Disability Living Allowance

(For people with Mental Health Problems)

This factsheet gives general guidance on claiming disability living allowance for people with mental health problems. If, after reading it, you want to find out more or need help with making a claim see the Where can I get more help or information? section below.

1. Introduction

Disability living allowance (DLA) is a benefit for people with disabilities, and is aimed both at people who need help looking after themselves and at people who find it difficult to walk or get around. You can qualify for DLA whether or not you actually have someone helping you.

This checklist is designed to help claimants and advisors have a better understanding of how someone with mental health problems can qualify for both the care and mobility components of DLA.

General points

1. It is important to explore any physical health problems as well as mental health ones.
2. Remember that a belief may be true to a client even if it seems bizarre to others. So the person can honestly say that they are being followed, or are turning into a cat or that people can read their mind, if that is their reality.
3. Nature of the illness. "Nervous Disorder" is often the term used on medical certificates issued by the GP, and is useful if the person needs prompting when being asked questions about the nature of their disability.
4. Supporting statements are vital - especially to distinguish "idleness" from lack of motivation and to validate the claimant's view of reality. These can be drawn from a wide range of people, from carer through to Community Psychiatric Nurse.
5. The more relevant information you provide on the claim form the more chance you have of "getting it right first time", which will enable the Disability Benefits Centre to make an award and thus avoid the need to appeal. The decision maker only knows what you tell them and can only go for supporting evidence from the GP or people you have named on the form; the clearer the picture, the more obvious it will be for the decision maker. Remember, a decision maker will have to process up to 15 - 20 claims per day and so a well constructed claim form will enable them to come to a decision more rapidly. Given that people with mental health problems may have high anxiety levels, avoiding the lengthy appeals process is particularly important. 
6. Loss of motivation and distraction cause very many real problems; think carefully how the mental illness affects the client’s day-to-day life. Does memory loss or side effects from drugs make life difficult?
7. Most people can provide all the information needed themselves; however, in a minority of cases the form will have to be filled out on the claimant’s behalf.

2. What the law says

2.1 Care component

The rules for the care component are contained in Section 72 of the Social Security Contributions and Benefits Act 1992.

For the disability test for the lowest rate DLA care component you must satisfy one of the following conditions:

• need attention in connection with bodily functions for a significant part of the day which can be during one or more periods.
• be age 16 or over and unable to prepare a cooked main meal.

For the disability test for the middle rate DLA care component you must satisfy one of the following conditions:

• need frequent attention throughout the day in connection with your bodily functions.
• need continual supervision throughout the day to avoid substantial danger to you or others.
• need prolonged or repeated attention at night in connection with your bodily functions.
• need another person to be awake at night for a prolonged period or at frequent intervals to watch over you in order to avoid substantial danger to you or others.

For the disability test for the highest rate DLA care component you must satisfy either of the following:

• have one of the day needs and one of the night needs shown in the middle rate conditions.
• you are terminally ill.

Children must satisfy one of the above tests but, in addition, their care, supervision or watching-over needs must also be greater than those of a child of the same age who is in normal physical and mental health.

What the care component disability test rules mean

needs - This is help that is reasonably needed, not what is given, nor what is medically essential. This is help to lead as normal a life as possible. This includes help you need outside your home. For example you can be given help to do your own shopping or to take part in "reasonable" social activities.

attention - This is help of an active nature required to be given in your physical presence. This can include help given to you to wash, dress or to go to the toilet. It can also be more indirect help such as signing, reading aloud or prompting and encouragement.

bodily functions - These include hearing, eating, seeing, washing, reading, communicating, walking, drinking, sitting, sleeping, dressing or undressing, using the toilet, shaving, shampooing, help with medication and thinking.

significant - This is around an hour in total.

cooking test - This is a test of whether or not you can cook a main meal for yourself if you have the ingredients (and regardless of whether you are a good cook or not). 

