LOOKING FOR ADVOCATES FOR ADVOCACY

Guest Post by Lucy Costa

What does advocacy mean? Advocacy is about speaking or acting on behalf of a disadvantaged person (or group), defending their wishes or rights, and remaining loyal and accountable to them despite pressures to do otherwise. Advocacy is also about changing systems for the better by influencing policy, practices, or laws in ways that will benefit people in our community and protect their rights. It requires commitment, focus, and skillfulness.

Advocacy is about speaking or acting on behalf of a disadvantaged person (or group)… Advocacy is also about changing systems

If you are a person with “lived experience,” a “peer,” or a “consumer” then please understand that this, in and of itself, is not valid enough

Photo: Marchers carrying signs, walking down Queen Street. Text:
Mad Pride Bed Push 2017

criteria to be a good advocate. While your identity and your experiences (especially as related to mental health) matter, they alone are not sufficient to challenge some of the tricky and complex institutional and governmental powers influencing our understanding of psychiatric disability and the distribution of resources (e.g. housing, services).

If you are a person with “lived experience,” a “peer,” or a “consumer” then please understand that this, in and of itself, is not valid enough criteria to be a good advocate.

I start with this controversial point because over and over again, the most popular advocacy “line” people offer at consults, focus groups, proceedings, etc. for ethical dilemmas and problems with the mental health system is to ask whether “peers were included,” or if, “peers gave feedback.”

Lately, I have challenged this knee-jerk response, because it is predicated on an assumption that if “lived experiencers” were involved in complex systemic issues, they would somehow be offering substantive or innovative feedback for change. Sometimes yes, but often no – not without research into a problem, or speaking with people most impacted, or developing relationships with supportive allies.

In fact, sometimes the very problems occurring in the system are reproduced via individuals who identify as “peers” or people with “lived experience.” Sometimes these peers adopt excessively cheerful or optimistic views of healthcare system delivery as opposed to critiquing it.

They contort themselves to accept clinical or policy justifications and in so doing become extensions of the system through their actions, words, and ability to be socially acceptable and conformist. I have seen examples of peer workers counselling hospital patients on their “best interests” as opposed to listening or following a patient’s instructions and hearing what would allow them to feel they have more control over their lives. There are very few advocacy and human rights campaigns being spearheaded by peer labourers though I think there is powerful potential for organising for change if community capacity were prioritized in this direction.

Thankfully, there are however a number of individuals and small organisations doing collaborative and innovative work to improve the lives of people who are on the margins and addressing advocacy issues related to violence, housing etc. There are smart, organized, coordinated and focused efforts that work to change and improve specific problems thanks to thoughtful planning, thorough research, and earnest selflessness.

We need more strategies like this which are focused on understanding how the system makes economic and policy decisions and directions. It would be great if younger activists and individuals interested in advocacy would create support groups looking at how to better understand the system, what ethical principles we should collectively adopt going forward, and more importantly how to meaningfully evaluate what has worked and not worked in the past for us – by us.

…create support groups looking at how to better understand the system, what ethical principles we should collectively adopt going forward, and more importantly how to meaningfully evaluate what has worked and not worked in the past for us – by us.

I also suggest that our community develop an extremely inquisitive appetite for scrutinizing anything that sounds like “inclusion.” The system knows it is supposed to be “inclusive” – that is not news to people in power, but what kind of inclusion is happening? We consumer/survivors advocated for inclusion years ago, and now we (to some degree) have it, but at what cost, and what kinds of identity and ideas are being included? An advocacy issue that currently needs attention is the Ontario government’s recently passed Bill 41, also known as the Patients First Act on December 7th, 2016.

This Patients First Act aims to ensure patients are at the centre of the health care system. Are there any consumer/survivor groups organising around this? Probably not. Who will monitor advocacy and the new discussions about accountability in a changing landscape within healthcare? The Psychiatric Patient Advocate Office, which is no longer at arm’s length from the Ministry of Health, is going through re-evaluation of its services to better align itself with Ministry initiatives such as the Patients First Act. What will this mean?

If we are to re-invigorate a movement that believes in justice, advocacy, and the protection of rights, we need a new approach that understands that while some gains have been made, there are many other losses we have not even begun to process—let alone respond to intelligently. The landscape of advocacy is changing and the fire of the past has dwindled.

We have fewer advocates. This is true amongst different groups and social movements looking for change.

The pendulum has definitely swung in disturbing directions, but it will swing back. In the meantime, we must be more aware of the losses of certain rights and be more resolute in our efforts to critique “inclusion,” especially the ways it has been used by neoliberal agendas that expend with both advocacy and individuals who cannot thrive in capitalism.

Written by Lucy Costa

This article was originally published on Toronto Mad Pride  http://www.torontomadpride.com/article/looking-for-advocates-for-advocacy/

Stepford Recovery College

Where Alternative Facts are Not Just for Americans

rc-cover

Dontcha wanna learn how to jump while wearing super colourful clothes?

 

 

Turning Binners into Winners since 2015
 

Introduction

Welcome, and congratulations on taking this brave first step towards your recovery.

Your Future Starts Here! We’ve made a college just for Mentals: prepare to be patronised! You can pretend you are going to college just like the Normals!

RC’s are really universities, with campuses, curriculums and graduation ceremonies. Thankfully you don’t have any student debt and no certificate of any value. (Try presenting your ‘Finding Happiness’ course attendance to UCAS.) You’ll meet the Mayor at your faux-graduation; we don’t mind if you wear mortar boards and take photos. Alongside your studies you will find many vocational opportunities and get invaluable, real life experience for your future zero-hours career and destitution by volunteering for us and providing unpaid peer support.

Take charge of your mental health! Challenge those self-defeating beliefs! You too can recover! (And if you don’t it is your fault and you can’t say we didn’t try to help you).

We provide the classroom, set the schedule, define the time limits – all you need to do is comply.  We have pictures with uplifting words on them like “HOPE” and “EMPOWERMENT”. Our fast-paced, shallow and fully self-contained courses have been designed to leave no need for further reading, questioning or dissent.

Our curriculum is brought to you with a total lack of evidence base – in the age of austerity we no longer need an evidence base, we just need to cut costs and get you pesky Mentals off our books. We can guarantee a 100% success rate – as long as you don’t ask to see the RCT’s. You will find many opportunities on your recovery journey to share your talents widely and publicly with Non-Mentals. This may involve art exhibitions, drama productions, or musical numbers. Unfortunately as funding is tight we can’t pay you. By knowing that you have challenged stigma and provoked discussion among regular folk you will be more than satisfied without need for monetary reward. Please don’t think of this as exploitation, you are giving back after years of receiving.  Recovery College is the alternative to actual support and SO MUCH CHEAPER. We have the technology, we can instruct you on how to recover in twelve easy sessions. No, wait – the funding has been slashed. Six. Yes, as long as you’re committed you can recover in six. Well, perhaps you don’t really want to get better.

Choose acceptance. Choose compliance. Choose someone else’s perfect life. Choose to recover. Choose it NOW.

We take pride in helping you learn that, quite frankly, you do not matter. Your life does not matter. Your experiences do not matter (unless they conform to our stereotypes and help fill our classrooms and coffers). We specialise in breaking your spirit and making you a willing slave to neoliberalism, and importantly, not bloody moan about it (or it’s off back to happiness class for you!)  We’ll blame your mental distress on you. YOU just have to DO BETTER.

Recovery is an individual journey with unique personal meaning. We will tell you which way to go and what it means, and how long you’re allowed to take.

There are so many opportunities for you at Recovery College: Become self-determining and self-reliant by joining our synchronised self-harming and sewing yourself-up group!  Mindful medication-taking – you too could learn the ancient art of accepting a depot up your bum! Straightjacket hindering your recovery? Why not join our colouring in with your mouth classes? Only biddable Mentals need apply. Mentals who think and ask questions don’t have sufficient INSIGHT for Recovery College and anyway you’d screw up our outcomes.

