I have an appeal coming up for a client soon, she has no points and only has mental health problems. I am finding it difficult to get the right number of points for the client due to her obsessional cleaning. The client also has other problems with regards to depression. But it seems to me IB reg do not take into account problems with obessional behaviour. Does anyone have any tips to get round this.

Had something similar. Possible points re:

Unable to cope with change in routine - client got upset and distressed if disturbed during cleaning house/herself.

Obsessiveness prevented/impaired ability to communicate with others - would not answer phone/door during obsessive cleaning.

Preferred to be left alone - allowed uninterupted obsessive behaviour patterns.

Also worth looking at whether client is PCA exempt because of severe mental illness or should be treated as incapable because of risk to health if found fit for work.

I find that if I have the list in front of me and directly ask the client whether each descriptor in turn applies to them, most clients surprise me with the number of mental health descriptors that apply, especially if I give them an example.
Here are some suggestions.
15a cannot answer telephone when cleaning. Has to start again with routine if interrupted.(2)
15e Mental condition prevents him from enjoying leisure activities. (I once used this saying that the client could not remember ever having enjoyed any leisure activities. We got the point)(1)
16c Is frequently distressed at some time during the day (1)
17b scared and panicky for no obvious reason. The reason may be obvious to the client, scared of dirt but not obvious to anyone else. (2)
17d is unable to cope with changes in routine (1)
17f is scared of going to work because of OCD (place of work may not be clean)(1)
18c communication (2)
18d irritated by things that would not have bothered him before he became ill (1)
18e prefers to be alone (1)

See also the earlier discussion about OCD, started by Jason. (Sorry don't know how to paste the link).

Here's the link to the earlier ICB + OCD thread started by jason -

http://www.rightsnet.org.uk/dc/dcboard.php?az=show_mesg&forum=111&topic_id=801&mesg_id=801&listing_type=search

The mental health charity Mind have an online booklet called Understanding Obsessive-Compulsive Disorder (OCD) which might also be worth a look at -

http://www.mind.org.uk/Information/Booklets/Understanding/Understanding+obsessive-compulsive+disorder.htm

The good news is that the guidance on mental health used by Atos Origin for training their doctors, and which is supposed to form the basis of the LiMA software, has 12 pages devoted to OCD, including 2 pages of reference and bibliography. It gives very clear indications of the ways in which OCD is likely to be relevant to the PCA. The bad news is that the doctor who carried out the medical in your client’s case seems to have ignored all of it.

I only have a hard copy of the guidance , so can’t quote extensively (though Benefits and Work members can obtain their own copy by simply copying and pasting an email and waiting patiently for 20 days). But the guidance does say that there is a strong association between OCD and depression, with a lifetime prevalence of depression in OCD sufferers of 70%. - it’s a bit astonishing that with both these conditions your client scored nothing.

Doctors are told that:

“Obsessions and compulsions are distressing, time consuming and have a negative impact on the sufferers interpersonal relationships and careers. . . .

Social isolation occurs in individuals with moderate to severe OCD, partly because they spend most of their day performing rituals and partly because others interpret their behaviour as peculiar. . . .

Obsessional thoughts interfere with concentration on study and work . . .

It may become apparent during the typical day history that the claimant spends so much time performing rituals, such as cleaning or checking, that their social functioning is severely restricted. Obsessive ruminations may occupy the claimant to such an extent that their awareness may be affected. . . .

Co-morbid depression may worsen the disabling effects of OCD. There may be reduced concentration, increased anxiety, increased irritability and social reclusivity. . . .

In the IB-PCA, it may be appropriate to advise exemption under the category of severe mental illness . . .

If the condition is not so severe as to warrant exemption advice then the examiner will find that the functional limitations caused by OCD may affect all four psychological functional areas. . .

Common reductions in reported functions are: decrease in self-esteem (92.1) – DL effects, Change of career or job or laid off from work (70.3%) – CP effects, Negative relationship with spouse (64.4) and Fewer friends (62.1%) – OP effects.”

Unless your client's OCD and depression are so mild that they are almost imperceptible it doesn't seem credible that a combination of these two conditions could lead any competent doctor doing their job properly to find that not a single mental health descriptor applied.

Steve, where can I get hold of this?

(don't suppose there's any chance you could fax a copy of the relevant pages to me is there? 020 7247 9924)

I've got a DLA case for a client with OCD going back to the Tribunal after going to the Commissioners & it might be of some help.

(got a couple of articles from medical journals indicating that OCD has a comparable effect on social functioning to schizophrenia if that is any use in return)

thanks

Paul

Hi all-
really useful to get this info on OCD.does anyone have any similar info from EMP guidance about manic depression/bi polar affective disorder?