frequent - Means more than twice.

throughout - This means spread over the day.

continual - Means regular checking but not non stop supervision; does not have to be constant.

supervision - This is watching over, ready to intervene.

substantial danger - The danger must be real, not just remotely possible.

prolonged - Means some little time (at least 20 minutes).

repeated - Means two or more times.

night - This is when the household has closed down for the night. It is generally the time when an adult is in bed but must be more or less within night-time hours - generally between the hours of 11pm and 7 am.

terminally ill - You are terminally ill if you are suffering from a progressive disease where death can be expected within 6 months.  Since 25 September 2006 an award made because you are terminally ill will be for a fixed period of three years. After that period it will be reviewed.

2.2 Mobility component

The rules for the mobility component are contained in Section 73 of the Social Security Contributions and Benefits Act 1992 and regulation 12 of the Social Security (Disability Living Allowance) Regulations 1991 (SI 1991/2890).

For the disability test for the lower rate DLA mobility component you must:

• need guidance or supervision with walking on unfamiliar routes because of your mental or physical disablement. If you are claiming for a child he or she must need substantially more guidance or supervision than a child of the same age who is in normal physical or mental health.

Children cannot receive lower rate mobility component until they reach the age of five. Also you can only get lower rate mobility component for a child if he or she needs a greater amount of guidance or supervision than a child of the same age who is in normal physical and mental health.

For the disability test for the higher rate DLA mobility component you must satisfy one of the following conditions:

• be unable to walk 
• be virtually unable to walk  
• the exertion required to walk would constitute a danger to your life or would be likely to lead to a serious deterioration in your health
• have had both legs amputated (or missing from birth) at or above the ankle
• qualify for the highest rate of DLA care component, be severely mentally impaired and show disruptive behaviour.
• be both blind and deaf and need the assistance of another person to walk out of doors.

Children cannot receive higher rate mobility component until they reach the age of three.

Any artificial aid used, such as limbs or walking frames are taken into account when considering your mobility except for cases where you are claiming on the grounds that you have both legs amputated or missing.

What the mobility component disability test rules mean

guidance or supervision on unfamiliar routes - You can get this if you can walk but need someone on hand to guide or supervise you. If you are blind, have learning disabilities or are mentally ill you are likely to qualify for this rate. The test is based on your ability to cope with unfamiliar routes (for example you may be able to find your way to your local shop but become confused, lost or anxious if walking in a strange place).

virtually unable to walk - This test looks at your ability to walk out of doors on a normal flat surfaced pavement or road. The following factors are taken into account :

• distance walked
• speed of walking
• length of time taken
• manner of walking

When stating how far you can walk remember that any walking done whilst you are experiencing severe discomfort does not count.

For example; you may be able to walk 100 metres but can only do the last 80 in severe discomfort. It would be reasonable in this case to say you can only walk 20 metres. Pain and breathlessness are also considered when assessing whether or not you experience severe discomfort.

severe mental impairment and disruptive behaviour - Severe mental impairment refers to someone who "has arrested or incomplete physical development of the brain resulting in severe impairment of intelligence and social functioning". Conditions that start later in life, such as recent brain damage or the onset of Alzheimer's disease which affect people whose brains are fully developed, do not count.

The disruptive behaviour must be extreme, require physical restraint to prevent physical injury or damage to property and also require someone to watch over you whenever you are awake.

Severe impairment of intelligence is determined in many ways. It can be through an IQ test or by assessing someone's "useful intelligence" - the ability to function in a real life context. 

blind and deaf - To satisfy this someone must have 100% disablement from loss of sight and 80% disablement from loss of hearing.

3. Help with personal care

Entitlement to the middle or higher rates of DLA would depend on the severity of the mental health problems and whether "frequent attention in connection with bodily functions" or "continual supervision" were required during the day and/or night.