I will end this introduction with an inspiring quote from a DWP assessor:

“What’s that? Did you attend Recovery College?” *removes PIP*

 

Courses

Special Introductory Course in Form Filling  

Before we even get to any mindful shenanigans you will learn the art of the outcome measure so that we can demonstrate outcomes and get paid in full. You get bugger all. Though maybe it’s mindful form filling.

Access to Work

On this course you will learn to love zero hour contracts, no job security and no sick pay. You too have the RIGHT to work.

Finding Happiness

Lost your happiness? Join our happiness location course. FREE colour it yourself map on course completion’. Sign up for a happy, healthy new you. We will teach you to laugh in the face of poverty, oppression and abuse. (Prohibited topics: poverty, welfare, shit working conditions and JCP bullying, food banks, discrimination).

Learn to sing this! https://www.youtube.com/watch?v=gLaToGfEaOg *Anti-emetics will be provided*

Equality for All

Are you failing to reach your full potential? Underpaid? Unpaid? Verging on destitute despite working for us? We have just the course for you: ‘Equality For All’ (Staff only, service users excluded).

Mindfulness

Bored of your regular toolkit of hammer and screwdriver? WE CAN EQUIP YOU WITH AN EMOTIONAL TOOLKIT to keep in your mindfulness toolbox. Mindfulness is proven to help you silently, repeatedly, re-experience all that long-repressed trauma. (Bring your own raisins.)

Activation Therapy

Learn how every action (walking, breathing, shitting) can be a therapy! It’s simple: just add therapy on the end and we have walking therapy, breathing therapy and shitting therapy. (Note: this therapy is not to be performed with words such as ‘smashy’ or ‘murder’.)

DSM 5 Class

Learn all about your psychiatric diagnoses and pretend it’s not a medical model. You will also learn to stop fighting your psychiatric diagnosis and just be it (whilst pretending to be recovered because it’s medical dx with recovery wrapped around it #ReBrand).

Recovery Porn

Join us for our inspirational class ‘Writing Your Recovery Narrative’ and see your life story used fee-free in our promotional literature to help us obtain more NHS contracts. When you recover you can come back and tell your story, thus joining the recovery porn industry. One student said of this course:

“Finally, I understood I had an mental illness and some of us have a genetic predisposition and I learned that I could recover by challenging my distorted thinking patterns and being mindful and distracting myself and ignoring the obvious bullshit inherent in these explanations and by ignoring anything that happened to me in the past because that makes MH staff look all awkward and cross with me and the staff were all really supportive and I think I’m ready to get a job now and maybe become a peer supporter because I’d like to help people like me who have a mental illness that just happens because they are a bit genetically broken to learn that their recovery lies in their own hands and not to think about this too much because it’s proper science and everything. Is that ok? Did I do well?”

In this class you will also learn how to look down on and judge fellow Mentals who fail to recover.

Gratitude Class

Learn how to be thankful for all psychiatric staff, and to reward them with good behaviour. Gain joy from fulfilling what you never before knew was your true role, because to feel joy when incarcerated for six months against your will is truly the first step in your recovery. You didn’t need that job, or that husband or home, because what you found by being denied human rights is how damn thankful you are to the psychiatric system for saving you.

Modified Behavioural Modification

Learn to desensitize yourself with modified behavioural modification and psycho-mechanism-schemata, where no one is responsible for the others’ emotions, and with strict boundaries of total lack of response to anyone who is upset. Learn about your limbic system and Inner Chimp. Learn to TAKE CONTROL and completely ignore the world around you (cos it’s all about your shit).  Learn to take control and personal responsibility for those things over which you have no control and are not responsible for.

Wank Your Way out of Sexual Dysfunction

Drug-induced impotence? Develop a more resilient wrist so you can wank for longer. You will come if you have hope, and a stronger wrist.

When to Call the Crisis Team

You will learn everything you have ever needed to know about how to engage with this elusive, nay, mythical mental health service. Hint: the answer to the title of this course is ‘never’. Advanced lesson: join us for our extra short 1 minute course on ‘How the Crisis Team Can Help You’.

How to Budget Successfully whilst Destitute

This course includes the award-winning class on ‘How to Make Delicious Milkshakes from Medication-Induced Lactation’.

Patronisation for Beginners

Have your photo taken for our brochure for an Inspiration Photo. NB: Only photos of Mentals who conform to western attractiveness ideals will be printed in brochures.

Special Guest Lecture from a Famous Mental

Topic: ‘How to be Successful and Mental’. Special lecture by rich, outgoing, ex-mental person who has been to university and never set foot in a Recovery College in her life. She works hard for her money *despite* being mental.

Lying on Your CV

Learn how to explain hospitalisations, extended unemployment, psychiatric meltdowns and the odd arrest for your own safety in ways that will sound attractive to any employer.

How to Gloss over Socioeconomic Oppression as the Root Cause of your Mental Distress

Tutor: a middle class theorist/academic with no lived experience.

Other Courses Include:

How to Be a Better Jesus

Work Will Set You Free is now rebranded as: Work for Wellbeing and Be Too Exhausted to be Depressed

Nipple Tassel Dancing for Recovery

How to Be Assertive but Not Too Assertive – we would still like to control you

Sleep Hygiene for Filthy Insomniacs

 

 

 

Coproduction

Learn the art of quashing service user dissent. Get paid less as a peer trainer than professionals teaching with you being treated equally – you’re giving back and contributing, you know.  Increase your skills and confidence through helping us co produce our courses – we would particularly like to hear from service users who would like to obtain advanced skills in ‘sit down and just shut the fuck up’. ‘Peer’ co-pro means we look great plus we’ll give u a service if you’re good. In the Netherlands peers are called “folding chair clients”. When needed, take 1 from storage, fold them out, and then back into storage.

Coming Soon: Recovery College Student Loans. Be in debt like a Normal! Please note Recovery College Student Loans will eventually come into place following the phasing out of all sickness and disability benefits. You might not value your recovery if you got it for free. We’re being kind. Really. We think. With interest rates this low (19.9%APR Terms and Conditions apply) you’d be mad not to!

Outcomes (also known as hidden agenda)

The required outcomes are: not using services; bugger off somewhere else, anywhere. To be viewed as properly recovered: go to a real university or get a job (any will do).

Job Opportunities

On successful completion of your studies you will be invited to join us in a paid or unpaid role as a peer support worker, peer buddy, or co-trainer. Earn less than your professional colleagues (but it’s better than zero hrs in a supermarket).  Earn less than the professionals because you might be equal under employment law but no matter how ‘recovered’ we say you are, you are still mental and will never be worth as much to the college as us.

Remember kids: Recovery is the new black.

Recommended Reading in Preparation of your Studies:

Ruby Wax

Stephen Fry

“Recovery has always only ever been an empty word that refers to whatever agenda or ideology anyone chooses.” Robert Dellar

 

© 2017 Recovery in the Bin, All Rights Reserved

Handy Guide for Crisis Team Workers

Times when it is appropriate to suggest a service user has a bath:

  • When service user is stinky
  • When service user has joint or muscle pain
  • When service user has a new rubber duck or submarine toy they want to try out

Times when it is appropriate to suggest service user has a nice cup of tea:

  • When service user is thirsty
  • when the service user wishes to throw tea at you
  • when service user has a surfeit of biscuits that need dunking. (Please note, in the interests of safeguiding we offer the following link to avoid the “drop off” http://news.bbc.co.uk/1/hi/sci/tech/220400.stm)

Most mentals can count, if you tell them you will ring them back in a set number of hours, despite being mentals, they might notice if you don’t .

2 min of speed talking support  is generally not considered an adequate amount of phone support time. It suggests mania on the part of the crisis team worker.

Try not to audibly sigh when you pick up the phone to one of those pesky mentals who insists on feeling desperately suicidal more than once in their lives.

Don’t run your colleague over when picking up a mental to take to hospital (advice based on experience of this happening…)

A choice is only a choice if someone can see that there are multiple, better, options to choose from. Abdicating any professionalism or responsibility in your paid role of supporting the most desperate by suggesting that, to you, ending their life is about as important as deciding whether to have cornflakes or shreddies is not at all helpful or empathetic. If you are so jaded / behind with your paperwork / bored of all those people phoning you about the same old thing, that you are unable to assist the person to see and achieve viable alternatives please try really really hard to reimagine the person on the other end of the phone as a unique human being every bit as important and worthwhile as you and yours. If this is too hard for you please consider an alternative career asap, I have heard the DWP are recruiting.

