I have an fairly unusual case at the moment. Client has been diagnosed with Schizophrenia for a number of years. The schizoprenia is not controlled at all and she has shown little if any improvement with medication. She suffers from auditory hallunications which cause some distress however her main difficulty appears to be the delusions she experiences. She had a previous DLA award of MRC/LRM but this was reduced on renewal to LRC/LRM. Despite her diagnosis and symptoms to my surprise I am stuggling to establish grounds for requesting MRC at appeal as I am not sure she is risk of danger to herself or others.

She has little insight into her condition and while excepting that it is not 'normal' to experience auditory hallucinations she believes that her health problems are mainly physical. She suffers very severe delusions about this believing that she is suffering from CJD and that she cannot walk properly, has breathing problems which restrict her mobility. She refuses to accept that it is not possible that she has CJD. Her GP has stated that there is actually not anything physically wrong with her.
Aside from this she also can be unrealistically demanding.

Despite this I have been unable to work out how an award of MRC could be established. There is no evidence of self harm or harm to others, she has not put herself in any dangerous positions, there have been no accidents within her home. The "physcial health problems" have meant that she requires some help with personal care but I would struggle to say it was needed through out the day for a MRC award. Would the delusions themselves be considered as a need for supervision?

Further to this the client is wanting a domicilary hearing as she states that she cannot leave her home due to her "physcial health problems", I am concerned that if I were to request this she could lose her LRM as they could argue that if she never or rarely goes outdoors then she cannot need the guidance or supervision.

Any ideas would be gratefully received.

is she washing, dressing, taking medication etc?

while auditory hallucinations may be a difficult one to show direct care needs arising from them usually in my experience they are accompanied with other quite limiting factors.

Sounds like she may well have extensive care needs stemming from her mental health issues i.e. the brain is a 'bodily function'. R(DLA) 1/07 paragraphs 18 - 27 may help crystalise things on the care front.

Auditory hallucinations can be really grim, even more so if they have an element of 'command' voices, coupled with the severity of the delusions definitely worth exploring the above.

Is she under the care of the CMHT? Also the idea is that she requires guidance and/or supervision to take advantage of the faculty of walking outdoors in unfamiliar places with no insight, severe delusions and auditory hallucinations sounds very credible to say the least.

Social withdrawal is so common under these scenarios its close to the norm, and very few people do not go out at all even if it is just to the GP's or family or corner shop.

Can you med get evid from CMHT i'm assuming she's on their books and GP.

Wed 15-Jul-09 02:17 PM by Frank Duvalier

I would suggest that the principles of Moran adequately support an argument for continual supervision in such a case.

Moran (R(A)1/88) confirms that "supervision may be precautionary and anticipatory." That a person who stands by to intervene in the event of danger can be said to be exercising supervision between the period danger arises. That the frequency or infrequency of the event of danger is immaterial to the question whether supervision is continual so long as the risk of substantial danger arising is not "too remote" a possibility.

Your client has little or no insight into her condition, so therefore would be unable to identify when her symptoms are exacerbating. It is also unlikely that she would rationalise failure to attend to bodily functions as self-neglect.

If there is care plan or a support network in place, consider the effect this would have if removed and the likelihood of a deterioration of mental health.

Also, there's the risk that altered state of consciousness or disorganised, intrusive thoughts can be so distracting that they have the potential to contribute to accidents.

You might not agree with some of these arguments but I hope it helps.

How did you get on with this Sam? I'm struggling even completing a DLA form.

I have a client who has never accepted there is anything wrong with him. He was diagnosed with schizophrenia some years after showing symptoms of serious mental imbalance when he was around 17. He' was sectioned several times back then and is now in his mid 40s.

His mum who is an intelligent woman is not convinced of the diagnosis any more but is pretty sure it stems from cannabis psychosis and abuse of LSD when he was younger.

He's currently staying with his mum who's now his appointee. He has had and will very likely have in the future lengthy episodes of street homelessness. He rarely speaks to her and when he does it is impossible to have any sort of normal conversation with him.

She has sought all sorts of help and is in regular contact with Making Space. He has never been assessed and has absolutely no insight into his illness, vehemently denying there is anything wrong with him.

To give you a small insight - he will only eat or drink food that comes in a particular type of packaging (but it's impossible for anyone to be able to guess which type). He then will only eat and drink from a certain type of plastic. He does cook for himself but everything (including pies with uncooked pastry, frozen chips, veg etc etc) is put into one plastic container and all microwaved together.

He will never buy food or clothes as he has an absolute aversion to money (it's "poision"). He won't accept his mum has to buy food and believes that somehow it just appears. He has no concept of bills or the expenses involved in running a home.

Believe me this is just a very small example of his very strange behaviour.

I'm finding it very difficult to completed the DLA1. Additionally there's no medical evidence whatsoever apart from that from 30 years ago. He would refuse point blank to see any EMP so I am concerned that any DM will argue there is no evidence.

A total absence of insight into the mental condition is characteristic of schizophrenia (which doesn't mean "split personality" as a lot of people think, but a condition in which the mind is completely split off from reality and inhabits its own world which has its own internal logic). An unlce of mine who was a consultant psychiatrist once said that if you ever find yourself wondering, when talking to someone, if it is you are them that is peculiar you are talking to a person with schizophrenia.

Refusal to engage with medical provision is all part of the condition. As the application is being made by an appointee his assent and understanding are not needed; but what does he have by way of income? The implication is that he is getting some sort of benefit already (IS?) and if it is a medical benefit there must be evidence there. Sadly its's not as easy as the sort of case where the patient is convinced the problems are of physical origin when they will not be worried about a doctor coming to see them. Are you sure there are no "physical" problems he could be induced to see a doctor about? Any evidence that is potentially harmful can be screened from him.

Ariadne I know this person and his family very well. He is very determined and there is absolutely no chance of him seeing a doctor about anything (many years ago had to be sectioned so they could treat a compound fracture!!)

He's been on IS for many years. I'd thought about evidence from a PCA but I've a sinking feeling he's one of those claimants who have slipped through the net and not been assessed for years. I cannot imagine him ever agreeing to submit to an examination (his benefit stopping would be of no concern to him). I've written to JCP for this info and am awaiting a reply.

I had a client who suffered auditory hallucinations and paranoia, and had no insight into her condition at all. She refused to engage with GP or CMHT. I collected witness statements from every professional with any experience of her behaviour (landlord, reception staff at council offices, school etc.) and also wrote an account of my dealings with her. She was often seen in the local high street ranting at nobody, and this went into the statements. I attended the tribunal without her and presented the evidence with my submission. She was awarded low mob and middle rate care.

This is what I'm going to have to do Rose - and thanks for the suggestion

Posted claim form in with lengthy statement I prepared from mum's viewpoint. Also very brief note written by a carer support coordinator 12 months ago about a debt matter.

I just thought we'd see what happened as it was proving difficult to get anything else before the DLA1 needed to be back.

Unbelievably got decision within 9 days - MRC and LRM - I'm buzzin' !