The questions for mental health on the ESA forms, the scoring system and atos guidelines Question 11. Can you learn to do everyday tasks without difficulty? By mental, cognitive and intellectual functions we mean things like mental illness, learning difficulties & the effects of head injuries. Answer Yes or No. If you answered Yes you have indicated no problem and you are asked to go to the next question in the form. If you answered No the form asks you two sub questions which you can answer each one a choice of No Yes or It Varies. For question 11 the two sub questions are: (a) Can you learn how to do a simple task such as setting an alarm clock? (b) Can you learn how to do a more complicated task such as using a washing machine? Descriptor Points 11 (a) Cannot learn how to complete a simple task, such as setting an alarm clock. (= 15 Points) 11 (b) Cannot learn anything beyond a simple task, such as setting an alarm clock. (= 9 Points) 11 (c) Cannot learn anything beyond a moderately complex task, such as the steps involved in operating a washing machine to clean clothes. (= 6 Points) (d) None of the above apply. (= 0 Points) Atos guidelines Scope This activity reflects ability to learn a task. “Learning” assesses the ability to learn and retain information. The method that people learn by is not relevant - what is important is the ability to learn to do a task. It is therefore of no relevance whether a person learns a task by watching a visual demonstration, learns by reading or through verbal instruction. Within the workplace, the ability to learn tasks is vital. If the person needs to be shown how to do a task again, they have not learned it. This activity may be relevant to conditions including learning disability and organic brain disorders including acquired brain injury or stroke. People with severe and profound learning disability are unlikely to be able to learn how to complete a simple task and people with moderate learning disability are unlikely to be able to complete a moderately complex task. It also may reflect difficulties in understanding language, such as receptive dysphasia. Issues to consider • The length of time taken to learn a task and the ability to retain the information must be taken into account. • If a person learns a task on one day but is unable to repeat it the next day, they have not learned this task. • If a person takes a very long time to learn a task, for example takes 2 years to learn how to wash and dress themselves, this would not be considered reasonable and that person would not be considered to have the ability to learn this task. The inability to learn a very simple task represents a very high level of disability such that they would also be considered to have limited capability for work related activity. • A simple task may only involve one or two steps while a moderately complex task may involve 3 or 4 steps. Details of activities of daily living Consider basic functions of personal care and leisure activities. Simple tasks may include: • Brushing teeth. This would involve remembering to put toothpaste onto a brush and brushing all areas of teeth. • Washing. This would involve the ability to use soap/shower gel and wash their body • Brushing hair • Turning on the television/ using basic functions on the TV remote control • Getting a glass of water Moderately complex tasks may include: • Using a microwave oven • Making a cup of tea including filling kettle, putting tea bags in teapot, pouring into cup and adding milk and sugar • Playing CDs on a stereo • Using a Playstation • Using a computer for basic activities such as playing a game More complex tasks should also be considered such as driving should be detailed and any previous tasks learned in training and employment should be considered. Careful enquiry must be made during the history to ascertain the individual’s true capacity to learn tasks. For example, using a mobile phone may be considered to be a moderately complex task if the person can text, set up speed dials, change ring tones etc, however, if a person can only use the phone in a limited way to dial a number pre-set by a carer, this may be considered a simple task. Similarly use of a television/ remote control etc must be carefully considered. If the person has simply learned to use the “on” button on the TV control and digital box this does not necessarily mean they have an ability to learn very complex tasks. Enquiry should be made into what other things they can do. If someone can set up a TV/DVD player, programme channels, rearrange leads at the back of the TV it suggests a much greater capacity to learn more complex tasks. Mental State Examination Relevant findings may be general memory and concentration, general decision making ability at assessment, their ability to cope at interview, general intelligence and requirement for prompting. It may be appropriate when considering this functional area to consider and document more specific tests of memory and concentration. Question 12. Can you keep yourself safe when doing everyday tasks such as cooking? This section looks at how you cope with danger Answer Yes or No. If you answered Yes you have indicated no problem and you are asked to go to the next question in the form. If