Replace “It is your choice if you want to die” with “Would you feel better if you punched me hard enough to bloody my nose right now?” This is a phrase that may actually make your patient feel better.

“Dear crisis team…why do you tell us ‘it’s our choice’ when we call and say we are suicidal. Do you think that we have somehow lost our capacity to understand the nature of free will?”

Please note that most callers have been assured that “help is there” and so are phoning to access said help. Being told one must “take responsibility” negates all previous and potential offers of “help”. (“they think that is helping us – it’s helping us understand adult roles and encouraging our independence”)

Don’t suggest gardening as a relaxation activity if:

  • the caller lives in a flat with no garden.
  • Or hates gardening.
  • Or has bodies buried in said garden.
  • Or is phobic of garden things.
  • Or if the person is a gardener for a living.

“ I once got told to take my dog for a walk. At 2am. When I lived in a dodgyish part of town. And I didn’t have a dog. Oh and was terrified of dogs.”

Suggesting callers distract themselves by watching daytime TV can increase suicidal ideation (have you SEEN the crap that’s on?!!).  Instead, suggest throwing television through a plate glass window, or remodelling it with a baseball bat.  “I once got told by a consultant psych to ‘go home and watch more tv’. Think I waited about 6 months for that appointment.”

Unless the Crisis Team have team uniforms like the Power Rangers they are not a real team.

Daily meds drop off does not constitute crisis care. That is Med FedEx.

“I’d like a computer crisis plan. Cake Crisis Intervention would also work”

Spell crisis Krysis, it’s fun and will distract you.

No one has yet suggested ‘mindfulness lego’. Lego could bring out a special range of undemanding kits that make – well, something soothing.

Get clients to sign up for a monthly care package, then once a month just post them a bin bag of junk you cleared out that even the charity shop rejected.

Do not suggest colouring in unless you are speaking to a child. If you are speaking to a child they have the wrong number.

We understand the government are fucking you over too, don’t take it out on us. And if you do take it out on us, don’t be surprised if we respond by asking if you’d consider taking a bath.

Don’t ask service users if they are “having thoughts” because to answer means having one.

To save time offer an automated phone service with options for dx and activity. (see http://rebot.me/april-61*)

If your attitude towards other humans would make you a good bouncer of a rough hartlepool nightclub….then maybe thats where you should work?

Stop telling us that refusing to help us is for our own empowerment and recovery …

If someone is suicidal/has attempted suicide, don’t try and scare them out of completing by telling them how awful “the other side” might be (actually happened to me)

“Yes, have had all off the above, including been told to find Jesus. Telling them I have already found him in the bath you will tell me to have, and we are painting the walls with our nipples, didn’t go down very well. Neither did telling the crisis worker it was their bath we were in.”

It is just a matter of time until the crisis line has call waiting muzak such as ‘Jump’ by Van Halen and ‘Loser’ by Beck, etc

Do not tell us our ‘serotonin module is broken’.

When advising suicidal people to ‘go and sit on the beach’ please check that the beach is not located under a 100 foot cliff.

If Jim calls late friday night feeling suicidal and desperate, do not ring jim on saturday morning pretending to be mary poppins and start the conversation, ‘so how is jim today?’ You are not a primary teacher and you have not listened to jim.

“we have a crisis/htt and a ‘crisis line’ the only thing the crisis line can do is call an ambulance for you. There is one woman on the line who gets angry if you say you want to hurt yourself, and tells you quitters don’t win and winners don’t quit. Yeah, uh, thanks for that.”

Maybe don’t say “who gave you this number. Don’t call this number” ( that’s when the number is even given or available, otherwise it’s covered by the Official Secrets Act or the answerphone is on”)

Please understand the double bind you put suicidal people in when you tell them they are attention seeking

You can’t spell crisis without ISIS. Suspicious eh?

I used to work in a crisis team and I loved it but a) the tories happened and shagged everything up and b) it demonstrated so clearly that there is *nothing* (apart from driving out with meds or arranging MHA assessment) crisis team can really do. There’s not enough time to properly spend with people, the shift pattern means you can’t work consistently with people to do anything genuinely useful. It all becomes an unsatisfactory stopgap. Again this is the NHS insisting they’ve got the answer and they’ve got nothing…”

 

Useful advice for service users

Show that you are putting in some effort and taking responsibility by having a crisis only during scheduled hours and not for too long. And then recover, so we look good.  “I once ‘phoned the out of hours crisis team in distress only to be told that there was no one there who could help and could I ‘phone back in the morning after 9am. I informed them that ok I would try to have a breakdown then instead then and slammed the ‘phone down.”

You’re crisis is simply too urgent to be called a crisis, we’ve upgraded you to complex needs, god will help you now, if you just didn’t have that 666 tattoo we could have helped.

“distress tolerance techniques” (never mind dealing with the cause of distress, tolerate it better!)

