PIP Activity 3 Monitoring or Therapy? Surely can't be limited to monitoring

[Deleted User]

Hi, 

Apologies to anyone that may take offence at the condition I have but it is not a choice. 

Since a child I have had numerous mental issues: OCD, fear and anxieties of differing types. My father died in 1994 and with this came cancerphobia to my already troublesome health anxiety. But from nowhere in 2006 I went straight into pathological jealousy (aka morbid or delusional jealousy or Othello Syndrome). With it came severe suspicion and hypervigilance of my wife. Repeated interrogations of her led to violence and she ended up stabbing me a number of times. So it caused big problems. 

Through psychiatric services they diagnosed me with pathological jealousy but also advised me that my mental make up is such that it could have been almost any other issue and it just happened to be this. But pathological jealousy hasn't gone  and is still there and the prognosis is that the suspicion and reactions to jealousy causing situations would likely be the same now as it was in 2006. 

Through psychiatric services and my GP we have a care plan in force which is working and has stabilised my condition and violence has stopped but only because of lifestyle modifications that make any new suspicions impossible. This has had to be agreed to by my wife and results in us being together at all times. A hard choice she made but we are both now used to. To remove this would result in problems which we don't want. Any of you reading this and unwilling to accept mental health issues you don't agree with; simply turn away and read something else. I need advice and not a disability purist saying pathological jealousy doesn't exist as someone once told me. I didn't choose it and it had just apparently been one manifestation of my mind. Regardless I can't remove it and medication and therapy failed.

Our lifestyle is safe and I am at no risk to anyone as things are. But my wife is described in how we do this as a therapy. My GP made sure to ensure the words recommended therapy are on his support letter. So I have looked into this now that I have a new PIP award to fight. The issue comes down to monitoring. I have always been on enhanced daily living but each time they give me zero points and months later it gets to enhanced at tribunal. 

My wife has had to give up work to care for me and to maintain her position within my illness as 'a therapy'. With jealousy being the issue nobody else can act as a therapy. My GP can spot issues coming on or someone else within reason may be able to 'monitor my condition' but nobody else can be the therapy or 'assist with therapy'. 

You get a single point for monitoring a health condition. Due to my other underlying mental illnesses, beyond pathological jealousy, the therapy she provides to that aspect, also provides a definite element of supervision and monitoring. She knows if I'm ruminating and have gone into myself. She knows how to break me out of it. But this is absolutely negligible compared to how I would be if she decided she was returning to work. She always loved work and unlike me was good in the workplace. But the therapeutic nature of her being with me is no choice but a necessity. I attempted suicide years ago so she keeps an eye on that too but without her I would be dead. 

So her 'therapy', understood and recommended by health professionals, also contains the far less involved aspect of 'monitoring'. The new law amendments mention that her 'therapy' should not count if any 'monitoring' is involved. Am I reading things wrong. Nobody would need to monitor my condition if she was not available as a therapy in the first place as it would be most easily observed that my 'condition had deteriorated'. 

I'm putting myself out there, if you are a non usual disability hater, just don't comment please. Otherwise if you have something valid to say, please do as it is most appreciated. Surely this can't be a way of moving a virtual '24/7 therapy' into a single point score under which someone may be able to do in seconds. My wife has to be with me and this is so confusing. 

Sorry for putting in remarks to those who would condemn us and our lifestyle as not worthy of nothing but contempt but I've had this before. 

Many thanks to anyone willing to offer advice. 

[Deleted User]

Hi, 

Apologies to anyone that may take offence at the condition I have but it is not a choice. 

Since a child I have had numerous mental issues: OCD, fear and anxieties of differing types. My father died in 1994 and with this came cancerphobia to my already troublesome health anxiety. But from nowhere in 2006 I went straight into pathological jealousy (aka morbid or delusional jealousy or Othello Syndrome). With it came severe suspicion and hypervigilance of my wife. Repeated interrogations of her led to violence and she ended up stabbing me a number of times. So it caused big problems. 

Through psychiatric services they diagnosed me with pathological jealousy but also advised me that my mental make up is such that it could have been almost any other issue and it just happened to be this. But pathological jealousy hasn't gone  and is still there and the prognosis is that the suspicion and reactions to jealousy causing situations would likely be the same now as it was in 2006. 

