My Service User has bi polar disorder, she is 17, has extreme disruptive behaviour, requires restraint and has HRC.

I am struggling with whether Bi Polar can come within the definition of 'severe mental impairement'. Does it satisfy the def in Reg 12(5)'arrested development or incomplete physical development of the brain, which results in severe impairment of intelligence and social functioning.' ??

My reading of the limited case law on the point is that:
Severe impairment of intelligence is a seperate test to severe impairment of social function (CDLA/1545/2004)
Severe mental impairment is a matter of medical evidence (CDLA/1545/2004)
Claimant must show severe impairment BOTH of intelligence AND social functioning (R(DLA) 1/00).
An IQ of 55 or less is a starting point for the test of impairment of intelligence (R(DLA)1/00).

We dont have any medical evidence yet, however, bi polar websites suggest there MAY BE a physical aspect to bi polar as its inherited.
I am inclined to put the claim in, await a (probably negative) decision and gather the medical evidence when dealing with the appeal.

Does anyone have any experience or suggestions to help?
Ferhana.

There is some evidence that there is a genetic component to bipolar affective disorder (both my mother and uncle had it. However its manifestations vary widely: mum would go hugely hyper over about a week and be able to fly, walk on water and smash up hospital television, then drop like a stone a couple of weeks later and take two years to crawl out of the black hole into some sort of normality until something else happened to set her off. Sounds like your service user cycles very rapidly: people who are deeply depressed aren't disruptive as they haven't the energy or motivation (not even to harm themselves). Is the diagnosis certain? What medication is she on - lithium?

When did it start? You need to show arrested or incomplete development of the brain (something that has no medical meaning at all according to doctors I know. The best guess for psychotic illness is that it is to do with brain chemistry - which is how medication manages to work at all, when it does: by making the brain work more like a "normal" brain. I learnt recently from one of my doctor friends that many people have just one psychotic episode and after treatment are substantially recovered. It might be hard to show the development thing if it's just a phase the body is going through!

Anyway, can you form an impression of her intellectual ability? Can she read, write, do maths? What sort of school, if any, did she go to? Did she pass any public exams like GCSEs? The severe impairment of intelligence referred to at 55 IQ, whatever that means, is associated with moderate learning disability - people who have difficulty acquiring literacy and numeracy. There are however some useful cases on autistic spectrum disorder and functional/socail intelligence: it's no use having a high IQ if your mind is so screwed up you can't use it and have no insight into anything.

Real problem is as with 99% of all known illnesses that everyone is affected differently: it comes down to facts. Have you asked her spychiatrist/CPN is she has such a thing?

Have a look at this thread which concerned 'virtually unable to walk' and has a lot of opinion and case-law on the subject, some of which will be relevant to your case.

Have a look particularly at R(M)2/78 and R(DLA)3/98.

In the latter, a client with schizophrenia was held to have arrested development of the brain and the decision was based on expert witness in front of the commissioner. I know it's not bi-polar, but I would say that the same principles apply.

Tony

The severe mental impairment/incmplete or arrested development of the brain/severe disruptive behaviour/restraint route is one possibility, but does require high rate care as well of course.

I have successfully used the virtually unable to walk route to high mob in two recent cases, one for an early onset dementia client who refused to walk and just plonked herself down in the road instead, and one for an 8yo severely autistic child who refused to walk past any object such as street furniture. This route does depend on being able to show that the inability to walk is caused by a physical disability, which was easy for dementia but more difficult for autism. I suggest you should put in as much research evidence as possible to show that the bi-polar probably has a physical cause and make it clear that you want the DM to consider this route.

Brian