you answered No the form asks you one sub question which you can answer with a choice of Usually Sometimes or It varies. For question 12 the sub question is: Do you need supervision (someone to stay with you) to keep yourself safe? Descriptor Points 6 (a) Reduced awareness of everyday hazards leads to a significant risk of: (i) injury to self or others; or (ii) damage to property or possessions such that they require supervision for the majority of the time to maintain safety. (= 15 Points) 6 (b) Reduced awareness of everyday hazards leads to a significant risk of: (i) injury to self or others; or (ii) damage to property or possessions such that they frequently require supervision to maintain safety. (= 9 Points) 6 (c) Reduced awareness of everyday hazards leads to a significant risk of: (i) injury to self or others; or (ii) damage to property or possessions such that they occasionally require supervision to maintain safety. (= 6 Points) 6 (d) None of the above apply. (= 0 Points) Atos guidelines Scope This activity is intended to reflect the ability to recognise risks from common hazards that may be encountered by people with reduced awareness of danger through learning difficulties, or conditions affecting concentration, including detrimental effects of medication; or from brain injury or other neurological conditions affecting self awareness. It may also apply to people with severe depressive illness and psychotic disorders as a result of a significant reduction in attention and concentration, but is unlikely to apply to people with anxiety disorders. Issues to consider • The activity reflects a lack of understanding and insight that something is dangerous or that there is an impaired ability to recognise that a situation will present a potential hazard. For example a person with dementia may lack the insight to recognise why it may be dangerous for them to cook - they lack the ability to recognise that they are at risk of forgetting that the cooker is on. • The descriptors do not reflect simple accidents that may occur through lapses in concentration/distraction such as cutting a finger when chopping vegetables when the phone goes. If a person knows that there is a risk and therefore avoids the situation, they would not score in this category. There must be evidence that they do not realise there is a risk. • The level of severity of the descriptors reflects the amount of supervision that would be required to ensure the safety of the person and others. • The “majority of the time” would represent a need for daily supervision. Frequently would represent several times a week. • As substantial supervision in the workplace may pose problems, the level of supervision required has been taken into consideration when determining the LCW threshold. Thus those who require supervision for the majority of the time should be considered for the Support Group. • If AH(b) is suggested, the HCP must consider whether the issues presented may present “risk” to the safety of the person or others and they must carefully consider whether the “substantial risk” NFD is appropriate. Details of activities of daily living When considering this functional category details you should ask about ability to cope with potential hazards. These may include: • Ability to cope with road safety • How they manage if they live alone • Driving • Ability in the kitchen • Awareness of electrical safety • Responsibility for children/pets It may be useful to consider the concept of whether the person could be safely left alone to manage basic daily life when you consider this functional category. Mental State Examination Cognitive issues will be important in assessing this issue. Insight will also be an important factor. You should consider whether the claimant has adequate insight into their problems to recognise the risks present and therefore whether they are able to avoid potential hazardous situations. . Question 13 Can you manage to do daily tasks without difficulty? This section is about whether you can manage to start and complete daily routines and tasks like getting up, washing and dressings, cooking a meal or going shopping Answer Yes or No. If you answered Yes you have indicated no problem and you are asked to go to the next question in the form. If you answered No the form asks you a sub question which you can answer with a choice of Never Sometimes or It Varies. For question 13 the sub question is: Can you manage to plan, start and finish daily tasks? Descriptor Points 13 (a) Cannot, due to impaired mental function, reliably initiate or complete at least 2 sequential personal actions. (= 15 Points) 13 (b) Cannot, due to impaired mental function, reliably initiate or complete at least 2 personal actions for the majority of the time. (= 9 Points) 13 (c) Frequently cannot, due to impaired mental function, reliably initiate or complete at least 2 personal actions. (= 6 Points) 13 (d) None of the above apply (= 0 Points) Atos guildelines Scope This activity reflects the ability to initiate and successfully complete tasks without need for external prompting. This Support Group describes a severe restriction of an individual’s ability to understand how to co-ordinate actions in the correct sequence such that they