Through psychiatric services and my GP we have a care plan in force which is working and has stabilised my condition and violence has stopped but only because of lifestyle modifications that make any new suspicions impossible. This has had to be agreed to by my wife and results in us being together at all times. A hard choice she made but we are both now used to. To remove this would result in problems which we don't want. Any of you reading this and unwilling to accept mental health issues you don't agree with; simply turn away and read something else. I need advice and not a disability purist saying pathological jealousy doesn't exist as someone once told me. I didn't choose it and it had just apparently been one manifestation of my mind. Regardless I can't remove it and medication and therapy failed.

Our lifestyle is safe and I am at no risk to anyone as things are. But my wife is described in how we do this as a therapy. My GP made sure to ensure the words recommended therapy are on his support letter. So I have looked into this now that I have a new PIP award to fight. The issue comes down to monitoring. I have always been on enhanced daily living but each time they give me zero points and months later it gets to enhanced at tribunal. 

My wife has had to give up work to care for me and to maintain her position within my illness as 'a therapy'. With jealousy being the issue nobody else can act as a therapy. My GP can spot issues coming on or someone else within reason may be able to 'monitor my condition' but nobody else can be the therapy or 'assist with therapy'. 

You get a single point for monitoring a health condition. Due to my other underlying mental illnesses, beyond pathological jealousy, the therapy she provides to that aspect, also provides a definite element of supervision and monitoring. She knows if I'm ruminating and have gone into myself. She knows how to break me out of it. But this is absolutely negligible compared to how I would be if she decided she was returning to work. She always loved work and unlike me was good in the workplace. But the therapeutic nature of her being with me is no choice but a necessity. I attempted suicide years ago so she keeps an eye on that too but without her I would be dead. 

So her 'therapy', understood and recommended by health professionals, also contains the far less involved aspect of 'monitoring'. The new law amendments mention that her 'therapy' should not count if any 'monitoring' is involved. Am I reading things wrong. Nobody would need to monitor my condition if she was not available as a therapy in the first place as it would be most easily observed that my 'condition had deteriorated'. 

I'm putting myself out there, if you are a non usual disability hater, just don't comment please. Otherwise if you have something valid to say, please do as it is most appreciated. Surely this can't be a way of moving a virtual '24/7 therapy' into a single point score under which someone may be able to do in seconds. My wife has to be with me and this is so confusing. 

Sorry for putting in remarks to those who would condemn us and our lifestyle as not worthy of nothing but contempt but I've had this before. 

Many thanks to anyone willing to offer advice. 

[Deleted User]

Please ignore this. I think this needs to be elsewhere and am trying to get it into the PIP, ESA, DLA thread. Thank you

[Deleted User]

Just to add. I have just considered one aspect to this. There are two distinct issues here. One is the pathological jealousy which is only stable because my wife is constantly with me. If I had no ruminations or other mental issues the need for her to be with me would be continual. So, if there was no slipping into a mood or similar to watch out for, there would still be a continual need for 'therapy' of her being with me. That means therapeutically she is maintaining stability of my pathological jealousy at all times only by being with me. 

The other aspects such as ruminating never caused me to be off work and this only happened with much more damaging and dangerous pathological jealousy. OCD and other anxieties etc. only made things more difficult but not dangerous. The monitoring is to do with these issues and to stop me being drawn into a depressed or anxious mindset by her pulling me out before I go in too deep. 

Looked at that way we have an ongoing need for monitoring and situation for OCD etc. But a permanent need for my wife acting as 'therapy' to avoid substantial harm. I am in ESA support group under regulations 29 and 35 as a substantial risk. 

This sounds the most reasonable way I can describe things by segmenting the needs. Does anyone have input please?

[Deleted User]

It may be worthwhile to others to determine, if this above seems to be correct, that sometimes you view yourself as one 'issue or condition' and not a multitude or complex of problems that can be broken apart and more usefully explored and used in PIP or other awards. 

calcotti

dulede said:

Please ignore this. I think this needs to be elsewhere and am trying to get it into the PIP, ESA, DLA thread. Thank you

The moderators will move it for you.

chiarieds

Hi @dulede - & welcome to this friendly & supportive community. Thank you for joining & telling us so clearly about yourself. I have one or 2 suggestions that may prove helpful as far as PIP goes. You haven't mentioned what stage you're at with your PIP claim, but I hope this will have some relevance.

