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.
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:
For the disability test for the middle rate DLA care component you must satisfy one of the following conditions:
For the disability test for the highest rate DLA care component you must satisfy either of the following:
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.
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 nighttime 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.
The rules for the mobility component are contained in Section 73 of the Social Security Contributions and Benefits Act 1992 and reguation 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:
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:
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.
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 :
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.
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.
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".
This 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 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.
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 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.
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 produced a new publication entitled "DLA/AA - a guide to making a claim" available to order at www.disabilityalliance.org/claimaadla.htm.
If you want more detailed information about the DLA rules see our Disability Rights Handbook, available at www.disabilityalliance.org/drh35.htm.
For information on DLA appeals see the following factsheets:
Disability Alliance has also produced a digest of disability living allowance and attendance allowance case law summaries available at www.disabilityalliance.org/digest.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.
www.disabilityalliance.org - 22 October 2009