Entitlement to the lower rate care is clearer, given that attention may only be needed for a "significant portion of the day". But by determining the level of need, and being clear about the range, type and degree of the person's symptoms, there is no reason why a person with mental health needs should not qualify for Middle or even Higher rate care.

Below we look at the activities referred to in the DLA claim form. REMEMBER to give specific examples where you need help with any activity.

3.1 Getting up and getting dressed

In deciding whether or not a claimant needs help with personal care, advisors should think about what the client actually does and how long it takes.

Motivation can be a major difficulty and it is difficult to admit to a lack of this. The following questions may help you begin to see a clear picture of behaviour which may give rise to a need for '"frequent" or "significant" "attention with bodily functions".

• Does the claimant stay in bed all day?
• Do they get up but don't get dressed?
• Do they dress but dress bizarrely?
• What do they wear when they get up? Are underwear/top clothes clean?
• What do they wear when they go out? In winter? In summer?

3.2 Moving around indoors

This could include some clients who are catatonic and unable to move for hours or days.

3.3 In the bathroom

Motivation can be the key issue here. Does the claimant

• Wash?
• Dress?
• Bathe?
• Shave?
• If not, do they have a need for prompting?
• Will they only wash etc. with regular prompting/visits from a carer/Social
• Services/Community Psychiatric Nurse (CPN)?

3.4 Toilet/incontinence needs

Less likely to be apply to people with mental health needs, but would include some people who lack the motivation to get to the toilet.

3.5 Help with medication or other treatment

Questions that arise from this issue may pose some problems, as the claimant may feel that they do not need the medication that the health services require them to have. But check to see if relapses have occurred (this is also covered under needs for supervision).

3.6 At mealtimes

Less likely for people with mental health problems to need assistance at mealtimes, but again may be appropriate if the person is catatonic.

However, irrespective of the diagnosis, it is useful to check for:

• Any prompting needed to eat?
• Does the illness mean that the claimant does not check that food is in a fit state to eat/sell by dates /cooked properly/exists on junk foods?

REMEMBER to list examples of self neglect and illnesses associated with that, eg stomach illnesses (living on junk food etc), bronchitis etc.

4. Lower rate component

4.1 Preparing a cooked main meal

A person's mental health problems may mean that they are unable to prepare a cooked main meal due to motivational problems. Cooking a main meal calls for decision making and precise actions to prepare it and finally cook it on a traditional cooker.

There may also be issues of safety if the client is frequently distracted or is unable to concentrate or liable to self harm.

5. Supervision

5.1. Someone to keep an eye on you
If a person's mental health problems mean they need someone to keep an eye on them or provide continual supervision in order to avoid substantial danger, they should qualify for the middle or higher rate care component.

Include those who have a need to be distracted from the voices of others and those who are anxious if left alone. Although many people actively don't want anyone to keep an eye on them, note the risks and if it seems likely that supervision is needed in order for the person to stay safe, then the need for supervision (irrespective of whether or not it is fulfilled) is sufficient.

5.2. Danger to self or others?
Note:

• Past risk of accidents due to fire
• Aggression, self harm
• Suicide attempts
• Does the household have young children in it? Are they at risk in any way?
• Is the claimant vulnerable or easily exploited? (ie at risk from others in a physical sense as well as in terms of getting into debt, signing credit agreements, loan sharks etc).

5.3. Not recognising danger
Is there:

• Unsafe smoking (smoking in bed, leaving lighted stubs on armchairs etc)
• Distractions caused by hallucinations
• Examples of inviting strangers home
• Behaviour provoked by psychotic experiences (eg wrapping lamp in blanket and switching it on or leaving gas unlit).

6. Condition getting worse
In this sectionDoes the client have an understanding of when their condition is deteriorating? if not, they may need constant supervision in order to be safe.

Check for:

• A degree of insight into the illness.
• Compliance with medication.
• History of compulsory admissions under the Mental Health Act.

