OP26 The mental health effects of universal credit: qualitative findings from a mixed methods study

Background The UK social security system is undergoing transformative changes with the introduction of Universal Credit (UC) for unemployed and low-income households due for completion by 2028. Despite extensive reports of hardship associated with the rollout of Universal Credit, no previous studies have comprehensively evaluated its impact on mental health. The aim of this mixed method NIHR-funded study is to evaluate the impacts of UC on mental health and health inequalities. Methods In-depth interviews were undertaken with UC claimants in Scotland and England between January 2022-February 2023. Purposive sampling was used to achieve a sample of maximum variation. Participants recruited through gatekeeper organisations took part in face-to-face, online or telephone interviews. The topic guide explored reasons for claiming, and experiences of claiming and managing on UC. Interviews were transcribed verbatim, anonymised, and checked against recordings for accuracy. Case, thematic and process analysis was undertaken. We developed a coding framework reflecting emergent themes, using NVivo to organise and manage the data. Data analysis is informed by public contributors with lived experience of UC and policy/practice partners supporting them. Results Seventy UC claimants (18–67 years) took part including 41 women, 27 men and 2 people who identified as non-binary. Most (n=30) were living alone, 8 were living with a partner/adult family member, 31 households had dependent children, of which 20 were single parents. Most participants (n=52) were not working , 12 were employed part-time and 6 self-employed part-time. 44 reported physical and/or mental health conditions or disabilities. The majority (n=49) identified as white British, 21 were from minoritized communities, including 9 refugees and 12 had English as an additional language. Early findings describe how specific design features of UC, including the digital system, wait for first payment, enhanced conditionality requirements, and threat of sanctions affect mental health and wellbeing through complex interrelated pathways affecting financial security, employment, family life and housing. We examine how policy implementation varies between England and Scotland. The risks, challenges and opportunities of involving UC claimants as public partners in the study are considered, including measures undertaken to mitigate these. Conclusion The effects of living on UC on claimant’s health are complex and variable. A few respondents experienced improved living standards and financial security, but others faced worsening hardship, insecurity and debt. We discuss policy and practice implications of our findings for different population groups in the future transition to UC and recommendations for future research.