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When mental illness does not fit the Pip activities

 

Jacky Philipson
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Housing and Benefits worker Manchester Mental Health Assertive Outreach Team

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She has a chronic diagnosis of paranoid schizophrenia and has been under secondary mental health care services since 2002. In 2013 she was referred to and remains under the care of the Assertive Outreach Team because of the high risk of disengagement, non-compliance and relapse. She has had several admissions into hospital over the last twenty years and was most recently admitted on 3/5/18 detained under s3 MHA. She currently remains an in-patient with no plans for discharge yet. So clearly she has a severe and enduring mental health diagnosis but I am struggling to fit her needs into the PIP activities. Her self care, diet, ability to cook etc. are fine and do not suffer even during periods of relapse. Her principal symptoms are fixed delusions around her father who speaks to her telepathically and her” job” in a grave yard where she has to “ensure that people are not hell bound”. She disengages with services, is not compliant with medication - usually an anti-psychotic depot -  and these delusions become more and more consuming and she then becomes very isolated although even when she is reasonably stable she has little contact with other people.

She claimed and has been awarded 2 points for mixing with others. However even with an MR if I could manage 8 points on mixing with others and 1 on managing treatment , I still need to scrape another 1. Clearly if the intensive support she received from the mental health services could be defined as “therapy” she would be fine.  She was previously on DLA so I can argue that the medical evidence provided for the DLA claim should be considered otherwise I am at a loss as to how to proceed.. Any suggestions would be very welcome!

     
SamW
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Jacky Philipson - 19 July 2018 05:26 PM

She has a chronic diagnosis of paranoid schizophrenia and has been under secondary mental health care services since 2002. In 2013 she was referred to and remains under the care of the Assertive Outreach Team because of the high risk of disengagement, non-compliance and relapse. She has had several admissions into hospital over the last twenty years and was most recently admitted on 3/5/18 detained under s3 MHA. She currently remains an in-patient with no plans for discharge yet. So clearly she has a severe and enduring mental health diagnosis but I am struggling to fit her needs into the PIP activities. Her self care, diet, ability to cook etc. are fine and do not suffer even during periods of relapse. Her principal symptoms are fixed delusions around her father who speaks to her telepathically and her” job” in a grave yard where she has to “ensure that people are not hell bound”. She disengages with services, is not compliant with medication - usually an anti-psychotic depot -  and these delusions become more and more consuming and she then becomes very isolated although even when she is reasonably stable she has little contact with other people.

She claimed and has been awarded 2 points for mixing with others. However even with an MR if I could manage 8 points on mixing with others and 1 on managing treatment , I still need to scrape another 1. Clearly if the intensive support she received from the mental health services could be defined as “therapy” she would be fine.  She was previously on DLA so I can argue that the medical evidence provided for the DLA claim should be considered otherwise I am at a loss as to how to proceed.. Any suggestions would be very welcome!

If she gets 8 points for mixing with others she’ll get SRDL without needing any points from elsewhere.

I’d maybe look into the decision to place her under section and try and identify what kind of risk they are trying to protect her against and see if you can fit that with the descriptors..

I agree with the general point re. the difficulty of fitting somebody in a situation like hers into the PIP descriptors.

     
Jacky Philipson
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Housing and Benefits worker Manchester Mental Health Assertive Outreach Team

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Hi Sam
Yes sorry mental block on points for SRDL but still would be tricky to argue the 8 points for mixing with others though. Interestingly however I spoke to her new Care Co-ordinator yesterday who described how her self care is actually quite compulsive i.e. she washes repeatedly, can’t touch door handles etc, can’t eat the food in hospital because she hasn’t prepared it herself etc so it does look like I’ve got something to work with after all

     
nevip
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If she gets released on a Community Treatment Order, then that can count as therapy.  I was about to argue this at a tribunal last year when the judge got it in first and told me that they couldn’t see how it was not therapy.  Appeal won in about 10 minutes.

     
Hattie S
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When she does not take her medication, does she dress appropriately? Does she struggle with motivation to dress herself? She could possibly be awarded points for this as well.

Can she manage her own finances? If not she should also get points for this.

