Personal Independence payment for client lacking insight into their own mental health problems

it sounds as though he may have capacity issues as well, from what you say…...

ClairemHodgson - 01 August 2017 05:22 PM

it sounds as though he may have capacity issues as well, from what you say…...

At this point it’s difficult to tell. The doctor’s have not made any reference to lacking capacity and client has not yet been assessed by social services.

Patricia Vespucio - 02 August 2017 09:21 AM

ClairemHodgson - 01 August 2017 05:22 PM

it sounds as though he may have capacity issues as well, from what you say…...

At this point it’s difficult to tell. The doctor’s have not made any reference to lacking capacity and client has not yet been assessed by social services.

 

it’s not for social services to assess a person’s mental capacity, they don’t have the expertise.  it’s for a psychiatrist.

but i’ve read plenty of CoP cases where psych evidence has been to the effect that the person’s mental health issues, which led to their having no insight into their condition and its effect on them, resulted in their not having capacity to decide whatever it was…...

so i’d be inclined to see what the GP has to say about this and whether s/he wants to refer to psych ..... which you’d think they would with something that’s been as long term as it sounds…

Leaving aside the capacity/appointee issues for a minute, I think that you are approaching this the right way. You have got a statement from the sister (main carer) and medical evidence from the doctor that client lacks insight into his problems. Hopefully this will be enough but anymore evidence that you can get is always helpful, particularly if client has previously accessed mental health services and has Care Plans, Risk Assessments, etc., which demonstrate the lack of insight. GP medical records may also be helpful, if not essential.

In these situations I have tended to also write an explanation spelling out the lack of insight, either on the PIP2 itself (but making clear it is me who has written it) or on a covering letter. If the client is refusing to access mental health services and/or take medication a brief explanation of the reasons why should be included (i.e. he doesn’t recognise that there is a problem).

The PIP Assessment Guide is littered with references to claimants potentially under-reporting their problems (as well as over-reporting them) and hopefully a competent HCP will recognise that this is the case. Obviously the sister/another carer/ worker should be encouraged to attend the consultation and spell it all out again.

Beyond that I’m not sure what else you can do until further assessments etc., have been carried out. Sounds to me like you are on the right track.

As there seems to be strong evidence of self neglect here, you could consider contaacting the local authority Safeguarding Adults Board - they should arrange a multi-disciplinary approach to working to help your client.

We do advise that, in general, this should be done with the agreement and consent of the person concerned but in practice, where someone lacks capacity, this might not always be possible.

ClairemHodgson - 02 August 2017 09:38 AM

it’s not for social services to assess a person’s mental capacity, they don’t have the expertise.  it’s for a psychiatrist.

 

In mental health in Wolverhampton a formal capacity assessment would usually be carried out by social services. Clinical staff would only assess capacity in respect to consent to treatment.

edit; other than that Billy’s got it right about medical evidence above. The claim form need not detail his needs if there’s plenty of medical evidence with it. I’d usually ask them to do a paper based assessment rather than a F2F.

Is Leeds ATOS or Capita?

Although distinguished, this might help.

Dan Manville - 02 August 2017 11:28 AM

ClairemHodgson - 02 August 2017 09:38 AM

it’s not for social services to assess a person’s mental capacity, they don’t have the expertise.  it’s for a psychiatrist.

 

In mental health in Wolverhampton a formal capacity assessment would usually be carried out by social services. Clinical staff would only assess capacity in respect to consent to treatment.

edit; other than that Billy’s got it right about medical evidence above. The claim form need not detail his needs if there’s plenty of medical evidence with it. I’d usually ask them to do a paper based assessment rather than a F2F.

Is Leeds ATOS or Capita?

In Leeds Atos, now called Independent Assessment Services, do the PIP assessments.

We’ll find out from his family next week if he has been referred to Safeguarding Adults Board and if not we’ll make the referral.

In the meantime are you saying Dan that we don’t actually complete the activities questions in the PIP2 and just write at the end of the form what we have observed and send it with medical evidence and statement from his sister?

Many thanks

Thank you for all your replies. I should use this forum more often!

Glad you found it helpful Patricia :)

There’s a lot of very knowledgeable and supportive people out there. Please do come back and encourage your colleagues to do the same…

And I agree with Dan and Billy that you can just leave the activities pages of the form blank and send in supporting evidence as to why that is the case. Though your client will still have to sign the form.

ClairemHodgson - 02 August 2017 09:38 AM

Patricia Vespucio - 02 August 2017 09:21 AM

ClairemHodgson - 01 August 2017 05:22 PM

it sounds as though he may have capacity issues as well, from what you say…...

At this point it’s difficult to tell. The doctor’s have not made any reference to lacking capacity and client has not yet been assessed by social services.

