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.
The self assessment form lends itself more readily to those claimants who have physical disabilities rather than mental health problems. 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.
To qualify for the CARE component, you must need care, supervision or watching over from another person because of your disabilities.
You must be:
"so severely disabled physically or mentally that…you require…"
DURING THE DAY (Middle/higher rate)
"frequent attention throughout the day in connection with your bodily functions"
or
"continual supervision throughout the day in order to avoid substantial danger to yourself or others"
and/or
AT NIGHT
"prolonged or repeated attention in connection with your bodily functions"
or
"in order to avoid substantial danger to (yourself) or others (you require) another person to be awake for a prolonged period or at frequent intervals for the purpose of watching over you."
PART-TIME DAY CARE (Lower rate)
"(you require) in connection with your bodily functions attention from another person for a significant portion of the day (whether during a single period or a number of periods)."
"(you) cannot prepare a cooked main meal for yourself if (you have) the ingredients."
For the MOBILITY Component, you should be aged 5 or above for the lower rate, or 3 or above for the higher rate, and
EITHER (Higher rate)
you are unable to walk
OR
you are "virtually unable to walk"
OR
the "exertion required to walk would constitute a danger to (your) or would be likely to lead to a serious deterioration in (your) health"
OR
you have no legs or feet OR are both deaf and blind
OR are entitled to the Higher rate Care component and are "severely mentally impaired" with extremely disruptive and dangerous behaviour (this is intended for those with "arrested development of the brain" and generally excludes those with mental illness or recent brain damage).
OR (Lower rate)
you are "so severely disabled physically or mentally that, disregarding any ability (you) may have to use routes which 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 rules for the Mobility Component are contained in Section 73 of the Social Security Contributions and Benefits Act 1992, and the rules for the Care Component are in Section 72 of the same act.
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" ie. about an hour. 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 how these should be reflected on the DLA claim form. REMEMBER to give specific examples to back up each assertion.
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".
Could include some clients who are catatonic and unable to move for hours or days.
Motivation can be the key issue here. Does the claimant
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.
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).
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:
REMEMBER to list examples of self neglect and illnesses associated with that, eg stomach illnesses (living on junk food etc), bronchitis etc.
A person's mental health problems may mean that they are unable to prepare a cooked main meal due to motivational problems; cooking calls for decision making, precise actions to prepare it and finally cooking it on a traditional cooker. There may also be issues of safety if the client is frequently distracted.
"In the main meal test ... we are seeking to adopt a new more practical approach to bring into benefit an important group who do not have care needs related to their bodily functions but whose disabilities cause them difficulties in performing what to many of us are routine but important daily tasks".
Tony Newton, (then Secretary of State for Social Security, Hansard, 21/11/90, col.313).
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.
Note:
Is there:
Does 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:
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:
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 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.
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 http://www.disabilityalliance.org/f15.htm.
Disability Alliance 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 buy on our website at http://www.disabilityalliance.org/benapp.htm or by contacting Disability Alliance on 020 7247 8776 (voice and minicom) or by fax on 020 7247 8765.
Disability Alliance has also published two guides on DLA.
Claiming disability living allowance - a self help guide for people aged 16-64 takes you through the process of making a claim for disability living allowance and goes through the claim form question by question, providing help and suggestions on how best to present evidence to support your claim. It is available to buy on our website at http://www.disabilityalliance.org/claimdla.htm
If you want more detailed information about the DLA rules see our Disability Rights Handbook, available at www.disabilityalliance.org/drh33.htm.
You can also obtain copies of these publications and factsheets by contacting Disability Alliance on 020 7247 8776 (voice and minicom) or by fax on 020 7247 8765.
April 2008
