is a personality disorder a 'specific mental illness or disablement',
the decision maker is contending that my client has a PO so does not qualify for IB.
my colleague says there is caselaw about this, but I can't find it!
any suggestions?

oops, meant to write PD as abbreviation for personality disorder, not PO, which is where I'm heading to get some stamps

If your talking about schizophrenia then you should get the DM to refer to the Disability Handbook used by DWP doctors where s/he will find the following.

19.3.1 Various forms of mental illness have been recognized in almost every culture in the world. Mental disorders encompass a very wide range of diverse illnesses which have been given a variety of different diagnostic labels. Although the nature and severity of disability in the individual case are of paramount importance in determining the nature and level of care needs, rather than the exact diagnosis of the condition giving rise to the disability, the following broad classification of mental health disorders greatly assists in predicting the likely range and extent of care needs which
may be associated with them:

The Psychoses (19.4)
• Schizophrenia (19.5)

• Severe Depressive Disorder, Manic-depressive psychosis
(Bipolar Depression) (19.6)
The Neuroses (19.7)
• Generalized Anxiety Disorder (19.7.3)
• Panic Disorder (19.7.4)
• Phobic Anxiety Disorders (19.7.5)
• Obsessive - Compulsive Disorder (19.7.6)
• Mild Depressive Disorder (19.7.7)
• The Personality Disorders (19.8)
• Dissociative (and Conversion) Disorders,
Hysteria and Somatoform Disorders (19.9)


19.5 Schizophrenia
19.5.1 Introduction
(i) Schizophrenia is one of the most serious forms of severe mental illness. Its lifetime prevalence is nearly 1%, its annual incidence is about 10-15 cases per 100,000 people in the population and the average general practitioner probably cares for 10-20 people with schizophrenia. Around 8% of people with schizophrenia are managed entirely by their general practitioner without referral to psychiatric services.
(ii) Contrary to continuing popular belief a person affected by schizophrenia does not have a split or multiple personality but has a general disturbance of thought processes and a disruption of the personality. The condition has profound effects not just on those affected, but also on their families and
friends.
(iii) Onset in men is usually before the age of 30. In women the onset is a little later, by some four years.

I think that the DM is trying to be clever but failing badly. The distinction between mental illness and personality disorder is purely for the purposes of clinical practice. The conventional view is that mental illness, in its narrowest sense, can be cured and therefore it may be appropriate to detain a person for treatment. Schizophrenia as a personality disorder, again in its narrowest sense, is a condition that cannot be cured and therefore it may not be appropriate to detain a person for treatment.

I cannot remember the case law references but, like you, I'm sure I've come across it somewhere.

Regards
Paul

Paul, I'm not disagreeing with you re: DM trying to be clever, but you're incorrect about schizophrenia. This is a recognised treatable mental health problem and is a condition that means a person can be placed on a section if their condition is considered bad enough, in order to bring about a "cure".

A diagnosis of personality disorder, on the other hand, is generally viewed as being untreatable in the usual MH sense and this is why, generally speaking, people with this diagnosis are not treated by conventional MH services. People with diagnosis of extreme personality disorders are often subject to prison unfortunately. In fact, the MIND leaflet "Understanding personality disorder" (see http://www.mind.org.uk/Information/Booklets/Understanding/Understanding+personality+disorder.htm ) notes that A new draft of the Mental Health Act 1983 aimed to ensure that ‘high risk’ patients, including those with a Dangerous and Severe Personality Disorder (not an acknowledged diagnosis), could be kept in detention for as long as they posed a high risk to others. This was widely criticised. It offered the prospect of locking someone up because they have a mental health problem (which is poorly defined), simply on the grounds that they might harm someone. In other words not because of something they have done, but because of something they might do. As of December 2003, the Government has now agreed to revise the draft. For the latest information on the Reform of the Mental Health Act visit www.mentalhealthalliance.org.uk

With regards to care/mobility needs, the information is under 19.8.3 and 19.8.4 of Disability Handbook, as you rightly highlight as being the basis on which DWP doctors should base their evidence. (see http://www.dwp.gov.uk/medical/dhb/index.asp )

19.8.3 Care Needs
(i) People with a personality disorder (or a member of their family) may claim that there are care needs because of the effects of the personality disorder. In those with a dependent personality disorder attention to bodily functions may be claimed. However the person with such a personality disorder will usually be capable of attending to their bodily functions in the absence of any other co-existing disabilities. However, people with dependent personality disorder may experience greater difficulties in coping with the needs which may arise from co-existing disabilities.

