And so the judgment is handed down…………..

So today a very important judgment was handed down regarding the Work Capability Assessment and those with Mental Health Conditions and no doubt has been a joyous day for many of us including me, so let me explain how this judgment directly affects me.

??????????As many of you will know and this blog is testament too I suffered an SAH Stroke 23 years ago and yes while I have made leaps and bounds in my recovery I will never be the same as I was and thus have various disabling conditions both physically and mentally and in many ways the mental health I suffer affects me the most because it is not there to see and thus people do not understand indeed how could they as it is something very hard to understand if you have not suffered it and yes even to those ministers who put the legislation in place for us mortal citizens to abide too however they have been told enough times so they should at least listen to those that are in the know because it makes a very sad Government indeed if they do not.

My SAH Stroke was on the 7th April 1990 a date pinned to the forefront of my mind and one I will never forget it was a very tragic event and one that I am reminded of so many many times during my recovery and beyond.

My SAH Stroke was long before coiling was devised as a method to stop the bleed and did not arrive here until 1992 some 2 years after my SAH Stroke so the only option open to me was a deep invasive craniotomy and my consultants told me I would be left with various forms of disability both physically and mentally due to the nature of the operation and where the bleed is located but I had to have it done because the only other option was die plus I was only just married and deeply in love with my wife who I could not leave behind.

So the time was set for my operation that took over 8 hours plus 2 months of induced coma following to limit brain activity and reduced the swelling because I did look like a beat up football I am told.

I was left with damage to my frontal and temporal lobes due to blood starvation and thus lack of oxygen which caused a stroke down my right side which was my natural side and thus made the recovery that much harder after 6 months in hospital and much physiotherapy I was sent home with very little support because post stroke care was not like it is today so was left with a few sheets of paper telling me what I must do.

Those sheets of paper meant nothing to me and may of just been blank as I could not relate to them and even my wife found it hard with no back up you see frontal and temporal lobe damage causes various forms of executive dysfunctioning and really should of had the mental health tests to see and diagnose at what levels this part of the brain is affected but I did not and was left in the later years to self diagnose myself via the internet which is no good when you are up against the DWP and/or ATOS and so have very much been stuck between a rock and a hard place.

What are executive functions?

Executive functioning is an umbrella term for many abilities including:

  • Planning and organisation
  • Flexible thinking
  • Monitoring performance
  • Multi-tasking
  • Solving unusual problems
  • Self-awareness
  • Learning rules
  • Social behaviour
  • Making decisions
  • Motivation
  • Initiating appropriate behaviour
  • Inhibiting inappropriate behaviour
  • Controlling emotions
  • Concentrating and taking in information

https://www.headway.org.uk/executive-dysfunction-after-brain-injury.aspx

So as you can see from the above I have been discriminated against and the DWP have failed in their duty under the equalities act 2010 because I struggle with what many take for granted as easy everyday tasks like motivation which many have accused me of laziness, if only that was true as it would be so much easier to put right but the fact is I struggle to understand the importance of things so being left to compile my own evidence to send to the DWP is where I really needed help and the 30 day time limit to return forms is quiet simply no good to me.

Some will say well why did you not get you wife to help you? well the reason their is because she is also tired and knackered because not only does she work part time she also cares for her bedridden mother who is also very poorly and has been for a good few years.

The fact remains that the lazy ones here are the DWP.

My emotions are up and down and quiet often I feel like just throwing in the towel and giving up but no I will not because that is what Cameron et all has done to us and left us to fend for ourselves so I will fight on in getting fair judgment and as for Mr Cameron and his Government well at the end of the local elections I hear him say he has a lot of work to do to win back the electorate, indeed he does starting right here.

 

Finally – legal proof that disability benefits test is unfair for people with mental illness

Via Paul Jenkins @ Rethink Mental Illness

Three judges today confirmed what campaigners have been shouting from the rooftops for years – the benefits test used to decide whether people are fit for work, actively discriminates against people with mental illness.

This is a huge victory for everyone who has been subjected to the cruel and unfair Work Capability Assessment(WCA), which is used to decide who is fit for work.