*Crisis bot courtesy of Mind our Minds https://mindourminds.wordpress.com/

RITB Welfare Training Oct/Nov 2016 part 4

Two further days of training were organised by Recovery in the Bin so that members could benefit from learning about challenging PIP and ESA decisions. RITB were very fortunate that Tom Messere agreed to deliver this training. Tom is a benefits expert, active adviser, trainer and the author of the Big Book of Benefits, revising this on an annual basis from the material created by his late wife the supreme welfare rights specialist Judy Stenger.
The aim of the two days was to increase the knowledge and confidence of members, most of whom had attended the first training event, in supporting peers in not only getting ready for applying for PIP and ESA but for challenging wrong decisions by the Department of Work and Pensions (DWP). Three of the eight participants had personal, current, experience of challenging a decision, one had recently been through a tribunal for PIP.
Tom started by giving a recap of the learning from the first training event which had covered in detail the barriers to claiming, the jargon used within the benefits system, the three steps to maximising entitlement and the difficulties experienced by those with mental health issues whose needs may not be understood or visible to decision makers.
The appeals system is run independently of DWP decision making and the chances of reversing benefits decisions on appeal are statistically high. In the case of PIP there is an overall success rate of 64% for claimants overturning original decisions to refuse or award a lower amount of benefit than was due. The chances of winning an appeal rise to 95% where the claimant has representation or support at the tribunal. There has been a recent consultation about the appeals system which suggests changes to the process behind independent tribunals. We await the outcome of this consultation with fear that claimants may be shortchanged and prevented from obtaining justice.
There are ongoing welfare reforms which amount to cuts to the social security budget. Several of these reforms are years behind schedule. Some claimants of sickness benefits are still waiting to be migrated to ESA and will remain on Incapacity Benefit or Income Support until this happens. The timetable set originally for the transfer to Universal Credit was that all claimants would move to UC between April 2014 and October 2017. This migration to UC has stalled and the roll out has so far only happened in most areas to ‘simple’ claims for single jobseekers. However, there are several parts of the country where all new claimants enter UC and the aspiration is that over the coming years that the coverage of UC will be extended. The migration in the case of UC amounts to an administrative changeover rather than a reassessment for benefit. However, many claimants will be worse off under UC given the loss of disability premiums, which is one of the social security cuts designed to raise in excess of £3 billion.
The ‘migration’ to PIP is on track again and all claimants, including those with indefinite awards of DLA, will be contacted before the end of October 2017 with their ‘invitation’ to claim this benefit. The change signifies the end of working age DLA. Whereas there is some protection in the case of ESA and UC to ensure that claimants don’t lose out financially, this doesn’t apply at all to PIP which is a different benefit with different criteria from DLA. Claiming PIP means in effect that the claimant’s disability is looked at afresh with no reference to their history and files for DLA.
ESA in brief
There are two kinds of ESA, one is means-tested which is calculated based on savings and income coming into the claimant and their household. Where a claimant has a partner then they will be assessed jointly, any children will also be part of the claim. Contribution based ESA is awarded where there are sufficient National Insurance contributions and means are not taken into account unless there is a claim for an element of income related ESA to top up the benefit to bring the award to a level the claimant is expected to live on. Contribution based ESA will remain outside of UC while income related ESA will be absorbed into UC using the same test of work capability. Payment of contribution based ESA is limited to one year unless the claimant is placed in the support group. New claimants of both types of ESA have a 13 week assessment period before they are allocated to the support or work related group. The test for this selection usually involves a face to face work capability assessment by a medical assessor working for a private provider appointed by the DWP (usually Maximus). Income related ESA can be paid indefinitely as long as the claimant continues to satisfy the criteria and ‘passes’ any reassessments of their award. However, a change coming in April 2017 is that claimants placed in the WRAG of ESA will not receive any payment for this component which is worth £29.05 per week. New claimants will receive the same level of benefit as jobseekers even though they require support to prepare to return to work due to their health condition.
There are linking rules with ESA so that if a claimant decides to start paid work for 16 or more hours per week they have 12 weeks in which to return to their ESA claim. If the claimant falls ill and needs to stop work after this 12 week period then they will need to make a completely new claim for ESA with the 13 weeks’ wait for assessment while on a basic rate of benefit. They will also be affected by the cut to the WRAG component if, after April 2017 , they are later selected for this rather than the support group. Participants on the course expressed a real concern for claimants who try out work only to find themselves in an endless cycle of reassessment when they are not able to hold down jobs.
Claimants on ESA can do permitted work of up to 16 hours, earning no more than £115 per week, and it may be advisable that they try this route to employment rather than coming off ESA and finding they need to be completely reassessed if work breaks down after 12 weeks. Those claimants on the support component can do permitted work for an indefinite period. While support group claimants are not mandated to get involved in work related activity they can volunteer to do so. These claimants may want to make sure that their permitted work does not contradict the reasons why they are claiming ESA and if managing to work without support or concessions it may be argued when it comes to any benefits review that they are fit for work. Individual advice should be sought by each claimant and the DWP will need to be notified about their starting this permitted work and its nature.
Part-time work under threat
One of the participants expressed fear for part-time workers who may receive working tax credits as a disabled worker but lose this status where turned down for PIP. There will be an expectation once on UC that the claimant will look to increase their hours to full-time, ie 30 hours rather than staying with part-time work eg 16 hours unless able to prove that this is all they can do due to their health condition. The work capability test used for ESA may be applied to these cases since it remains the same in UC for those both in and out of work. RITB members also expressed disillusionment and frustration with disability charities which seem to be working with the government to endorse reforms rather than campaigning against cuts which threaten the security of part-time workers.
There was discussion throughout the day about the bias against mental health in the benefits system. A RITB member on the course had recently been turned down for PIP and the decision twice mentioned the way she was not receiving ‘regular specialist input.’ It was agreed that mental health services were now firefighting and it was rare for them to keep service users on for long periods. The DWP decision makers don’t seem to grasp the way that mental health services are discharging vast numbers of patients, unless they have section 117 aftercare protection against this action. In contrast a claimant with a physical disability may be under a hospital specialist for years even though seen rarely. While PIP is meant to be a benefit paid to those in work it was questioned whether working could go against the claimant even though they may need additional support in order to carry out their working duties.
Getting PIP
In a similar way to ESA, PIP is worked using a points system. Many mental health claimants are refused PIP even where they had long-term DLA awards on the grounds of needing supervision. Each activity within PIP is scored based on the claimant’s difficulties in completing that task. Some claimants previously on low level care of DLA are finding that they can obtain the standard rate of PIP as their points accrue when not being able to do a particular activity at their worst time of day. The most significant overall cut in awards has been to those receiving the mobility component. The introduction of PIP was planned based on a 26% cut in the amount spent on working age disability benefits. 29% of claimants should receive more out of PIP than they did on DLA, 29% of claimants will receive a lower award, 26% of claimants will receive nothing from PIP and only 16% of awards will stay at the same financial level. There is no transitional protection except for a four week run on in payment before DLA ends. PIP can’t be paid during any appeal.
There has been a mixed experience of PIP medical assessments among claimants and the success rate of PIP appeals is high. If a claimant is turned down for PIP they have 28 days to request a mandatory reconsideration – which is benefits jargon for a ‘review or revision’ of the decision. Once the claimant receives the mandatory reconsideration notice they can appeal against this decision.

Appeals

There was a discussion about sanctions and Tom encouraged any affected claimant to appeal since over half of sanctions (for ESA WRAG and JSA) are overturned. There was agreement among participants that sanctions could be cruel to mental health claimants who may have difficulties with timekeeping due to their health issues but find themselves sanctioned. It appears that job centres may have targets for sanctions and staff will knowingly apply sanctions to vulnerable people.
Participants asked Tom if he could do a flow chart of the route to follow if turned down for a decision. This would go in either of two directions – a decision could be challenged in one month and end in a revision. If the claimant remains unhappy with the decision then they could appeal within one month. This appeal could lead to a better decision for the claimant given the good rates of success at appeal tribunals. The other branch of this diagram was supersession which is explained later in these notes. Tom made clear that he wasn’t expecting participants to become advisers or to represent eachother at appeals, but to offer support to peers while working with a benefits adviser, eg Citizens Advice volunteer or case worker. Many local Citizens Advice offices are willing to write submissions for clients even if they do not have the capacity to accompany them to tribunals.

Hard decisions

There was a discussion around benefits decisions and how these are always legally binding and in writing. The time limit for challenging a decision is usually one month. Claimants should aim to keep within the time limit wherever possible, even if not sure of their challenge they could write two lines and submit this before the deadline eg ‘I disagree with the decision and I will be sending further details shortly.’ Challenging a decision can be done over the phone but preferably should be followed up in writing.
Bad decisions about entitlement to benefits do happen throughout the system and do so more often with sickness and disability benefits. While the mandatory reconsideration is the first step to challenging the decision only 15% of these are successful for the claimant. In the past there has been confusion by DWP phone operators about the advice they should give to claimants turned down for benefits, in some cases they have discouraged claimants not to appeal or not told them about asking for a mandatory reconsideration. The DWP has issued a memo to staff in order to improve the information given out to claimants so that they know their rights around challenging a decision. The message was not to be deterred from asking for a mandatory reconsideration and then appealing.
Most decisions in the DWP administered benefits system are appealable except for those which are procedural such as how the DWP will pay you. Any benefits decision can be revised. Local authorities each have their own rules for challenging decisions against council tax benefit and local welfare assistance.
In all cases where asking for the decision to be looked at again or appealing the decision, the claimant should seek advice and think carefully about the implications. The DWP can revise the award downwards or remove it entirely as well as keeping it the same or increasing it.
Decisions about benefits entitlement are made by the Secretary of State who delegates powers to decision makers working within the DWP. In the case of Tax Credits, the board of HMRC gives delegated authority to decision makers working for HMRC. Local authorities use benefits officers to rule on council tax and housing benefit decisions.

There are three ways of challenging a decision for the claimant

1) Mandatory reconsideration/revision
This can be done on any grounds whatsoever. The time limit is one month though this can be extended in some cases for up to 13 months where there are valid, recognised reasons for late submission eg being in hospital at the time of the decision notice. The mandatory reconsideration is usually completed within 4-6 weeks. 15% of decisions are changed. The next step would be appealing within the time limit of one month.

2) Supersession
A supersession can be requested at any time but only on certain grounds. Supersessions are relevant only where someone is already receiving benefit. Any award made would result in arrears being paid from the date the supersession was requested eg the change of circumstances was reported. A claimant can go to a mandatory reconsideration if not satisfied with the outcome, there is usually one month in which to do this.

