People with a severe mental illness are exempt from the Personal Capacity Assessment. The handbook for doctors states that the mental health assessment should be applied in all other cases where the claimant is suffering from a specific mental illness or disablement. The handbook also lists the following types of claimant to whom the assessment should be applied.
The handbook cites a Commissioner's decision (CIB14202/96) to the effect that the mental health assessment should only be undertaken where there is mental disablement rather than "a mere disturbance of mood." The decision states "In this context, therefore, the matters specified in Part II of the Schedule under the heading “Mental Disabilities”, can qualify for “points” only if they result from “mental disablement” (reg. 24). In other words, they must not be mere matters of mood but must relate to a recognisable mental disablement, in the nature of an illness and not shared by healthy members of the population." (emphasis added).
Doctors are advised to record their reasons for not applying the mental health assessment in those cases where the claimant reports a mental health problem but there is no clinical evidence for this.
With regard to the assessment itself the handbook emphasises that the various statements are interlinked and that no single question stands on its own. The purpose of the statements is to provide a complete picture so that an opinion can be arrived at.
Doctors are reminded that it is not a diagnosis that is required but a view as to the effect of the condition that is required.
The point is made that some claimants may present stereotypical symptoms and behaviour which reflects their perceptions of how they expect others to see them. Doctors are therefore encouraged to "get behind this presentation" by adopting an understanding and empathic approach.
Doctors are instructed to allow some time to build a rapport with the claimant and to ask open questions rather than direct ones. The following are given as examples of appropriate open questions-
Doctors are also told to assess and record the relevant parameters of a mental state examination. These are listed as-
Emphasis is given to the need to be sensitive and responsive to cultural and linguistic differences with regard to mental health issues.
The point is also made that doctors need to be sensitive to the fact that some claimants who present solely for physical examination may also require a physical examination as well - depressive illness and some paranoid disorders may present with exclusively physical symptoms.