Read more about our new campaign – Unfair WCA

The WCA is riddled with problems but this judicial review focussed on one specific issue – that of gathering supporting evidence. Under the current system, no matter how ill or even delusional you may be, you are responsible for proactively gathering your own medical evidence and sending it to the Department of Work and Pensions (DWP). If you fail to do this, it simply won’t be looked at.

This means your ability to work will be judged from a one-off 15 minute assessment by a stranger who may well have no mental health training whatsoever and has no idea what your GP, psychiatrist or Community Psychiatric Nurse has to say about your illness. It means all the paperwork documenting your long history of severe and enduring mental illness can be simply ignored.

While for most people, gathering this kind of evidence would be fairly straightforward, for someone with a severe mental illness, it can be an impossible task. We’re talking about people who may be in the midst of a psychotic episode or someone who perhaps hasn’t left the house for months.

“It’s like asking someone in a wheelchair to walk to the assessment centre.”

Our CEO Paul Jenkins on the Unfair WCA

Unfair WCA – our new campaign

It’s these very people, those who are most ill, who are least likely to be able to gather their own evidence and who are being penalised as a result. It’s like asking someone in a wheelchair to walk to the assessment centre. It sets people up to fail and means that some of the most vulnerable people in our society are being left without the basic financial support they need.

The system flies in the face of equality legislation, which has been carefully developed over the last 50 years to protect people with disabilities. It creates the impression that the DWP isn’t too worried about getting it right, they’re just interested in slashing benefits, no matter what the human cost.

What makes it even harder to stomach is that it’s completely at odds with the government’s repeated insistence that mental health is a top priority. On the one hand, they are pushing forward with the Mental Health Strategy and the recently passed Mental Health Discrimination Bill, and on the other they are penalising the very same group by forcing them through this discriminatory process, which is putting lives at riskA poll of over 1,000 GPscommissioned by Rethink Mental Illness last year, found that over 20% have patients who have felt suicidal due to the WCA.

The judgment is a huge victory for everyone affected by severe mental illness, but it’s sad that it took a court case to force the DWP to take action. They have been dragging their heels on this issue for years while making vague and empty promises to improve. All this time, people with severe mental illnesses have continued to be subjected to this unfair test and many have wrongly had their benefits reduced or removed. Now that the court has ruled that these tests are unfair, it would be completely irresponsible to carry on using them. We are calling on the DWP to halt the mass reassessment of people in this group receiving incapacity benefit immediately, until the process is fixed.

We’re not saying people with severe mental illness cannot work. For some people work can be central to recovery and staying well. Those people should be offered support to get back into employment. What we are saying is that benefit tests should be fair and accurate, to ensure the most ill and vulnerable people in our society don’t slip through the net. It’s in everyone’s interests that we get this right. Inaccurate assessments lead to costly appeals and put further strain on the public purse.

Today’s ruling is a huge step forward, but the real work starts now. There has been a lot of tinkering around the edges of the system, but not enough real action. Now we not only need to see major reforms to the WCA, but also to the assessment process for all benefits so we can be sure people with mental illness are getting a fair deal.

We will keep campaigning on behalf of everyone we represent until the whole system is fair for everyone. Read more and get the latest on our new campaign about the Unfair WCA.

http://www.rethink.org/news-views/2013/05/finally-legal-proof-that-disability-benefits-test-is-unfair-for-people-with-mental-illness

Two win sickness benefit test legal challenge

Via The BBC

Two people with mental health problems have won a legal challenge against the government tests for sickness benefit.

Judges at the Upper Tribunal ruled the Work Capability Assessment puts people with mental illness, autism and learning difficulties at a substantial disadvantage.

The process is too difficult for many to navigate, a court heard.

The Department for Work and Pensions says there are safeguards in place and it will appeal against the ruling.

Work Capability Assessment (WCA) tests, which measure a person’s entitlement to Employment and Support Allowance (ESA) by determining whether they are fit for employment, were introduced in 2008 and are carried out on behalf of the government.

The claimants alleged the system discriminated against them but the judges have asked to see further evidence before it can make a decision on this.

