Hi ive just received an EMP report. EMP has confirmed client's chronic anxiety and need to be accompnaied outdoors. Also agrees depression and mental state would impact upon ability to self care.

S/he states in report that client refuses medication or therapy to ease her condition, which s/he feels would be of great benefit to client, particularly chronic anxiety.

I am not sure that this is strictly correct as she is on medication and I am pretty sure she is compliant, need to check. However client does catergorically refuse psychiatric input/ counselling, she has received this treatment before and found it to be counterproductive.

Any thoughts on how the tribunal may treat this statement?Could this be used against her or am i worrying about nothing?

Look at R(DLA)10/02. It's on the OSSCSC website at

http://www.osscsc.gov.uk/judgmentfiles/j129/R(DLA)1002ws.doc

Commissioner Parker holds that refusal of treatment can only operate to negate the reasonableness of the claimants care needs if
(1) treatment is immediately available (no waiting list nonsense!)
(2) it is certain to work (not "let's try this...)
(3) it is certain to reduce care needs to negligible or eliminate them altogether.

She also said that refudsal might be itself a manifestation of a mental disablement and that refusal of psychiatric treatment in such circumstances does not negate the reasonableness of care needs.

(Don't think that link is going to work, but a search on OSSCSC site for that decision number will find it)

You could argue that your client has por "insight" regarding the mental illness. Has his psychiatrist fully explained what treatment is avilable, what alternatives there are and the different side effects of various drugs. Or has the psychiatrist just prescribed either the cheapest option or the option sold by a particular drug company. Your client may well be within his/her rights to delay starting treatment until all the options have been discussed.

Thanks both, i am sure the decision will be very useful. My client just doesnt trust any health professional except her GP. He carries out consultations over the phone because of chronic agorophobia. GP not attempted to make any referrals lately as far as i am aware. She has previously had counselling and psychiatric input, she found that it was not beneficial at all and very intrusive, she is a very private person. This was all quite a long time ago but its no secret that she does not want this help. Presumably thats why GP not tried to refer.

As for having an insight, its difficult to judge really, she has accepted her illness. She has suffered with it for so long now, i get the impression that she does see any point of treatment anymore. To say she has been let down by the system is a real understatement. But you are right I dont think anyone has recently discussed in detail what options are available to her now.

thanks