 

it’s not for social services to assess a person’s mental capacity, they don’t have the expertise.  it’s for a psychiatrist.

but i’ve read plenty of CoP cases where psych evidence has been to the effect that the person’s mental health issues, which led to their having no insight into their condition and its effect on them, resulted in their not having capacity to decide whatever it was…...

so i’d be inclined to see what the GP has to say about this and whether s/he wants to refer to psych ..... which you’d think they would with something that’s been as long term as it sounds…

I am not an expert in capacity but as I understand it the Mental Capacity Act does not specify which professional has to carry out the assessment does it? In my experience it’s mainly social workers that end up doing it, but it can be any suitable professional can’t it? I have seen OTs and nurses do them before

JAS1 - 02 August 2017 03:27 PM

I am not an expert in capacity but as I understand it the Mental Capacity Act does not specify which professional has to carry out the assessment does it? In my experience it’s mainly social workers that end up doing it, but it can be any suitable professional can’t it? I have seen OTs and nurses do them before

Who should assess capacity?

4.38 The person who assesses an individual’s capacity to make a decision will usually be the person who is directly concerned with the individual at the time the decision needs to be made. This means that different people will be involved in assessing someone’s capacity to make different decisions at different times. For most day-to-day decisions, this will be the person caring for them at the time a decision must be made. For example, a care worker might need to assess if the person can agree to being bathed. Then a district nurse might assess if the person can consent to have a dressing changed.

4.39 For acts of care or treatment (see chapter 6), the assessor must have a ‘reasonable belief’ that the person lacks capacity to agree to the action or decision to be taken (see paragraphs 4.44–4.45 for a description of reasonable belief).

4.40 If a doctor or healthcare professional proposes treatment or an examination, they must assess the person’s capacity to consent. In settings such as a hospital, this can involve the multi-disciplinary team (a team of people from different professional backgrounds who share responsibility for a patient). But ultimately, it is up to the professional responsible for the person’s treatment to make sure that capacity has been assessed.

4.41 For a legal transaction (for example, making a will), a solicitor or legal practitioner must assess the client’s capacity to instruct them. They must assess whether the client has the capacity to satisfy any relevant legal test. In cases of doubt, they should get an opinion from a doctor or other professional expert.

4.42 More complex decisions are likely to need more formal assessments (see paragraph 4.54 below). A professional opinion on the person’s capacity might be necessary. This could be, for example, from a psychiatrist, psychologist, a speech and language therapist, occupational therapist or social worker. But the final decision about a person’s capacity must be made by the person intending to make the decision or carry out the action on behalf of the person who lacks capacity – not the professional, who is there to advise.

4.43 Any assessor should have the skills and ability to communicate effectively with the person (see chapter 3). If necessary, they should get professional help to communicate with the person.

Mental Capacity Act 2005 Code of Practice

Paul_Treloar_AgeUK - 02 August 2017 03:48 PM

4.41 For a legal transaction (for example, making a will), a solicitor or legal practitioner must assess the client’s capacity to instruct them. They must assess whether the client has the capacity to satisfy any relevant legal test. In cases of doubt, they should get an opinion from a doctor or other professional expert.

 

Mental Capacity Act 2005 Code of Practice

this is possibly why i said what i said;  frankly, save in the very obvious situation, i wouldn’t necessarily be able to say whether or not anyone had capacity

and solicitors have been caught out not recognising there was an issue (not that long ago, someone was successfully sued for negligence having settled someone’s PI case some years previously but hadn’t recognised there was a capacity issue.  turned out claimant hadn’t had capacity at the relevant time ....)

and i also always bear in mind that it took a long time for me to realise my mother had lost hers ........looking back afterwards, it was clear, but it wasn’t during the process at all…..

in some situations/decisions, it’s a very low bar (e.g., who has capacity to decide whether or not to consent to sexual intercourse).  but frankly, given what OP said about her client’s issues, and the impact of mental health on that, it’s not that simple - or surely, the GP would already have recognised the point (or should have done!)

ClairemHodgson - 02 August 2017 04:46 PM

, it’s a very low bar (e.g., who has capacity to decide whether or not to consent to sexual intercourse).  but frankly, given what OP said about her client’s issues, and the impact of mental health on that, it’s not that simple - or surely, the GP would already have recognised the point (or should have done!)

Institutionally it is often seen as quite a high bar which can be unhelpful, for instance assessing capacity for appointeeship; the complexity of decision making in some of the benefit transactions I assist my punters with should have the bar at their ankles but there is usually resistance to that, especially where resources might be at stake.

Having spoken to a lot of doctors I wouldn’t be surprised if a GP’s perceived the bar to be quite high which might have coloured their assessment of said client’s capacity.

Dan Manville - 03 August 2017 03:53 PM

Having spoken to a lot of doctors I wouldn’t be surprised if a GPs percevied the bar to be quite high which might have coloured their assessment of said client’s capacity.

is that about them failing to be aware that capacity can differ depending on the complexity of the decisions required/ability to understand the issues/etc?

my example of the low bar (sexual intercourse) can be contrasted nicely with some of the benefits things one has to understand/grapple with ......money issues can be easy, but can be very difficult indeed….