‘Significant improvements’

The court was told people who have conditions that mean they lack insight can struggle to gather the right documents needed for a successful claim, such as doctors’ reports.

The judgment was the result of a judicial review brought by two claimants with mental health problems, whose identities have been protected.Lawyers for the two argued that where a claim is from someone with a mental health problem, it should be the government’s responsibility to seek additional medical evidence.

UK charities Rethink Mental Illness, Mind and the National Autistic Society intervened in the case to provide evidence based on the experiences of their members and supporters.

Almost 20,000 people are assessed each week for ESA – including those moving over from the old benefit system of Incapacity Benefit (IB) – in England, Wales and Scotland, DWP figures show. The benefits system in Northern Ireland is administered separately.

More than a third of these people are claiming primarily for mental health problems, meaning tens of thousands of people each month are going through a process that puts them at a substantial disadvantage, the mental health charity said.

Under the current system, evidence from a professional, such as a GP or social worker, is expected to be provided by claimants themselves. There is no obligation for the DWP to collect this evidence, even on behalf of the most vulnerable claimants – apart from in some rare cases.

The charities involved in the case called on the government to suspend use of WCA tests for the people they help.

Mind’s chief executive Paul Farmer said: “The judgment is a victory, not only for the two individuals involved in this case, but for thousands of people who have experienced additional distress and anxiety because they have struggled through an assessment process which does not adequately consider the needs of people with mental health problems.”

The DWP said it wished to work with charities to “continually improve” the WCA for people with mental health problems.

But a spokesperson said: “We disagree with today’s ruling and intend to appeal.

“We believe we have made – and continue to make – significant improvements to the WCA process for people with mental health conditions. The percentage of people with mental health conditions who go into the support group for ESA has more than tripled since 2010.

The DWP said the tribunal had made clear that there are safeguards built in to the WCA process to help ESA claimants.

http://www.bbc.co.uk/news/uk-22620894

How not to miss – subarachnoid haemorrhage

By Professor Tim Harris  professor in emergency medicine, Queen’s Mary University London and Bart’s Health NHS Trust.

Mr David Sayer is specialist registrar in neurosurgery, Queen’s Hospital, Romford

Via PULSE

Professor in emergency medicine, Tim Harris, and specialist registrar in neurosurgery Mr David Sayer discuss the signs and the pitfalls in diagnosing subarachnoid haemorrhage

 

hemorrhagic_250wWorst outcomes if missed

SAH is a devastating disease with a mortality of 45% and from which 30% of the survivors will have severe disability.3 The chance of an aneurysm which has had a small rupture, having a further bleed is approximately 1.5% per day for the first two weeks. Early treatment with either surgery or angiographic coiling aims to prevent further bleeding and serious neurological damage, thus early diagnosis is important.

The worse outcome is death or disability following a re-bleed in a well patient. The patient who has a grade 1 SAH (GCS 15 with no deficit) has the most to gain from prompt treatment of the aneurysm and the potential to lead a completely normal life. If the first bleed is missed and a subsequent one happens, the risk is highest in the first two weeks, then this has a significant chance of causing death or disability, which is preventable. These, as they are neurologically intact, are the patients most likely to present to primary care.

Epidemiology

SAH is most commonly due to rupture of a Berry aneurysm, causal in around 85%. 10% are idiopathic perimesencepalic bleeds and around 5% are due to rarer causes, including intracranial artery dissection, arterio-venous malformation, tumours, angiitis, cerebral venous thrombosis and RCVS. The incidence is around 6-8:100000/year.1

Asymptomatic Berry aneurysms are common, occurring in 3-6% of the population.2

The prognosis for non-aneurysmal SAH is good.

Symptoms and signs

Acute severe headache

Patients with SAH usually complain of having an acute severe headache, but can present with

  • altered consciousness
  • coma
  • seizure
  • syncope.

The classical presentation is a ‘thunderclap headache’, defined as a headache that reaches 7/10 or more on a 0-10 pain severity scale within one minute of onset.4 It lasts from minutes to days.