3) Appeals
Independent tribunals hear appeals and will take a fresh look at the claim presented to them. Tom was positive about appeal tribunals and said that these may offer the first experience of the claimant feeling that they are heard and their evidence has been taken seriously. The tribunal will want to hear an account from the claimant, eg their typical day and the activities they have difficulty with. It is possible to withdraw an appeal at any time or to not turn up for the hearing leaving the panel to make a decision on paper. Oral hearings are far more likely to succeed than paper based hearings. Having someone with you, ideally a support worker or adviser, increases your chance of a successful hearing and while not speaking for the claimant they can share their knowledge which may flag up difficulties the claimant doesn’t think to mention. Parents are often crucial to appeals against refusals of benefit for their children as they can explain their caring routines.
A decision maker and the tribunal do not have to take into account any matter not specifically raised by the claimant.
Complaints about assessments
A participant asked if it was worth complaining about their Atos assessment which appears to have been preferred by the DWP over their own evidence. The assessment had felt wrong at the time and the conclusions drawn were wrong, including the way she had attended alone whereas she was with a friend at the medical. Tom thought that while Atos may not resolve a complaint to the satisfaction of the claimant, a tribunal would be interested in seeing the complaint letter and using it in their own weighing up of evidence. Tom encourages claimants to make notes after their experience of a medical, eg how long they were in the room for and what went on. Any inconsistencies or inaccuracies shown in the medical report could be highlighted to a tribunal. Medicals can be recorded but claimants would need to let the medical provider know in advance that they intended to do this. The provider would need an identical recording to that made by the claimant. It is advisable that the claimant would seek audio recording equipment (cds or tapes or two Dictaphones) if they are wanting to take this course of action as sometimes the provider will not be able to find the equipment on the day of the medical. A phone app wouldn’t be suitable since it can’t generate the recording to give to the provider. A RITB member offered to look up sound recording equipment and come back to the group with suggestions which comply with requirements. He has previously found tape recorders on ebay.

Supporting each other with appeals and full entitlement

One of the participants was concerned about a friend who had been turned down for PIP seemingly due to a lack of specialist medical evidence. She asked how she and others could encourage vulnerable people to appeal decisions when they may otherwise accept them or give in. Tom’s advice was to work with claimants on a step by step approach, introducing the idea of a mandatory reconsideration and working through each part of the journey with them. The claimant can withdraw at any time though should be made aware of the further they go in the process the more likely they are to be successful. Many claimants may find appeals intimidating since these can be heard in various buildings including a crown court. However, Tom explained that the tribunal tries to be as informal as possible while in a formal meeting. The tribunal values the claimant’s evidence in a way that they may not have experienced up to that point.
There was discussion throughout the day about the political climate and discourse about claimants as scroungers. The reality is that fraud in the benefits system amounts to 0.3%. The majority of welfare spend is on state pensions. There is a high amount of unclaimed benefits with estimates of around 40-70%. Claimants may be entitled to ‘any time revisions’ where the DWP accept there are grounds such as official errors, any money due can be claimed back for a period of up to 6 years. Claimants on ESA should check that they are getting the severe disability premium where they are in the support group since this may have been overlooked.
Where a tribunal awarded PIP then any award should apply to other benefits missed out on due to the first decision. This would include disability premiums within ESA and the claimant should notify their benefits office of this entitlement and arrears owing. If a claimant is already on income related ESA it is straightforward for arrears to be paid once the ESA section of the DWP is made aware. However, if ESA wasn’t in payment during the appeal time then retrospective backdating may be limited to three months. It is advisable that the claimant applies for ESA within 10 days of challenging the PIP decision. The ESA may be refused to begin with. However, a new claim for ESA could be made following the tribunal decision pointing out the date of the previous claim. Advice should be sought on this in order to protect the severe disability premium.
What to expect at a tribunal
Tribunals are independent and work outside of the DWP. You can apply for your case to be considered by a tribunal by completing form SSCS1 which goes to the Courts and Tribunals Service. The appeal needs to be in writing. If you are not using this form then you should ensure that you include all of the details that this form requires are submitted. A copy of the mandatory reconsideration notice should be included. The grounds for the appeal should be set out, for instance that you don’t think enough attention was given by the decision maker as to whether you could do activities reliably. You can also state the outcome that you are looking for, eg an award of PIP at the enhanced rate of care or ESA support group. It is advisable to send as much evidence as possible, this can come from friends and carers as well as health professionals.
At the ‘first tier tribunal’ there is usually a judge who is the legally qualified person on the tribunal, judges tend to be trained solicitors. The judge does not wear robes. There is a medical person, usually a GP who has knowledge of medical issues. The other tribunal member may either be a carer or a person with a disability. The tribunal tries to make a decision unanimously or goes to a majority verdict. The decision is made in private and the claimant is informed on the same day where possible. There may be a presenting officer from the DWP who acts as a ‘friend of the court’. The presenting officer is not there to defeat the claim but act in a neutral way.
Tribunals are held in public places, while members of the public could attend they are unlikely to do this. You should be asked if you consent to people sitting in the tribunal to watch proceedings, eg a law student or welfare rights adviser. If members of the public did come you could ask for them to be excluded. Appeals can be struck out for a limited number of reasons such as failing to comply with tribunal directions as with being outside the absolute time limit or making “frivolous or vexacious” claims. Claims that are struck out could be reinstated, do seek advice on the process.
The tribunal should give the appellant at least 2-3 weeks’ notice of the hearing. You can waive the right to be given two weeks’ notice but would need to think about whether this allowed you enough time to prepare. Once the date for the tribunal is given then it is hard to get this moved. You should notify the Courts and Tribunals service of dates which you or your representative cannot do in the next three months.

Being prepared

When preparing for an appeal you can nominate a representative who could receive papers on your behalf. The tribunal papers will be a bundle of documents with each page numbered. These papers should be sent to you within six weeks of your lodging an appeal. A reconsideration may take place again before the date of the tribunal but only a small number of decisions are changed at this stage. As the appellant at the tribunal you can prepare a statement and take in a notebook.
Any submission to the tribunal should ideally be made in advance and set out the number of points that should be applied to your care and mobility needs as found in the PIP or ESA criteria depending on the appeal decision being appealed against. When receiving this bundle of appeal papers do take a step back to consider where the decision maker is coming from, look for any weaknesses or mistakes in the medical report and at what points have been missed out. Do think about whether you can provide any further evidence. It was stressed that you can go to a tribunal even if you do not have medical evidence with you. It would be advisable that you take someone with you to the tribunal wherever possible as a support or adviser.
When you first arrive at the tribunal the clerk would usually have a chat with you and any representative/companion with you in the waiting room. In the room the judge will introduce the tribunal and your representative and any presenting officer from DWP will be asked if they wish to make initial comments.
The tribunal is inquisitorial and you will be asked many questions with answers probed and tested. This is usually done not to doubt evidence but to make sure that the judge’s decision making is robust. There was concern from participants about whether the tribunal could make judgements though it was noted that members should have wide experience of seeing claimants with different disabilities. Tom encouraged anyone making a claim to a tribunal to explain the mental health reasons behind any non compliance with medication.
The tribunal will always look at your health and needs at the time of the decision and will not generally be interested in what has happened since that decision. However, if something has occurred which may have done before the decision but has been triggered afterwards, eg the benefit result bringing on mental health crisis, you could explain how this related to your health before the decision was made.
With ESA it is important to look at the descriptors taking into account pain, fatigue, and repetition of activities. Regulations 29 and 25 can be cited where there is a risk to the claimant or others if they will be at risk of harm if not so treated as having limited capability for work or limited capability for work related activity. As for PIP the support needed in order to carry out an activity reliably and repeatedly, and within a reasonable time, needs to be stated. ‘Reasonableness’ runs through benefits legislation. Caselaw is emerging for PIP and ESA which can be used in arguments against the decision to refuse/not award the rate expected of PIP or ESA.
The DWP’s role at the tribunal
As already stated, the DWP can send a presenting officer to every tribunal. At present the DWP are recruiting 200 more presenting officers. However, the presenting officer is not meant to act as a prosecuting council. The officer should be detached and serve as a friend of the court. The DWP officer can advise on process. If you are in a tribunal and feel intimidated by the way a presenting officer is acting then you could speak with the judge. The DWP can refer tribunal decisions to upper tier tribunals. However, it is often welfare rights advisers or claimants who appeal to upper tribunals though the grounds for doing this are specific and defined eg an ‘error in law.’