successfully complete any personal actions in a logical order for example washing before dressing It is intended to reflect difficulties that may be encountered by people with conditions such as psychosis, OCD, autism and learning disability. A very severe depressive illness that results in apathy, or abnormal levels of fatigue experience problems in this area. It may be compounded by the effects of medication. Issues to consider • The intention of the activity is to assess whether a person has the capability to carry out routine day to day activities or activities that may normally be associated with work. The concept of 2 sequential tasks could include showering, and getting dressed to go out. • The issue of whether a person can repeatedly and reliably complete tasks must also be considered. • There must be evidence of effective personal action. For example, someone with OCD may initiate many actions, but due to rituals they may not actually be able to complete them and therefore should be considered not capable of personal action. Similarly, if a person perhaps with bipolar illness manages to wash and dress but then goes out and spends all their money on non essential activities, giving no consideration to issues such as bills, rent, food etc, they would not be considered to be initiating effective personal action. “Personal action” may include: • ability to plan and organise a simple meal • ability to get up, washed, dressed and ready for work in the morning • ability to cope with simple household tasks e.g. sorting laundry and using a washing machine • dealing with finances • arranging GP appointments, picking up prescriptions, taking medication Details of activities of daily living Areas to consider should include any behaviour that involves a decision to plan or organise a personal action to enable them to perform it. Activities may include: • Making travel arrangements • Writing shopping lists • Organising finances • Planning a simple meal • Getting washed and dressed • Ironing clothes for the next day • Caring for children: preparing clothing, lunches etc. Mental State Examination General memory and concentration will be important areas to consider. Intelligence and severity of depression should be considered. It would be expected that the Mental State Examination findings should be consistent with significant impairment of mental function if choosing a descriptor in this functional category. Where depression is present, evidence of psychomotor retardation would be likely if these descriptors were applicable. Question 14 Can you cope with changes to your daily routine? Answer Yes or No. If you answered Yes you have indicated no problem and you are asked to go to the next question in the form. If you answered No the form asks you two sub questions which you can answer each one with a choice of No Yes or It Varies. For question 14 the two / three sub questions are: (a) Can you cope with small changes to your routine if you know about them before they happen? (b) Can you cope with small changes to your routine if they are unexpected? Descriptor points 14 (a) Cannot cope with any change to the extent that day to day life cannot be managed. (= 15 Points) 14 (b) Cannot cope with minor planned change (such as a pre-arranged change to the routine time scheduled for a lunch break), to the extent that overall day to day life is made significantly more difficult. (= 9 Points) 14 (c) Cannot cope with minor unplanned change (such as the timing of an appointment on the day it is due to occur), to the extent that overall, day to day life is made significantly more difficult. (= 6 Points) 6 (d) None of the above apply. (= 0 Points) Atos guidelines Scope This activity reflects the flexibility needed to cope with changes in normal routine. It is intended to include difficulties that may be encountered by people with moderate/severe learning disability, autistic spectrum disorder, brain injury, OCD, severe anxiety or psychotic illness. It is not intended to reflect simple dislike of changes to routine, but rather the inability to cope with them. The permanence of the change is not relevant to the descriptors. Issues to consider • This activity reflects a significant level of disability where small changes result in the individual’s day to day life being significantly affected i.e. day to day life is made significantly more difficult or cannot be managed. • The highest descriptor represents a level such that a change to routine would mean that life would stop for everyone involved and basic activities could not continue. • More specific short lived episodes such as leaving the supermarket as it is too crowded would not be considered if this was the only change to their planned day. Similarly a person who has a panic attack but manages to do most usual tasks in a day after the episode of panic would not attract a scoring descriptor in this area. • It is important to obtain examples of when change occurred and what happened to the person when this occurred. Activities of daily living In this functional area you should consider the person’s ability to cope in situations where some change is possible. Areas to consider may include: • Use of public transport • Shopping • Dealing with appointments at