Ok, to start with, some disclaimers. Please don’t treat anything I say as gospel truth. If I say something in this, then as far as I’m aware it’s true, but I could be wrong.
If you’re applying for Incapacity Benefit (IB), or facing a re-assessment, then the single most important piece of advice is this: go and talk to the Citizen’s Advice Bureau (CAB). They’ll not only be able to offer advice which, unlike mine, is guaranteed to be up to date and accurate, but they’ll also be able to give you guidance related to your individual circumstances, which obviously I can’t. In particular you should go and see them if you end up having to dispute or appeal against a decision not to award you benefit. They can help you with every stage of this, and will even arrange for a representative to go with you to the appeal tribunal. I’m not exaggerating when I say that if it wasn’t for the help of the CAB, I don’t think I would have won my appeal.
The information in this post relates to the personal capability assessment (PCA) for Incapacity Benefit. From the 27th October 2008, all new applicants will have to apply for the Employment and Support Allowance, which will have different rules, and no doubt different criteria for assessing medical incapacity. People who are already receiving IB will continue to receive it for the time being, and any re-assessments will (as far as I know) be done on the basis of the existing PCA, so hopefully this post will stay relevant for some people for some time.
What I say about the PCA is based on two things. Partly it’s based on my own experiences of going through the process several times, and so it will only focus on the mental health part of the PCA, as I don’t have any serious physical health problems. It’s also based on documentation I was given as part of my appeal process, which outlines what the criteria for the PCA are. This documentation outlines the PCA as it was in 2005. As far as I know, there haven’t been any changes since then, but if there have, then what I say will be out of date. This is why I very strongly recommend that you contact the CAB for advice, rather than relying on what I say.
Ok, on with the actual information. (If you can’t face wading through all this text, there’s a 10 point summary at the end.)
The decision on whether or not an IB applicant is fit for work is made by a DWP administrator (called a decision maker), not a doctor, or nurse, or anyone else with a medical qualification. Their decision is based on three things:
- the information provided by an applicant in their form (form IB50);
- any information provided by the applicant’s doctor, or someone else who is involved in treating the applicant;
- a report made by a doctor appointed by the DWP.
The decision maker is specifically empowered to overrule medical opinion if s/he thinks it appropriate, which makes it very important for an applicant to present their problems in terms of the criteria used in the PCA.
The PCA criteria are based, not on what illness or condition you have, or even on the severity of the symptoms you experience, but on how those symptoms affect your day-to-day life, and so your ability to work. At a basic level, this means that a statement on the IB50 form saying something like “I suffer from very bad anxiety” isn’t very useful to the decision maker. A statement saying “Because of my anxiety I cannot leave the house on my own” is more useful. You should also make sure that you talk about the full range of difficulties that a particular problem presents. For example, if anxiety also makes other things difficult or impossible for you, you should say so clearly.
It really is important to stress the full range of effects that a particular problem or symptom has on your day-to-day life both when filling in the form and when talking to the DWP doctor. The reason for this is that you’re not trying to convince the decision maker that you’re ill, but that your illness affects your ability to work. This can seem fairly obvious when it’s written down, but it can take some getting used to, particularly in the consultation with the DWP doctor. In a medical consultation you will be used to describing your symptoms, being told (probably) what’s wrong with you, and what can be done about it. It can take quite a big mental leap to realise that in this particular consultation it’s not the symptoms that matter, but the effects they have.
The reason I’m stressing this quite so much is that in one DWP consultation I had (the one that led to the appeal) I focussed on telling the doctor about my symptoms, but because I didn’t talk much about the problems they caused me, she decided they weren’t bad enough to interfere with my ability to work. Although you might hope that the DWP doctor will ask you specific questions to reveal the information they need to know, you can’t be certain that this will be the case.
When they come to decide whether an applicant is fit to work, the decision maker is faced with a list of statements, which are known as descriptors. They decide whether or not a particular descriptor applies to the applicant. If they decide that it does, then a set number of points are awarded. In order to be judged unfit for work as a result of purely mental factors, an applicant has to score a minimum of 10 points, from a maximum of 34. It’s obviously useful to know what the descriptors are, in order to know what specific problems the decision maker is looking for. It’s a good idea to try and keep them in mind both when completing the IB form (IB50) and when talking to the DWP doctor. It would obviously be very difficult to try and remember all 25 mental descriptors, but you will probably find that some don’t apply to you, and that some are of greater importance than others.