There was a recent decision about mental health relating to PIP mobility activity 1 and overwhelming psychological distress, may not be relevant to her but might be worth checking: https://www.rightsnet.org.uk/welfare-rights/news/item/government-confirms-process-for-reviewing-pip-claims-upper-tribunal-decisio

     
Tony.W
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Hello Jackie

I have faced the same problems myself.

The compulsive aspect give you an inroad to washing and dressing as they may need prompting not to wash too often.  This leads to whether they can do it safely, acceptable time period (taking too long).

With budgeting does she deal with mail?  Does she open letters?

The PIP is her opinion of how her health affects her; getting a letter from her psychiatrist is the medical model opinion of her mental health.  The PIP people, invariably, will always go with this opinion.

Hope it helps.

     
Vonny
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stevenmcavoy
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points for requiring a person trained in communication support to help them?

     
Dan Manville
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nevip - 20 July 2018 09:19 AM

If she gets released on a Community Treatment Order, then that can count as therapy.  I was about to argue this at a tribunal last year when the judge got it in first and told me that they couldn’t see how it was not therapy.  Appeal won in about 10 minutes.

I am thinking that would probably stretch to S117 aftercare???

     
nevip
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I would certainly argue that Dan.  And rather forcefully too.

     
Dan Manville
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nevip - 02 August 2018 06:28 PM

I would certainly argue that Dan.  And rather forcefully too.

Thankfully “aftercare” is now defined as:

(a)

meeting a need arising from or related to the person’s mental disorder; and
.

(b)

reducing the risk of a deterioration of the person’s mental condition (and, accordingly, reducing the risk of the person requiring admission to a hospital again for treatment for mental disorder).]”

How well does that sit next to:

“therapy to be undertaken at home which is prescribed or recommended by a—
(a)
registered –
(i)
doctor;
(ii)
nurse; or
(iii)
pharmacist; or
(b)
health professional regulated by the Health Professions Council;”

I wonder. Is a social worker a health profession regulated by HCPC as it’s the social worker who in practice designs the aftercare plan; it should be signed off by the Responsible Clinician though.

      [ Edited: 3 Aug 2018 at 03:45 pm by Dan Manville ]
nevip
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Dan Manville - 03 August 2018 03:40 PM
nevip - 02 August 2018 06:28 PM

I would certainly argue that Dan.  And rather forcefully too.

Thankfully “aftercare” is now defined as:

(a)

meeting a need arising from or related to the person’s mental disorder; and
.

(b)

reducing the risk of a deterioration of the person’s mental condition (and, accordingly, reducing the risk of the person requiring admission to a hospital again for treatment for mental disorder).]”

How well does that sit next to:

“therapy to be undertaken at home which is prescribed or recommended by a—
(a)
registered –
(i)
doctor;
(ii)
nurse; or
(iii)
pharmacist; or
(b)
health professional regulated by the Health Professions Council;”

I wonder. Is a social worker a health profession regulated by HCPC as it’s the social worker who in practice designs the aftercare plan; it should be signed off by the Responsible Clinician though.

All social workers in England must be registered with the HCPC under Article 13B of the Health and Social Work Professions Order 2001.

 

 

     
Dan Manville
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nevip - 03 August 2018 05:38 PM

All social workers in England must be registered with the HCPC under Article 13B of the Health and Social Work Professions Order 2001.

 

as much as I hate to undermine an argument on here…

Even HCPC’s home page makes the distinction between Health Professionals and Social Work Professionals (as did most of the Social Workers in my team when this was mooted a few years back when regulation moved to HCPC from GSCC) and, further, SW regulation will soon pass to Social Work England.

There’s no role for a Responsible Clinician at S117 as there is at S17 (edit: the RC is responsible for any conditions on the CTO; attending for depot, living arrangements etc) so the CTO argument has more weight to it. However, local policies might demand a role for the RC in agreeing an aftercare plan; we’ve just formalised that locally so going forward there’s some weight assuming I can produce the Aftercare Plan.

      [ Edited: 8 Aug 2018 at 10:38 am by Dan Manville ]
ClairemHodgson
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my partner had been an AMHP for years - but was never, and never considered herself to be, a health care professional (and doesn’t now, even though she now works for the NHS ).  A social worker has social work qualifications, not health care qualifications - the fact that s/he might learn a lot about the medical field in question (particularly where s/he is an AMHP) doesn’t make them qualified in health care.