The Law

Appeals are legal processes so references to the law behind benefits criteria does come up frequently.
Statute Law
This is primary law – eg the Welfare Reform Act 96
Secondary Legislation eg ESA and PIP regulations.
Reasonableness runs through all regulations and case law is created by upper tribunals based on case rulings. One of the participants pointed out how Social Care legislation didn’t refer to the same reasonableness test and there may be a conflict of opinion if sending in social services assessments for PIP evidence as the criteria are different. The reliability provision also applies to PIP activities which does not happen with social services assessments. Tom reminded members that they could select their own evidence and didn’t need to include everything they had received from services.

Defence help

There was a discussion about whether paying for a solicitor or welfare rights adviser could be worthwhile. While free advice services do exist in the UK these are under pressure due to local authority funding cuts. One member recommended Fightback and will get more details from them about their services and share these with the group. It would be important to members to have a list of reliable, legitimate advisers with experience in social security legislation and appeals.
ESA appeals
Overall ESA appeals have a 40% success rate. Around 90% succeed if a support worker or adviser is involved in supporting the claimant. It is possible to appeal being in the WRAG but do seek advice to ensure that you will not lose this status and ESA entirely. If evidence comes up in the appeal that contradicts the claim made then the tribunal sometimes may warn the claimant of this, and so allowing time for the appeal to be withdrawn. However, the claimant should consider an outcome where they do lose ESA as a result of a tribunal if there are weaknesses in their case. Independent advice should be sought when weighing up decisions.
ESA can be paid during the appeal but not during a mandatory reconsideration. The mandatory reconsideration usually takes 4-6 weeks and claimants may need to consider whether to claim JSA or see if they can manage without benefit if they have other resources, such as PIP, to live on for that period of time. However, losing ESA will trigger the loss of Housing Benefit and council tax support so the claimant would need to make a new claim with their local authority on the basis of having no income. If claiming another benefit such as JSA the local authority will need to be informed and any new claim made in line with local requirements.
It is important to appeal any ESA refusal since coming off the benefit but reapplying in future would mean starting again in the basic assessment rate group for the first 13 weeks. It is possible to claim JSA while appealing ESA and some claimants may be financially better off doing this though will need to meet jobseeking expectations ie actively seeking work and signing on. There is meant to be flexibility built into JSA where the claimant has a disability. However, there is a danger of being moved to UC and not able to go back to income based ESA even if this is later awarded on appeal. Being on UC will have disadvantages for many claimants due to the loss of disability premiums. In most areas of the country appealing ESA would be seen as too ‘complex’ for the UC cases they are processing as single jobseekers. However, parts of the country eg Croydon, Sutton and Southwark, implementing UC in full would move all claimants to UC on any change of circumstances like this. The message was to seek local advice before putting yourself in a position where you may be placed on UC.
It is advisable to claim ESA even if only getting NI credits and no income. Breaking a claim for contribution based ESA may mean that this would need to be claimed on the basis of different years’ NI contributions in future. NI contributions also matter for pension entitlement later in life.

Losing at Tribunal

While claimants have a good chance of winning a tribunal there is the possibility of the tribunal not changing the original decision or downgrading an award that was made. You should ask for full written reasons if this happens. Specialist advice is needed before appealing to an upper tribunal as that appeal must be on an error of law and not simply because you disagree with the decision reached on the day. There are further routes for appeal after the upper tribunal but decisions rarely go to these; the court of appeal and House of Lords. Where the upper tribunal agree that an error of law has been made then they may send the decision back for rehearing at a tribunal.
Means testing again
The second day of training concluded with further discussion and learning about means tested benefits. Jobseekers allowance set at £73.10 comes far short of meeting a single person’s needs for living. Tom explained applicable amount as reflecting the circumstances of the claimant and the amount the government determined was due for that type of household. There are various premiums in means tested benefits which can be very useful. Some benefits, such as carers allowance may not lead to an award of that particular benefit but instead an underlying entitlement could result in premiums. The day ended with an exercise looking at the impact of three types of individual claiming carers allowance for a person with a disability and whether money would be lost or gained, and to which party, as a result of that claim. The severe disability premium is worth £61.85 per week and care should be taken before Carers Allowance is claimed by someone else, whether or not already on benefits.

Tips from the sessions

Make sure that you are in receipt of the severe disability premium where already in the support group of ESA. You should refer to letters from the DWP setting out your award.
For claimants who have not yet been ‘invited’ to claim PIP, they may want to consider requesting their DLA files from the DWP. Though PIP is a different benefit, claimants may find that some of the material they submitted for DLA is relevant and medical evidence could be used selectively where it still applies to their current situation. This may help claimants who are no longer under specialists but whose health issues remain the same.
It does feel disappointing and unfair to claimants that years on indefinite DLA counts for nothing in the PIP process. A good way to prepare for the PIP invitation is to write a draft PIP form. This will help when needing to fill in the actual PIP form where only around three weeks is allowed in practice due to a return deadline date given by the DWP. You can find a sample PIP form on the internet and use this to practice.
If going for appeal do gather as much evidence as possible including letters on anything relevant, evidence can be for informal support such as friends and carers. You can be selective of medical evidence and choose not to send in professional letters where they do not help or add nothing to your case for benefit. Forms of medical evidence that you could send include medical letters, care plans, risk assessments and letters from a GP or ideally a consultant psychiatrist for mental health claims. However, don’t be deterred from going to a tribunal if you do not have evidence. The tribunal will see your verbal/written account as evidence. Be prepared to talk the tribunal through your reasons and points scoring. Go with someone eg CPN, support worker, adviser, friend.
Do photocopy pages 63 and 295 from the Big Book of Benefits for professionals so that they can see the descriptors for ESA or PIP when writing their evidence letters.
In writing the tribunal submission do go back to the descriptors and justify the points that you think should have been awarded and the difficulties you have around those activities. Check for law and DWP guidance that may be relevant. You can find case law on PIP on pages 346 and 347 of the Big Book of Benefits.
Some members were concerned about the date of their next ESA assessment. This date is not usually known to the claimant but tends to relate to their last assessment and the time indicated by the decision maker then. Other members feared PIP face to face assessments. The position from the introduction of PIP has changed where it was predicted that 97% of claimants would need this face to face assessment, the average is around 75% of claims with 25% decided on the papers alone.
The government has recently made announcements that regular testing for those with a deteriorating health condition will cease. The government has yet to set out a full list of conditions.

RITB extend heartfelt thanks to Alex for her excellent write up of all 4 training days and to Together for offering us a room for this training.

Tom Messere
Big Book of Benefits
http://www.bigbookofbenefits.com

Sample PIP form:
https://www.gov.uk/government/publications/personal-independence-payment-pip-clerical-claim-form

Appeal forms:
https://www.gov.uk/social-security-child-support-tribunal/appeal-tribunal

Recovery In The Bin’s ‘PD’ leaflet has been shortlisted for an award.

Dear Recovery In The Bin

I am writing to inform you that your article ‘A simple guide on how to avoid receiving a diagnosis of ‘personality disorder’’ has been shortlisted for the 2016 Clinical Psychology Forum Award. The shortlist has been created by the editor selecting one paper from each of the previous 12 month’s issues of CPF.

The full short list is:

  • Listening to what is already known: Recovery through the creative arts Emily Skye
  • Keep NICE and carry on? Reflections on evidence-based practice Laura Tinkl & Syd Hiskey
  • How accurate are modern IQ tests at categorising people as having an intellectual disability Simon Whitaker
  • A lean approach to service development Deborah Strachan & Tim Cate
  • Prevalence of offending in a community sample of individuals who have suffered a moderate- severe traumatic brain injury
    Daniel Friedland & Joerg Schultz
  • The road less travelled? An attempt to understand why families consult independent clinical psychologists
    Lynne Hipkin
  • Is access to clinical psychology training in the UK fair? The impact of educational history on application success
    Katrina Scior, Janice Williams & John King
  • Team formulation: A critical evaluation of current literature and future research directions Samantha Cole, Katie Wood & Jason Spendelow
  • Human rights: Giving clinical psychology a backbone Sarah Butchard & Beth Greenhill
  • DCP Scotland – Miller Mair and the Dumfries Clinical Psychology Department Simon King-Spooner
  • Knowing something about the bird: Formulating developmental trauma, its various relationships to substance misuse problems and service implications
    Jo Stevenson
  • A simple guide on how to avoid receiving a diagnosis of ‘personality disorder’ -Recovery In The Bin Anonymous

    The next stage is for the CPF team to select the winner according to the following criteria:

    Innovative quality: This may, for example, be a new way of working, a new political or ethical challenge for the profession, novel research methodology, or a new way of applying clinical psychology.