The mental descriptors are arranged under four broad headings: completion of tasks; daily living; coping with pressure; and interaction with other people. I’ve listed the various descriptors here, together with the number of points that are awarded if they apply. (A list of the descriptors is also available here, along with the list of physical descriptors.)
Completion of tasks
- Cannot answer the telephone and reliably take a message – 2 points.
- Often sits for hours doing nothing – 2 points.
- Cannot concentrate to read a magazine article or follow a radio programme – 1 point.
- Cannot use a telephone book or other directory to find a number – 1 point.
- Mental condition prevents him from undertaking leisure activities previously enjoyed – 1 point.
- Overlooks or forgets the risks posed by domestic appliances or other common hazards due to poor concentration – 1 point.
- Agitation, confusion or forgetfulness has resulted in potentially dangerous accidents in the last 3 months – 1 point.
- Concentration can only be sustained by prompting – 1 point.
- Needs encouragement to get up and dress – 2 points.
- Needs alcohol before midday – 2 points.
- Is frequently distressed at some time of the day due to fluctuation of mood – 1 point.
- Does not care about his appearance and living conditions – 1 point.
- Sleep problems interfere with his daytime activities – 1 point.
Coping with pressure
- Mental stress was a factor in making him stop work – 2 points.
- Frequently feels scared or panicky for no obvious reason – 2 points.
- Avoids carrying out routine activities because he is convinced they will prove too tiring or stressful – 1 point.
- Is unable to cope with changes in daily routine – 1 point.
- Frequently finds there are so many things to do that he gives up because of fatigue, apathy or disinterest – 1 point.
- Is scared or anxious that work would bring back or worsen his illness – 1 point.
Interaction with other people
- (a) Cannot look after himself without help from others – 2 points.
- (b) Gets so upset by ordinary events that it results in disruptive behavioural problems – 2 points.
- (c) Mental problems impair ability to communicate with other people – 2 points.
- (d) Gets irritated by things which would not have bothered him before becoming ill – 1 point.
- (e) Prefers to be alone six hours or more each day – 1 point.
- (f) Is too frightened to go out alone – 1 point.
There are some strange things about this list. For example, someone suffering from long-term unipolar depression doesn’t seem to have their distress counted – it has to result from a ‘fluctuation of mood’ [my emphasis]. This shows the importance of relating your experience to the criteria, and talking about it in these terms, both in the form, and during the DWP medical consultation. For example, my level of depression varies to some degree over a day, so I have used this as evidence that a fluctuating mood causes me distress.
Even so, most people will probably find that a lot of the descriptors don’t apply to them, how ever much they try to fit their experiences to them. This doesn’t mean that things are hopeless, and you should try not to panic. On the application I sent in this week, I found that only 9 of the descriptors definitely apply to me (although I think another 6 partly apply). That doesn’t sound like a lot, but would result in a score of 11 points, which would mean I would be judged incapable of work. It’s pretty damn scary to realise that the margin is so tight, but I have tried to be as realistic as possible – I think even an unsympathetic doctor and decision maker would have to give me those 11 points. If the decision maker and doctor assigned to me are strictly neutral rather than unsympathetic, I would expect to get closer to 14 points.
One of the possible responses to knowing the list of descriptors would be to invent evidence so that lots of them seem to apply to you. I don’t recommend doing this. The most important reason is that if you succeeded in getting benefit on the basis of lying, this would be fraud, and you could go to prison for it. I also don’t think it would be very likely to be successful, as the DWP will want evidence for anything you claim applies to you.
So, for example, if you claim that you are too anxious to go out alone, but arrive at the DWP medical consultation on your own (they will make a note of this), this increases the chances that the decision maker will decide that descriptor doesn’t apply to you. Equally, if you say that you need encouragement to get up and dress, the DWP will very likely want to know who provides this encouragement, which is clearly a problem for people like me who live alone, but nonetheless sometimes manage to get up and get dressed. I actually think this is one of the most unfair things in the PCA, as it effectively discriminates against those of us who are single, and have no option but to do certain things for ourselves.