7. Help with getting around
In this section, we are referring to the criteria for the Lower rate mobility component. People with mental health problems with additional physical disabilities may qualify for the higher rate on that basis.

You must be "so severely disabled physically or mentally that, disregarding any ability (you) may have to use routes that are familiar to (you) on (your) own, (you) cannot take advantage of the faculty out of doors without guidance or supervision from another person most of the time".

The key question for the lower rate is to consider what happens if, or when, a client with mental health problems tries to walk alone outdoors in an area they are not familiar with.

Can they "take advantage of" the ability to walk if in an unfamiliar area, without someone else to guide or supervise? Always check where people actually go - some appear to go out but in fact can only do this with help or stay in familiar places. They may not admit to themselves that there is a problem.

Check for the effects of:

1. Agoraphobia that is untreated or has not responded to treatment.
2. Difficulties getting around due to psychotic experiences; eg "I'm turning into a cat and might be chased by dogs." or "I worry when I'm out because people read my thoughts."
3. Difficulties due to motivational problems; eg "I don't get around to going out unless someone is with me." ie a need for personal encouragement rather than physical support in order to go out.
4. Difficulties due to distraction; eg "I don't watch the traffic when the voices are talking." or "I hear voices and I get lost and can't get home."
5. Difficulties due to behaviourial problems; eg "I stare at people when I'm out - it could cause a fight."  or "I talk to strangers about God." or "I shout at people outside; they sometimes threaten me."
6. Can they get to a place they've never been before? - What might happen if they tried?
7. Can claimant follow directions?
8. List all examples of getting lost or becoming disoriented.

8. If you are unhappy with your decision
If you are not satisfied with the rate of benefit you have been awarded or you want the decision on your claim reconsidered, you can challenge it.

There are two ways to challenge a decision on a new claim:

A decision can be revised if the decision maker agrees it is wrong and you challenge it within one month. This may happen, for example, if you give in some more evidence to support your claim. You must ask for a revision within one month of the date the decision was made.

If your benefit is increased on revision you will get arrears of benefit.

You can appeal in writing to an independent tribunal. You do not have to ask for a revision before you appeal, but you only have one month from the date the decision was made to make an appeal. If your benefit is increased on appeal you will get arrears of benefit.

In very exceptional circumstances the deadline for an appeal or a revision can be extended for up to 13 months after the decision was made.

If you challenge a decision too late for it to be revised, or a decision is now wrong because there has been a change of circumstances since it was made, then that decision can be superseded. If your benefit is increased on a supersession then the higher rate of benefit will only be paid from the date that the new decision is made. For example, if you are already getting the lower rate for day-time care and your condition has got worse, so that you now need night-time care as well, you can ask for the rate to be increased. This will be treated as a request for the original decision to be superseded.

However, if you have been awarded benefit, think carefully before asking for the decision to be reconsidered. This is important because the whole question of your entitlement may be looked at again, and sometimes this can lead to benefit being reduced rather than increased.

WHERE CAN I GET HELP?
You should seek further advice if you want to challenge a decision about your benefit. You can get help with your appeal at a local advice centre, such as a citizen's advice bureau. You can get more information about this from our factsheet F15, Finding a local advice centre, which is available at www.cara-online.org

Central Africa’s Rights and AIDS (CARA) Society has also published Benefit appeals - A guide to benefit appeals for advisers and disabled people. This guide helps you prepare for an appeal tribunal and will increase your chances of success at the hearing. It takes you through all the stages of the benefit decision-making process from the moment you receive an unsatisfactory decision through to the tribunal hearing.

It is available to have a look at it on our website at www.cara-online.org or by contacting CARA, 18 - 22 Ashwin Street, Dalston, Hackney, London E8 3DL - Tel: +44 (0) 844 478 0015 -Mob: +44(0) 795 695 2645 -Fax: +44(0) 872 115 8436 -Email: info@cara-online.org

Updated April 2010