hospital, GP or Jobcentre Plus • Coping with children and their out of school activities It may be useful to consider some of these activities in terms of the level of disability intended, for example: • A claimant with a severe form of mental disablement who may become so distressed by the supermarket being out of stock of their usual brand of breakfast cereal that they cannot continue with other activities or complete the rest of their shopping. • A claimant who would be unable to cope with the train being cancelled and would return home rather than wait for the next train. Mental State Examination It is expected that the Mental State Examination findings would be consistent with the type of conditions this descriptor is intended to reflect. They may have poor rapport and be extremely anxious at interview. It may be that they have been completely unable to attend the MEC for assessment. It would seem unlikely that a claimant who manages to attend the MEC alone would meet the level of severity of functional restriction for anything other than none of the above to apply. Question 15 Can you go out on your own? Answer Yes or No. If you answered Yes you have indicated no problem and you are asked to go to the next question in the form. If you answered No the form asks you two sub questions. The first (a) can be answered with a choice of No Yes or It Varies and the second (b) with a choice of Usually Not very often or It varies. For question 15 the two sub questions are: (a) Can you leave home and go to places you know if someone goes with you? (b) Can you leave home on your own and go to places you dont know? Descriptor points 15 (a) Cannot get to any specified place with which the claimant is familiar. (= 15 Points) 15 (b) Is unable to get to a specified place with which the claimant is familiar, without being accompanied by another person. (= 9 Points) 15 (c) Is unable to get to a specified place with which the claimant is unfamiliar without being accompanied by another person. (= 6 Points) 15 (d) None of the above apply. (= 0 Points) Atos guidelines: Scope This activity is intended to reflect inability to travel without support from another person, as a result of disorientation; or of agoraphobia causing fear of travelling unaccompanied by another person. People with a learning disability may have significant problems in this activity. The highest descriptor represents a complete inability to leave the home. Issues to consider • When considering this activity, the means that the person arrives at their destination is not considered. For example, individuals who are unable to use public transport but are able to arrive at their destination by other means will not score on this activity. • The descriptors do not reflect lesser degrees of anxiety about going out. Nor do they reflect planning and timekeeping. • For people with anxiety, panic disorder and agoraphobia there should be supporting evidence that corroborates the severity of the condition, for example, level of medication / psychiatric input. • Specified places with which the claimant is familiar would be locations in their local area such as the GP surgery, dentist, bank, post office, local shops etc. If a person simply avoids the large supermarket in the town but manages to go to other local shops etc, they would not score in this area. • A person who has been unable to leave the confines of their own village for many years may attract GA(c). Activities of daily living General level of function should be considered in this category with regard to level of anxiety and ability to leave the house. Activities to consider may be: • Shopping • Attending the chemist • Attending hospital or GP appointments • Walking the dog • Supervising children outdoors • General safety awareness and abilities in kitchen may support significant cognitive disruption resulting in safety issues if going out unaccompanied. Mental State Examination Intelligence and cognitive function must be carefully considered. It would be expected that evidence of severe anxiety would be apparent to support the level of functional restriction in this area. Lesser degrees of anxiety would not fulfil the criteria. The descriptors reflect true panic disorder or severe agoraphobia. Question 16 Can you cope with social situations? By social situations we mean things like meeting new people and going to meetings or appointments Answer Yes or No. If you answered Yes you have indicated no problem and you are asked to go to the next question in the form. If you answered No the form asks you two sub questions which you can answer each one a choice of No Yes or It Varies. For question 16 the two sub questions are: (a) Can you meet with people you know without feeling scared or anxious? (b) Can you meet with people you dont know without feeling too anxious or scared? Descriptor Points 16 (a) Engagement in social contact is always precluded due to difficulty relating to others or significant distress experienced by the individual. (= 15 Points) 16 (b) Engagement in social contact with someone unfamiliar to the claimant is always precluded due to difficulty relating to others or significant distress experienced by the individual. (= 9 Points) 16 (c) Engagement in social contact with