SAH is identified in around 10-25% of such presentations and in 10-12%, other serious diagnoses are found.5,6

Thunderclap headache requires urgent referral to the emergency department for evaluation, regardless of associated findings such as neck stiffness or normal cerebral function. Urgent referral should still be made for patients attending in the days post thunderclap headache, as this may represent a ‘warning bleed’ for SAH.

Less severe headache

SAH may present with less severe headache. The so called sentinel bleed, in which a small leak of blood from an aneurysm occurs some days or weeks prior to a larger bleed, is well described and sees clinicians have a low threshold for investigation of headache.6

Differential diagnoses

Benign

  • Migraine
  • Medication overuse headache
  • Acute trigeminal autonomic neuralgias (such as cluster type headache)
  • Musculoskeletal disease
  • Benign sex headache
  • Sinusitis

Severe

  • Intracerebral haemorrhage
  • Extradural haemorrhage
  • Meningitis
  • Cervical artery dissection
  • Aneurysm of intracranial vessels.
  • Temporal arteritis
  • Cerebral venous sinus thrombosis
  • Pituitary apoplexy
  • Space occupying lesions
  • Glaucoma
  • Reversible cerebral vasoconstriction syndrome (RCVS).5

To avoid missing SAH, GPs should have a low threshold for the investigation of headache, not simply thunderclap headache, even if the patient being assessed has a history of headache in the past.

A headache of different character to usual is most safely assumed as potentially representing a different aetiology.

Only around 70% SAH presents with isolated headache and this meets the definition for ‘thunderclap headache’ in only 50%.

Investigations

A non-contrast CT brain scan is the key to most headache diagnoses. A lumbar puncture (LP) is commonly recommended if the CT scan has not identified a cause for the headache.

CT accuracy for diagnosing SAH falls with time from headache onset – approaching 100% if performed within six hours but falling to 90% to around 24-48 hours and 50% by one week. 7,8

The LP is performed 12-hours post-headache in order to identify xanthochromia. CSF is sent to the laboratory for cell counts and spectrophotometry. If the latter identifies bilirubin this is taken as diagnostic of SAH.  However, the LP is non-diagnostic in up to one third of cases.

The requirement for an LP on all CT negative patients with a history suggestive of SAH has been recently challenged with a large prospective cohort study suggesting that CT scanning may exclude SAH if CT is performed within six hours of onset. Some departments offer alternative further investigations for patients presenting with thunderclap headache, such as MRA or CT angiography. If the non-contrast CT or LP suggest SAH then the investigation of choice to identify the cause of SAH is a CT angiogram.

 

Five key questions

  • Is this your worse ever headache and different to your previous headaches?
  • How long did it take to reach peak intensity? (SAH peaks within minutes)
  • Are there any features of meningeal irritation? For example, neck stiffness, photophobia, nausea and vomiting
  • Was there any associated loss of consciousness, no matter how brief?
  • Any family history of brain haemorrhage? There is an increased chance of aneurysm if two first degree relatives have suffered from a subarachnoid haemorrhage.

Five red herrings

  1. In patients with previous headaches, these can confuse the issue. The biggest risk is failure to consider the diagnosis. In particular, a different headache from usual is important.
  2. Are there any focal neurological deficits? This points to a different diagnosis as patients presenting to a GP surgery with SAH are unlikely to have a focal deficit, these tend to happen in poorer grade patients. The exception is an acute third nerve palsy which can signify a posterior communicating artery aneurysm.
  3. Treat falls with suspicion. Did the event happen before and caused the fall, rather than the headache being a result of a bang to the head.
  4. Increased blood pressure often occurs in SAH. Be wary of attributing headache to hypertension.
  5. Fevers, particularly high, suggest an alternative diagnosis such as meningitis.

 

Professor Tim Harris is professor in emergency medicine, Queen’s Mary University London and Bart’s Health NHS Trust. Mr David Sayer is specialist registrar in neurosurgery, Queen’s Hospital, Romford

http://www.pulsetoday.co.uk/clinical/how-not-to-miss-subarachnoid-haemorrhage/20002996.article#.UZ0ImKK1GE0