Agororaphobia and the support group

Just in relation to the coping with social engagement descriptor, the following taken from the DWP’s WCA Handbook for healthcare professionals might be useful - ( see http://www.dwp.gov.uk/docs/wca-handbook.pdf ) -

3.5.7 Coping with social engagement (Social Interaction)
Activity 16: Coping with social engagement due to cognitive impairment or mental disorder

Descriptors

CS(a) Engagement in social contact is always precluded due to difficulty relating to others or significant distress experienced by the individual.

CS(b) Engagement in social contact with someone unfamiliar to the claimant is always precluded due to difficulty relating to others or significant distress experienced by the individual.

CS(c) Engagement in social contact with someone unfamiliar to the claimant is not possible for the majority of the time due to difficulty relating to others or significant distress experienced by the individual.

CS(d) None of the above apply.

Scope

This activity is intended to reflect a significant lack of self-confidence in face to face social situations that is greater in its nature and its functional effects than mere shyness or reticence. Those with severe anxiety, autism, psychosis or learning disability may have problems in this area. It reflects levels of anxiety that are much more severe than fleeting moments of anxiety such as any person might experience from time to time.
Issues to consider
• The level of anxiety referred to suggests a specific and overwhelming experience of fear, resulting in physical symptoms or a racing pulse, and often in feelings of impending death such as may occur in a panic attack.
• There must be evidence that the social engagement results in significant distress to the individual. CSa represents almost total social isolation.
• For people with anxiety, panic disorder and agoraphobia there should be supporting evidence that corroborates the severity of the condition, for example, level of medication / psychiatric input.

Activities of daily living

Consider any form of social contact such as:
• Use of public transport
• Shopping
• Talking to neighbours
• Use of phone
• Hobbies and interests
• Social interaction with family

Mental State Examination

The Mental State Examination findings would be expected to reflect severe anxiety or communication problems. Rapport is likely to be poor with lack of eye contact. The claimant may be sweating and finding the consultation difficult. They may be somewhat timid in demeanour at interview. It would seem likely the person would require a companion to attend at the MEC due to the level of anxiety/communication restriction that this descriptor would normally be expected to reflect.

In terms of case law, Judge Williams deals specifically with the coping with social situations descriptor in CE/2373/2009 -

  ‘What is clear from the descriptor ... is that the test of ‘normal activities’ is potentially wide. I agree that the descriptor suggests that the activities to be contemplated are activities of ‘normal’ people, not the previous activities of the claimant. At the same time, the wording of the descriptor suggests that the ‘overwhelming fear or anxiety’ does not have to be experienced in respect of all normal activities. Nor does it have to occur continually to be significant. In this case, for example, the representative asked for consideration to be given to experiences either for ‘a majority of the time’ or ‘frequently’. It is common ground that ‘frequently’ means less than most of the time. It might fall somewhere near the ‘often’ in the ESA50.

  It is a question of fact whether an intermittent reaction at the level stated in the descriptor occurring either in temporal terms or in activity terms (or both) meets the test. For example, someone who is genuinely overwhelmed about the idea of going out - and rarely does so - may not be overwhelmed when making a phone call to a friend or neighbour or answering a call on a phone which (like so many phones now) tells her or him who is calling. It is at least arguable that someone who cannot go out most of the time for this reason meets this descriptor at least at some level even though he or she is prepared to sit at home and telephone. There is a balance to be struck between different social situations. Where there is evidence of significant problems with some social situations, there may be a need to explore a wider range of those situations to make a full judgment of the extent of the limitation.’

See - http://www.administrativeappeals.tribunals.gov.uk/aspx/view.aspx?id=2854

There is also a discussion of activity 16 (19 as it was then) in the decision of the upper tribunal, cited as CE/0191/2010.  The wording of the descriptor has changed slightly but the principles elucidated in CE/0191/2010 and in CE/2373/2009 (as cited by Ken) remain valid.  See attached.