someone unfamiliar to the claimant is not possible for the majority of the time due to difficulty relating to others or significant distress experienced by the individual. (= 6 Points) 16 (d) None of the above apply. (= 0 Points) Atos guidelines Scope This activity is intended to reflect a significant lack of self-confidence in face to face social situations that is greater in its nature and its functional effects than mere shyness or reticence. Those with severe anxiety, autism, psychosis or learning disability may have problems in this area. It reflects levels of anxiety that are much more severe than fleeting moments of anxiety such as any person might experience from time to time. Issues to consider • The level of anxiety referred to suggests a specific and overwhelming experience of fear, resulting in physical symptoms or a racing pulse, and often in feelings of impending death such as may occur in a panic attack. • There must be evidence that the social engagement results in significant distress to the individual. CSa represents almost total social isolation. • For people with anxiety, panic disorder and agoraphobia there should be supporting evidence that corroborates the severity of the condition, for example, level of medication / psychiatric input. Activities of daily living Consider any form of social contact such as: • Use of public transport • Shopping • Talking to neighbours • Use of phone • Hobbies and interests • Social interaction with family Mental State Examination The Mental State Examination findings would be expected to reflect severe anxiety or communication problems. Rapport is likely to be poor with lack of eye contact. The claimant may be sweating and finding the consultation difficult. They may be somewhat timid in demeanour at interview. It would seem likely the person would require a companion to attend at the MEC due to the level of anxiety/communication restriction that this descriptor would normally be expected to reflect. Question 17 Does your behaviour upset other people? Answer Yes or No. If you answered Yes you have indicated no problem and you are asked to go to the next question in the form. If you answered No the form asks you one sub question which you can answer with a choice of Every day Often or Occasionally. For question 17 the sub question is: How often do you behave in a way which upsets other people? This section looks at whether your behaviour upsets other people Descriptor Points 17 (a) Has, on a daily basis, uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace. (= 15 Points) 17 (b) Frequently has uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace. (= 15 Points) 17 (c) Occasionally has uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace. (= 9 Points) 17 (d) None of the above apply. (= 0 Points) Atos guidelines Scope This activity is intended to reflect difficulties in social behaviour which might for example, be encountered by people with psychotic illness or other conditions such as brain injury that result in lack of insight. The activity also includes the difficulties people with autistic spectrum disorder may have in social behaviour. It is intended to reflect the effects of episodic relapsing conditions such as some types of psychotic illness, as well as conditions resulting in consistently abnormal behaviour. Issues to consider • There should be evidence of a disorder of mental function for this descriptor to apply. This may be as a result of a specific mental illness or a condition, whether mental, physical, or sensory resulting in cognitive or intellectual impairment of mental function. The descriptors do not simply relate to aggressive behaviour/anger management issues where there is no underlying mental health issue. • The descriptors relate to behaviour that would be considered in an average workplace such as a call centre as this provides a more general concept rather than applying “reasonable” to one person’s standards as this may be subject to considerable variability. It is likely that the behaviour would extend beyond verbal aggression for the descriptors to apply. • There must be evidence that the individual is unable to control their behaviour for the descriptors to apply. • The history and nature of the events should be detailed along with the frequency in which they occur. • Where the episodes occur frequently and the episodes are major, the “risk” NFD must be carefully considered and whether or no it is applied fully justified. Activities of daily living Consider any activity involving interaction with others: • Previous occupational history • Shopping • Childcare • Parents nights at school • Relationships with neighbours • Ability to cope at appointments: GP/ Hospital etc • Ability to cope with bills and on the phone • Dealing with finances and bills at the post office • Appointments with official persons such as the Bank Manager/ Social Worker/ Benefits Personnel Mental State Examination There is likely to be evidence of reduced insight. Cognitive function should be carefully addressed. Evidence of addiction or thought disorder should be carefully assessed. Rapport may be poor and communication difficult.
Posted on: Sun, 19 Jan 2014 13:12:11 +0000
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