(ii) Impulsive or irresponsible behaviour by some people with antisocial personality disorders may be advanced as a reason for supervision or watching-over. It would be rare for someone with such an antisocial personality disorder which produces behaviour that poses danger to the person or others to be permitted to remain in the community.

(iii) Therapeutic community methods are sometimes used, in which people with the more severe forms of personality disorder reside in, or attend, a therapeutic community for several months where they can talk about their problems in relationships and try to help other members of the group to identify and resolve their own problems. This form of therapy as well as group or individual counselling may be of benefit. However, treatment in such a therapeutic community does not imply the presence of any significant care needs.

19.8.4 Mobility Considerations

(i) Supervision when walking out of doors is most unlikely to be required by someone living in the community who has a personality disorder. See also paragraph 19.7.8 above.

19.8.5 Further Evidence
(i) The borderline between the limits of a normal personality and personality disorder is hard to define. Moreover, the effects of personality disorders themselves are highly variable. It is very likely that someone with a personality disorder whose effects are so disruptive or disordered that they are claimed to give rise to care needs, will have been assessed by a consultant psychiatrist and will be known to the local psychiatric and social community services.

(ii) Confirmation of the diagnosis and an assessment of its principal features is essential. Information should thus be sought from a hospital doctor (usually, consultant psychiatrist) who has been involved in the case. It may also be helpful to seek information from the general practitioner or mental health care worker.

We have a client with PD - however in their case it leads to random verbal attacks on strangers and the odd act of arson directed at badly parked (empty) cars and vans: they have at present Low Care/low Mob but we are trying to get middle care back (which they lost) on the grounds that they require constant supervision of the type being provided by the family.

The point is that it depends to some extent on what type of PD your client has and how it affects them - there are about ten different types - see the MIND website for an info page - http://www.mind.org.uk/index should work.

From that page, and apologies for length of posting :-
========================================================================
What are the different types?

There are ten personality disorders, according to the DSM-IV (The American Psychiatric Association’s diagnostic and statistical manual of mental disorders). Information about multiple personality disorder is not included here, since it is classified as a dissociative disorder. (See Understanding dissociative disorders)

Paranoid personality disorder
A continual and unwarranted distrust and suspicion of others is a sign that someone has this problem. They are always on their guard, in case someone harms them.

Schizoid personality disorder
A person with schizoid personality disorder isn’t really interested in forming close relationships. He or she tends to be solitary, inward looking and cut off from other people.

Schizotypal personality disorder
Making close relationships is extremely difficult for anyone with this problem, which often involves social anxiety, eccentric behaviour and distorted thinking. A person might believe they can read minds and exercise magical control over other people, or that they have some huge part to play in world events. Some researchers suggest that this personality disorder is related to schizophrenia.

Borderline personality disorder (BPD)
This may involve:

intense, unstable relationships
highly impulsive behaviour
major mood shifts
inappropriate anger
self-harm
having a weak sense of identity
long-term boredom and a sense of emptiness
a fear of being abandoned.
People with BPD may cling on to very damaging relationships, because they don’t have a strong sense of identity and are terrified of being alone. Many people with BPD also meet the criteria for histrionic, narcissistic or antisocial personality disorder (see below). (See, also, Mind’s booklet, Understanding borderline personality disorder)

Histrionic personality disorder
People who are histrionic tend to be highly emotional and attention-seeking in their behaviour. They are very dependent on the support and approval of others, and yet constantly in search of novelty and excitement.

