Incontinence and PIP Activities 9 & 11

Hey folks,
Helping a client with an MR who suffers from severe bowel incontinence due to Ulcerative Colitis. I was wondering if anybody has any tips or knows some case law that may help when dealing with the above activities?

Client currently doesn’t go out and cannot bare the thought of socialising due to the frequency and immanency of her accidents.

Thanks

EDIT: I mean’t activity 11 but originally put 12. Sorry about that

I think it worthwhile considering whether Activity 9 is applicable here at all unless it can be proven that the unwillingness, reluctance or inability to go out is caused specifically by “psychological distress” which means distress related to a (recognised or at least acknowledged if not diagnosed) and enduring mental health condition or an intellectual or cognitive impairment…....so, apart from the (completely understandable) “embarrassment” of leaving the house (presumably because other people will generally be around to witness your client’s discomfort/predicament etc, it is unclear if your client would be prevented from social enagagement as defined in CSPIP/208/2019.

Even if it were a diagnosed MH issue, it is arguably not the act of engagement (or the thought of the engagement itself) which prevents him engaging as such…it is his incontinence and all that goes with it.

As for Activity 12, I am not convinced it can apply here at all as Activity 12 is related to a physical ability to move around…...Activity 11 may of course consider psychological distress in a broadly similar terms to Activity 9 (above) ......so unsure if that helps your case either.

Worth remembering that only 9 (d) (i) mentions overwhelming psychological distress, but I agree that it is the engagement that is being tested not the ability to go and about generally.  Engagement is defined as interacting in a contextually and socially appropriate manner, so could apply depending on the facts of the case?

I don’t strictly disagree with Peter and Helen, but I do take a more optimistic view of your client’s prospects of a PIP award.

Certainly for Mobility 1 (not 2) you could argue for difficulties planning for toilet access etc and following in terms of frequency and unpredictability of episodes of incontinence etc. I regularly see 12 points scored here.

As for activity 9, I think you’ll find that the stress that bowel incontinence brings frequently contributes to more general anxiety of meeting people - it would depend on the facts of the case. But again, not uncommon to score points here.

EDIT: One issue I’ve come across a few times is that client’s have been too embarrassed to seek help for the issue - and might not have thought to or been able to afford incontinence pads etc - which often brings significant improvements in quality of life, including enhanced ability to travel, meet people etc. A key factor here might be the severity of incontinence - i.e. where a pad wouldn’t suffice, and in terms of meeting people, not forgetting smell etc.  Other physical issues might also cause issues cleaning themselves after. 

People’s perceptions of themselves and how other people view them can be important in terms of scoring for MH issues. In the words of one of my former clients: “The thought of having shite running out the bottom of your trouser leg” - in a public place - can certainly imagine the overwhelming psychological distress that might cause.

Thanks for the answers,

I foolishly titled it for Activity 12 but as people rightly assumed was looking for advice regarding Activity 11.

I suppose I’m more on the optimistic side too with Va1der so I’ll be certainly making the argument that the anxiety and stress of not knowing when or where they may need the toilet contributes to the anxiety of meeting and engaging people.

Thanks again folks

Certainly don’t see an issue with Mobility 1.

9di is interesting and perhaps not as straightforward as it’s engagement and not just going out and mixing with/passing other people which is being tested. It’s less the fear of engaging with people which is an issue here so much as being seen by anyone at all if an issue occurs. If it’s being seen by anyone that’s the issue then there is an argument that does not qualify as social engagement.