People who are deemed to be severely mentally ill are exempt from the personal capacity assessment. People
receiving the following types of care are deemed to be exempt:
- Sheltered residential facilities where the person receives regular medical or nursing care.
- Day care at least one day per week in a centre where qualified nursing care is available.
- Care at home with intervention, at least one day a week, by a qualified mental health worker.
- Long term medication with anti-psychotic preparations including depot, neuroleptic or mood modifying drugs or equivalent modern
oral medication
The DWP's Handbook for Approved Doctors also states-
"Where, as result of their mental disease or disablement, the person's behaiviour is so adversely affected that-
- Their ability to function is severely limited.
- They are very likely to pose a real threat or danger to themselves or others (such as work colleagues or members of the public).
Then you should consider advising that they meet the severe mental illness criteria."
The handbook makes the point that each individual case should be judged on its merits.
Chronic schizophrenia and long established bipolar affective disorder will usually be classed as severe mental illness
The following features are identified as indicating those cases of chronic psychosis that may be exempt-
- "Insidious rather than sudden onset, in young adults rather than middle life apart from first episodes which can be short lasting and never recur.
- Chronic relapsing rather than acute intermittent course.
- Long or frequent periods of hospitalisation.
- Repeated compulsory treatment especially in a secure unit.
- Requiring ongoing treatment which is compatible with a severe and chronic disabling condition
- Poor insight/compliance and/or self harm.
- Negative symptoms eg apathy, withdrawal, cognitive impairment and personality destruction"
The handbook lists the following features of severe depression that would qualify someone as being exempt:
- "A more distant history of attempted suicide needs to be considered in the light of evidence concerning the claimant's current mental health.
- History of self neglect.
- Requirement for recent hospital admission and/or current day hospital treatment.
- Supervision by community mental health team as well as GP.
- Lack of insight and/or poor compliance with treatment/supervision.
- Additional conditions including personality disorder, alcohol abuse."
With regard to severe phobic anxiety, the handbook lists the the following features which may indicate that the person is exempt-
- Severe anxiety symptoms such as depersonalisation, derealisation, panic attacks.
- Severe panic disorder with rapid spiral of anxiety, predominant physical symptoms, and fear of catastrophic consequences.
- Secondary depression, where significant symptoms persist despaite treatment
- Additional disorders producing cumulative effects, including personality disorder.
- Paranoid schizophrenia maquerading as agoraphobia.
The handbook makes the point that Obsessive Compulsive Disorder can be severely disabling
and advises that exemption can be considered when there is an associated severe depressive disorder or when
the obsessive compulsive behaviour is having a "severe negative impact on daily living activities and social functioning."
The handbook makes the point that alcoholism does not by itself meet the criteria for severe mental illness but also state that the following
may be worthy of consideration:
- Alcohol abuse of such a degree that there is associated cerebellar degeneration, especially if combined with peripheral neuropathy.
- Alcohol abuse which has led to loss of insight due to cognitive impairment.
- Alcohol abuse where loss of personality and self regard has led to abnormal behaviour and lifestyle to the point of extreme poverty and neglect.
- Cases with an associated stroke, myopathy, or cardiomyopathy.
With regard to drug dependency the handbook indicates that drug dependency to a degree which adversely
affects a person's behaviour and severely restricts social functioning to such and extent the residential treatment is required may be sufficient to qualify as
being severely mentally ill as may a severe psychotic disorder resulting from drug abuse.