My strategy in situations like this is to stress the level of difficulty I face. So, although I can’t say that I’m always too frightened to go out alone, I have stressed that I find doing it very difficult, have given examples of the difficulty, and have related it back to my MH problems. The PCA is not supposed to relate to any specific day, but rather to an average day. By emphasising the level of difficulty I face, my aim is to demonstrate that there are days when I am too frightened to go out alone, and hope that this will influence the decision maker’s opinion about an average day. Although there’s no guarantee any of this will be taken into account, there’s a chance that it will make a difference, if not in relation to this particular descriptor, then more generally.
Officially, doctors working for the DWP are told not to use the descriptors as a check-list, but rather to use their clinical skills to establish the general level of incapacity experienced by applicants, and then use that clinical opinion to rate their capabilities in the various activities described in the PCA. This means that, rather than asking a series of specific questions that relate to each descriptor in turn, the doctor should ask more general questions, and by listening to what you say, and observing your reactions, arrive at positions on the specific issues. In reality this seems to vary wildly between doctors. One DWP doctor did nothing but ask me a series of questions that were clearly based on individual descriptors. At the other extreme, another doctor asked extremely general questions that seemed to hardly relate to the PCA at all.
This freedom given to doctors is really a double-edged sword as far as applicants are concerned. On one hand it’s positive, because it means specific criteria are less important than the general level of incapacity you face. On the other hand, although the doctors are allowed to take this general view, the decision maker will still make their decision based on the various descriptors in the PCA. If a doctor is asking very general questions, it can be hard to be sure that accurate information about the problems you face with the activities described in the PCA will make it into the doctor’s report.
Really the only advice I can offer here is to keep in mind that, how ever the doctor expresses themselves, your job is to emphasise the problems that you face in doing the day to day activities mentioned in the PCA. Obviously you have to answer the questions the doctor asks, but you should remember that, ultimately, the doctor will be looking at your capabilities under the various headings of the PCA, and you should do whatever you can to make sure s/he has a clear understanding of the difficulties you face. In some situations this may result in you having to be more assertive than you are used to being in medical consultations.
Certainly, speaking personally, I tend to think that it’s my role in a consultation to answer questions in the same terms that the doctor asks them, but that can be dangerous. For example, when I had to appeal, part of the reason was that the doctor I had seen had asked various leading questions (“So you were having problems with depression, but your doctor’s prescribed some antidepressants for you. What improvements have you noticed in your mood?”), and I hadn’t realised that it was essential to emphasise the problems I still had, rather than what had got better.
I think I’ve probably covered more or less everything I can think of in terms of advice about facing the PCA, but here’s a summary:
- Try not to panic. Dealing with this is a horrible experience, but it is survivable.
- Read the various descriptors listed above, and decide which of them you think might apply to you.
- Think about your recent experiences and the problems you have in relation to the various descriptors, and present your evidence in such a way as to make the best possible case for a descriptor applying to you.
- Remember that your goal is not to convince the DWP’s decision maker that you are ill, but to explain to them why your illness means a particular descriptor applies to you.
- If you’re not sure whether or not a particular descriptor does apply to you, make a case for it anyway.
- Don’t invent evidence to support your case for any descriptor.
- The space provided in the IB form for your statement about your mental problems is tiny, but take as much space as you need to say what you have to say. There is an overflow space provided on the form itself, and you can also attach extra sheets of paper to the form.
- Keep in mind the descriptors you think apply to you when you are being interviewed by the DWP doctor, and try to answer the doctor’s questions in a way that supports your case.
- Try not to let yourself be intimidated or influenced by the doctor into being more positive about things than you should be.
- Remember that throughout the whole process your aim is to keep explaining as many times as necessary the ways your illness make it impossible for you to work.
Well, that’s that. I hope it will be of some use to some people, and maybe interesting to some others. But please don’t rely too much on anything I’ve said here. If you need advice and support, contact the CAB. You can be sure the advice they give will be up to date and accurate, but you shouldn’t assume that mine is. Obviously I’ve done my best to make sure it is, but I would hate to think of anyone getting into any problems or difficulties because they rely on something I’ve said.