Narcissistic personality disorder
Anyone with this diagnosis will have an over-inflated sense of their own importance, with fantasies of unlimited success or achievement, a constant need for attention and admiration, and a tendency to exploit others.

Antisocial personality disorder (APD)
Known as ‘psychopathy’, under the Mental Health Act 1983, this is the disorder most closely linked with adult criminal behaviour. Someone with APD is likely to ignore and ride roughshod over other people’s rights. Although charming on the surface, they may be callous and self-serving underneath, and lack any empathy with other people.

They may not be able to hold down a job for long or stay in a long-term relationship. They usually behave impulsively, without considering the consequences, and this is often linked to criminal offences, particularly involving violence. Central to the problem is a complete lack of guilt about their behaviour.

There seems to be a higher rate of alcoholism and substance abuse among people with APD than in the rest of the population, and the effect of alcohol or drugs makes their behaviour even more extreme.

Avoidant personality disorder
Feelings of inadequacy, and fear of disapproval, criticism or rejection will make someone with this problem avoid social situations. Although it’s similar to social phobia, it’s more about fear of social relationships and intimacy than of social situations, as such. (This is also known as anxious personality disorder.)

Dependent personality disorder
Driven by an overwhelming fear of separation and a need to be taken care of, people with dependent personality disorder tend to become very clinging and submissive towards others.

Obsessive-compulsive personality disorder (OCPD)
OCPD sufferers are preoccupied with orderliness, perfectionism and keeping everything under control. They set unrealistically high standards for themselves and others. OCPD is not necessarily linked with obsessive-compulsive disorder (OCD) and the other obsessional disorders, but some people may be diagnosed with both. (OCD is likely to interfere much more with someone’s day-to-day life.) Someone with OCPD may also suffer from depression or social phobia. (See Understanding obsessive compulsive disorder

I think I should clarify. I did not say that scizophrenia culd not be treated. I said it could not be cured in the conventional sense such as " I once had schizophrenia and now I don,t". (If I am wrong on that then I stand corrected). That is why mental health professionals are reluctant to detain people with schizophrenia who have committed no crime, or attempted to take their own life, (because of the concerns of others however well meant) because it could mean detaining them indefinitely, if say they refused treatment. Various moves to change the law in this regard has been fiercely resisted, and quite rightly in my opinion, by people with schizophrenia themselves.

What distinguishes shizophrenia from the other personality disorders is that it is primarily a disorder of thought. A diagnosis of schizophrenia cannot be made without the first rank symptoms being present, such as audio-halluninations. Other second rank symptoms may include thought blocking, thought broacasting, word salads, the making of neologisms, knights move thinking, among others.

Of course there will be instances when it will be appropriate to detain someone with schizophrenia for short term treatment. However a lot of people with shizophrenia are, after initial assessment, treated in the community with medication. Sometimes people stop taking their medication and come to the attention of the mental health social work teams. The more extreme cases may be detained for 28 days for assessment then released, say with regular visits by a CPN to administer a depot injection.

People with schizophrenia are rarely likely to harm others and are far more likely to hurt themselves and, with appropriate treatment, should not be in detention. There are of course, like most tings in life, exceptions.

Personally I have never come across a person with schizophrenia being refused ICB or DLA in this neck of the woods because of shizophrenia not being classes as a mental illness.

Regards
Paul

I have a submission on this already and can forward it to you if you provide e-mail address. (From memory) it argues that PD's are designated as mental disabilities under mental health legislation (1983 act) and refers to hospitals that treat PD's and consultation documents. It is a few years out of date, but might be useful.

Client in this case was severly disturbed and we had a lot of supportive evidence from GP, probation and others, which obviously helped a lot.

Have another one now, with no supportive evidence, and am really stuck! (Not having to deal with "not menatlly disabled" argument though, just diffcult in terms of showing how behaviour is affected by condition).