    Research quality: High standards from a methodological and evidential perspective. This applies to audit and evaluation as much as it does to traditional research.

    Academic quality: Researched, and considered in the context of available literature. Given the low word count for CPF articles, it should be succinct, focused and respectful in tone and style.

    The award winner will be informed prior to the Annual DCP conference and will receive:

  • –  Full conference expenses for the DCP annual conference (Conference registration fee, travel to conference, meals and accommodation). This is covered within the CPF budget line
  • –  An award lecture delivered at the DCP annual conference
  • –  A book token to the value of £200
  • –  A framed certificate
  • –  A copy of the issue of CPF in which your article appeared

    It is a great achievement to make the shortlist. Well done! I will write to you again soon with details of the winning article.

    Yours sincerely

    Dr Stephen Weatherhead
    Editor, Clinical Psychology Forum

In Place of the Crisis Team by a RITB supporter

You can contact your local PALS team if you aren’t getting the help you need from services. You can also call your local crisis team if you think you need help right away. Their number can usually be found on your local mental health trust website somewhere – check local policy for referral criteria.

If you don’t have the energy (or they are engaged) do not worry. Here is some specialist acute mental health crisis management advice that I’ve gained from using the crisis team:

1. Have a hot drink (but not hot enough to scald yourself)
2. Have a warm bath – bubbles optional
3. Distract yourself by stroking a pet (or yourself)
4. Distract yourself by watching tv or reading a magazine or book
5. Ring a friend or a mental health helpline
6. As a last resort…go to sleep
7. If you can’t sleep lie in bed in the dark
8. If none of the above work, have another bath and try them all again – mindfully.

To support longer term care you can also
1. Leave a message for your keyworker/GP to call you in the morning
2. Arrange a pdoc appointment to review your meds
3. Go for a walk in the morning since you didn’t like the suggestion to go for a walk in the dark.
4. Buy a lavender pillow

There, I have just provided you with top notch mental health advice…and saved the taxpayer the need to spend 3 years training a RMN plus the additional cost of specialist courses in crisis care.

Oh, I suppose I better give you the full extent of crisis team advice:
1. Please remember YOU need to TAKE REPONSIBILITY for your health problems
2. Thank you for sharing that you want help. Please note such requests may indicate dependency. Therefore we will support you by not supporting you. Call back if you need us.

Thank you

UPDATE: new good practice guidelines suggest bananas and colouring books also have a place in your recovery.

LATEST NEWS: Recent claims that eating more than 6 bananas could kill you are false. It would take 400 bananas to have the amount of potassium needed to kill you – and your body wouldn’t absorb it so….
YOU CANNOT OVERDOSE ON BANANAS. http://www.bbc.co.uk/programmes/p032805k?ns_mchannel=social&ns_campaign=bbc_radio_4&ns_source=facebook&ns_linkname=radio_and_music

Conclusion: Bananas remain an integral part of the ‘alternatives to the crisis team’ self-help plan
*‘Inspired by the North Durham Crisis Resolution and home based Treatment Team, an HCAS accredited provider*

RITB Welfare Training June 2016 part 3

This is the third of three posts covering the training.

This first post is the background and purpose.

The second and third posts are by Alex Williams who has written about both days – both the experience and the information.

Account of the RITB Welfare Benefits training delivered by Tom Messere and Yvonne Bennett by RITB member Alex Williams
Disclaimer: these are notes from the training days and don’t replace individual benefits advice and reading through the Big Book of Benefits and Mental Health.

“the trainers were brilliant, so knowledgeable, clear and pro-claimant”

More ESA

The trainers explained that they were behind schedule due to the amount of questions generated by the subject on day 1 of the training. The approach used on the second day was to work through topics and allow questions at the end of each section. There would then be time for questions at the end of the day.

There was more discussion about the Support Group component of ESA and the limited capability for work test. Page 63 of the Big Book of Benefits and Mental Health outlines the descriptors for the support group. One of the useful, though often overlooked, descriptors for mental health is ‘conveying food or drink to mouth (without regular prompting)’. If this descriptor is satisfied then the claimant should qualify for the support group even if they have not scored sufficient points on the main test for ESA.

The group worked through a case study, introduced yesterday as a conjurer called Merlin who had fallen out of work and needed benefits help. This exercise led to discussion about the wording used for descriptors, for instance what it means to not be able to set an alarm clock or washing machine. Yvonne explained that she often encourages claimants to think about how they would cope with a new washing machine rather than one they had become used to. This can lead to questions about how easily someone would find it to pick up the instructions, change the settings and use the machine for the first time.

With ESA there is a need to give answers on the basis of how things are for the claimant for the ‘majority of the time.’ This view does allow for a good day but the answer needs to give a realistic, overall, picture for most of the time. It is helpful to back up answers on the form with examples eg whether when doing this activity the person found things went wrong, how many times this has happened, consequences of it going wrong etc. In the case of coping with unexpected change, it would be helpful to state for how long the claimant felt affected by the change afterwards.

It was pointed out how ‘getting about’ wasn’t one of the support group criteria yet could be the most debilitating feature of someone’s mental health in the case of agoraphobia.

The word ‘disinhibited’ was discussed in relation to coping ‘in the workplace’ descriptor 17. This word could apply to uncontrollable crying if emotions were close to the surface as well as behaving in an ‘inappropriate’ way. It is necessary for descriptor 17 to imagine how someone would react in a workplace rather than in safe, known surroundings like the day centre.

There is an ESA50A which is sometimes sent instead of the ESA50. This is a shorter form and just includes the support group descriptors.

When filling out the ESA50 it is best to keep the list of health problems, tablets and treatments very brief. The way that health problems affect the claimant should be completed within the main questions in relation to the descriptors and at the back of the form where there is more space. In mental health cases, payments of ESA should not be stopped if someone doesn’t complete the form. It is though very important to return the form in line with the four week time limit. The trainers encouraged participants to complete their forms in stages, allowing themselves a treat after each section. If a support group descriptor applies then this should be made clear on the form. The claimant needs to keep ‘reasonable, reliable, repeatedly’ in mind when considering how they could perform an activity.

Many participants reported having fluctuating conditions and relapses that would last for a few weeks or months before easing. The trainers urged people to be honest on the form and explain how things vary for them. Both Tom and Yvonne said that it would be wrong and bad advice to fill out the form as though on your worst day ever. This way of filling out the form may weaken someone’s credibility if they needed to go to a tribunal and explain how they were affected by their difficulties.

The face to face medical assessment is requested of around 93% of claimants of ESA. Maximus now have this contract after ATOS pulled out of its delivery. The medical assessor produces an ESA85 report which is considered by the decision maker along with evidence and the ESA50 form. There is a second part of the medical assessment called the ‘work focused health related assessment’ but this is currently suspended.

Several participants said that it would be a personal risk for them to attend a medical. The trainers said that a home visit could be requested, as could being seen by a professional of the same sex. The claimant can request in advance for the medical to be tape recorded. It would be good advice to go accompanied to the medical. The companion can offer moral support and take notes of discussions for the claimant. The assessor will still want to hear from the claimant rather than for the companion to speak for them. It was felt by participants that going to a medical alone could well lead to assumptions being made by the assessor about their capability. The medical could possibly be waived in some cases if medical evidence was very strong, eg a psychiatrist’s letter stating that the medical would lead to a psychotic episode which may result in hospitalisation.

