interactive Search system.

In our most recent study, published in Social Psychiatry and Psychiatric Epidemiology, we looked at how people move through different UC regimes over time to identify typical groups of UC journeys, and investigate the traits related to group membership.

Who was included in this research?

Earlier research from our team reported that 1 in 4 people who have accessed South London and Maudsley mental health services received UC between 2013 and 2019. For this more recent study, we selected people who received UC for the first time in 2016 (4,876 people) and looked at their UC journey over 4.5 years. We noted in each month whether someone was receiving a specific UC regime, were not receiving UC, had reached retirement age or died.

What does our data tell us about how people who access mental health services move through the UC system?

We identified six distinct groups of typical UC journeys. Each of these groups reflect variation in the UC regimes within the groups and the time spent in each (see Figure 1).We have summarised these groups and their UC journeys in the table below.

Figure 1: Mean time spent in each UC status by group  

What does our data mean for different groups of people? 

Our data demonstrates the range of journeys that people can take through the UC system and provides  insight into which route people accessing specialist mental health services might take. 

This research can help identify key barriers in accessing and returning to work; and suggests which groups of people may need greater support to help them back into employment. People stuck searching for work longest weren’t necessarily those with the most severe mental problems, suggesting other barriers like local job opportunities, caring responsibilities or skills gaps were the real barriers.  

The positive news is that UC did help people move on: between 73% and 100% of claimants had stopped claiming UC by the end of the study. This shows that UC worked as a temporary support during difficult times, not permanent dependency. As policymakers consider changes to the benefits system, this research shows we need better support that recognizes individual circumstances, rather than forcing people into long job searches that may harm both their recovery and job prospects.   

Stevelink, S.A.M., Ledden, S., Bakolis, I. et al. Universal credit trajectories among individuals who access secondary mental health services: analysis of linked data. Soc Psychiatry Psychiatr Epidemiol (2025). https://doi.org/10.1007/s00127-025-02930-3