The tape recording would need to be requested from Maximus. It would be risky for the claimant to refuse to take part if the tape recording equipment wasn’t available on the day since this could be seen as non compliance. Recording the medical covertly or openly on a mobile phone would not be acceptable to the DWP or the provider.

Several participants were anxious about completely dissociating during the medical. The trainers recommended having someone with them who could observe the onset of dissociation and point this out to the medical assessor. One participant had dissociated at their medical and the doctor had asked for her permission to end the appointment.

A question likely to be asked by the assessor would be to talk about a ‘typical day.’ It would be helpful for a claimant to have the descriptor activities in their mind or written down so that these were included in their account. The medical is really only a snapshot of the person on the day and not a true mental health assessment.

Following a medical, the claimant can request a copy of the medical report. It would also be helpful to make notes afterwards about how long the medical was, and anything that felt wrong. If there are concerns about the way the medical was conducted then a complaint should be made by the claimant to Maximus as the provider and copied to the DWP.

If the outcome of the ESA assessment (including consideration of the evidence, any medical and the ESA50) is that the person is found fit for work then they should request a mandatory reconsideration straight away. The trainers advised against rushing into a claim for JSA, particularly if living in areas where UC is being rolled out. It is important at this stage to seek advice, get the mandatory reconsideration over quickly then to lodge an appeal if the decision remains unchanged. Once making an appeal the claimant can go back to ESA at the assessment rate, or has the option of claiming JSA. Gathering evidence for a mandatory consideration could lengthen the process in an unhelpful way, so it is best initially to let the reconsideration be determined on what material has already been submitted. There are rules on repeat claims which mean that unless someone has a new or worse condition from the time when the fit for work decision was made, then they wouldn’t be paid ESA until they had another Work Capability Assessment. It is important to appeal decisions about ESA refusals in case repeat claims are made in future.

If the claimant is placed in the WRAG rather than the Support Group they will also need to consider appealing. The WRAG does entail claimants participating in work focused interviews and work related activity which could include mandatory training or work placements, or permitted work. Unlimited sanctions do apply to those in the WRAG and these have become tougher under the new health and work programme.

A claimant applying for JSA while appealing the ESA decision doesn’t amount to a self declaration of being fit for work. The Jobcentre will need to take into account the jobseeker’s health issues. It is possible to apply for an extended period of sickness up to 13 weeks when on JSA.

It was agreed that it was useful to obtain proof of posting for benefits claims though possibly not worth sending them by recorded delivery. All post is directed to a sorting office in Wolverhampton. In future the claiming method is expected to be online by default.

“the Big Benefits Book, a superb resource”

Disability benefits and mental health

DLA and AA were introduced in 1992. These disability benefits were based on the social model of disability with an emphasis on the claimant being listened to about the impact of their health difficulties. The success for mental health claims was limited to begin with but over time caselaw defined attention needs, cooking and supervision in a way that fitted with mental health issues.

PIP has been devised as a replacement to DLA for working age adults. PIP isn’t all bad but it is undermined by the government’s intention to cut 30% from the DLA bill. DLA and PIP are payable to those in and out of work; 20% of people on DLA are in full-time work. It is though essential to inform the DWP if starting work, otherwise it could be that the claimant would have to defend a fraud allegation if reported by a third party. Starting work could potentially lead to an increase in care needs if the person needs more support to be in a workplace.

DLA, PIP and AA can lead to carers being able to claim Carers Allowance or for claimants who work to get a disability element of Working Tax Credit.

There is a qualifying test to DLA/PIP where difficulties must have been present for three months and to be expected to last for a further six months (though this doesn’t apply to DLA to PIP migrations). AA has no mobility component though this does seem to be discriminatory on the basis of age.

With PIP there is no equivalent of lower rate care of DLA. However, this doesn’t mean that those on this lower rate of care will be excluded from PIP. Some in this group will be able to qualify for standard rate of daily living component for PIP.

With PIP it is true that ‘points make prizes’ as qualifying scores come from meeting the descriptors. There are points for both daily living and mobility activities. Unfortunately, the daily living test doesn’t cover all difficulties and so the claimant needs to be aware of the descriptors so that they can focus on the most relevant points. Getting out of bed isn’t anywhere in the form as it was for DLA. Night time needs aren’t referred to either. Many people on DLA with mental health issues qualified on the grounds of needing continual supervision; this doesn’t feature in PIP in the same way. The closest aspect to this continual supervision is one point for monitoring a health condition (activity 3b). The highest scoring of the descriptors applies where more than one answer may describe someone’s difficulties with an activity.

The mobility component criteria could lead to people with mental health issues being awarded the highest rate which was rare with DLA (except for those with a severe learning difficulty). There are only 4 points available for ‘needs prompting to undertake any journey to avoid overwhelming psychological distress to self.’ The higher number of points to qualify – 8 – applies instead to ‘cannot plan a route of a journey.’

Unlike with ESA, whether the cause of difficulties is mental health or physical doesn’t matter.

“knowledgable, approachable and very friendly trainers”

The use of aids and appliances can mean that the claimant qualifies for 2 points in some descriptors. While this feature is positive, claimants should also take care not to miss the higher points available in the descriptor if other responses are true. Regulations for PIP emphasise the need for an ability to perform tasks reliably, safely, to necessary and appropriate standards, repeatedly and in a timely manner. If the claimant cannot do an activity reliably then they should be counted as not able to do that descriptor at all. If a descriptor applies at any time of day during a 24 hour period then it is considered to apply for the entire day.

As with DLA, the claimant doesn’t have to be receiving the support to have an underlying need for that support. There are specific meanings for wording of the descriptors which can again be found in the Big Book of Benefits and Mental Health. There are rules around variability which can be helpful. For PIP the claimant does need to think about how they are throughout the whole year.

There was a discussion about what counted as a meal, it was agreed that this would be a simple meal for instance chicken and vegetables. It wouldn’t amount to frozen food which is simply heated up rather than prepared. There is also a descriptor about ‘taking in nutrition’ which is about whether the claimant manages to eat and drink.

Page 322 of The Big Book of Benefits and Mental Health refers to PIP mobility and planning and following a journey. This change in policy from DLA means that many people with mental health issues may lose lower rate mobility. If someone has a person accompanying them then they would need to be there not simply for reassurance but to actively help the claimant to follow the route. Yvonne said it may be helpful for someone to imagine what happened when they had a panic attack and whether during this state they could work out how to get to somewhere safe, what would another person need to do in those circumstances. Case law does concentrate on navigation and not support. There is also a higher descriptor which could apply if the person cannot go out for the majority of days. If PIP mobility is refused but the daily living component is granted, then the claimant would need to think carefully about appealing since there would be a risk to the daily living award.

If claimants do need to go to tribunals then representation definitely helps. Participants had heard of a case where a tribunal had used the claimant’s social media profile against him. The trainers said that research on social media was more likely to apply to ‘living together’ cases but all users of the internet should still be cautious and use privacy settings.

A participant asked whether savings always needed to be declared. The trainers were clear that savings above the thresholds (please refer to the Big Book of Benefits and Mental Health) should definitely be declared and not doing so does amount to fraud. Claimants who have savings are allowed to spend them but not with the intention of depriving themselves of capital in order to qualify for benefits.

A participant asked how to notify the DWP if moving home. The trainers recommended doing this in writing. Someone else asked whether they needed to notify the DWP if they had more conditions diagnosed; the response was this would depend on whether there was a change in the amount of care/attention/prompting required.

Several participants were concerned about prejudice against PD and asked whether benefit awards were more likely to be made for other mental health conditions. The trainers suggested that diagnoses such as schizophrenia could be taken more seriously than anxiety and depression. However, for the purposes of completing the form, it is helpful to forget the diagnosis and focus on what are the effects of the health conditions on that person’s daily life.

Future training days?

  • Appeals and Tribunals
  • Universal Credit and tax credits
  • Means testing and the benefits system

Suggestions

A private Facebook group be formed for those who have been on the training so that they can support each other while helping other survivors with their benefits claims.