Firstly please have a look at the following link which is about claiming PIP for those with mental health problems. See: https://www.mentalhealthandmoneyadvice.org/en/welfare-benefits/pip-mental-health-guide/help-with-your-pip-claim/how-to-fill-in-the-pip-form/

Secondly I would like to emphasise that you need to be able to do any activity 'safely,' i.e. without causing harm to yourself or another, so you may need supervision. Now this is what i would stress, because as you rightly say you only get 1 point for managing therapy. I believe I see where you're coming from, but as far as PIP goes 'therapy' is something you're prescribed by a health care professional. (As an aside, I'm a physiotherapist, & due to my disability exercise several times a day, every day; I scored 0 points, because no one had prescribed the therapy I was doing!) So, I wouldn't fight that one, rather stress that you need supervision. Here are a few examples from the Benefit & Works Guide to PIP:

'Can you give examples of dangerous or distressing things that have happened to you when you have not had supervision?
Or how danger has been avoided because you did have supervision?
Can you give examples of the ways in which having someone with you might make you less likely to come to harm? What can they say or do or prevent you doing?
Have you ever been admitted to a hospital as a voluntary patient or on a compulsory section because it was not safe for you to be left alone?'

You have given detailed examples yourself above, but concentrate on the safety aspect, stressing that you need supervision all the time (rather than saying 'therapy' if you don't mind me saying).

Please have a look through the link which will provide ideas as to how to get across your need for constant supervision, & do come back with any questions.

[Deleted User]

Hi,

I created another link as didn't realise I had posted in welcome section. In the other very similarly titled one in the PIP, DLA ESA section I say that I believe I have worked out how to gain the extra points. Bearing in mind that this is a 168 hours a week issue and not just a few hours and my wife has given up work simply to maintain stability of my condition. 

To save writing it all again, here is my new post on there: 

Just to add. I have just considered one aspect to this. There are two distinct issues here. One is the pathological jealousy which is only stable because my wife is constantly with me. If I had no ruminations or other mental issues the need for her to be with me would be continual. So, if there was no slipping into a mood or similar to watch out for, there would still be a continual need for 'therapy' of her being with me. That means therapeutically she is maintaining stability of my pathological jealousy at all times only by being with me. 

The other aspects such as ruminating never caused me to be off work and this only happened with much more damaging and dangerous pathological jealousy. OCD and other anxieties etc. only made things more difficult but not dangerous. The monitoring is to do with these issues and to stop me being drawn into a depressed or anxious mindset by her pulling me out before I go in too deep. 

Looked at that way we have an ongoing need for monitoring and situation for OCD etc. But a permanent need for my wife acting as 'therapy' to avoid substantial harm. I am in ESA support group under regulations 29 and 35 as a substantial risk. 

This sounds the most reasonable way I can describe things by segmenting the needs. Does anyone have input please?

and additionally I posted:

It may be worthwhile to others to determine, if this above seems to be correct, that sometimes you view yourself as one 'issue or condition' and not a multitude or complex of problems that can be broken apart and more usefully explored and used in PIP or other awards. 

____________________

In effect if the DWP can segment things as they feel necessary, so can a claimant. 

I may need monitoring and supervision for OCD, mood swings and all the other things I suffer from and get 1 point.

But my pathological jealousy came last in this list, caused violence and I ended up stabbed and hospitalised for surgery. By my wife. 

The mental health team knew they could do no more and my GP has been clear in stating that she acts as a therapy in this regard. This is done at home. There is no further dictionary or legislative terms to discount further the term 'therapy' other than something which has a level of curative effect and without which a condition would worsen. 

The pathological jealousy if provoked results in highly volatile immediate reactions. It is not this which is being monitored as it is always there and never goes away and as such nothing can be done to prevent or treat it other than the GP recommended therapy, which is my wife's attendance with me. For her to go to work, which she would love, would break the situation in place. I would stop her leaving by whatever means necessary as I would automatically assume she would be unfaithful. It sounds ridiculous but this is what pathological jealousy is. Even when my psychiatrists were telling me my mind was acting delusionally I never accepted it. To me these issues were and are real. So, I'm going to segment the answer into two. One for the less damaging OCD and the like and another for the constantly hypervigilant and dangerous pathological jealousy. This makes the only sense I can see in such an awkward question. 

You wouldn't lump a ruptured eardrum and an amputated hand in together even if they caused a similar problem. The issues would be dealt with individually. My diagnoses are separate and I am going to use them as such. 

Most helpful comment by the way. Thank you so much.

chiarieds

Hi @dulede - you can of course segment things, but I fear you are going down the wrong path. PIP is not about diagnoses (altho you list them at the beginning of your claim pack), it is about your functional ability against certain activities/descriptors. Imagine 10 people who all have rheumatoid arthritis......they will all likely be affected differently; some will struggle with one activity of daily living, some with a couple, some with 3 or 4 of the activities, some with most of them. So, an individual response is needed.

If you haven't given a couple of detailed examples of the difficulties you face for each applicable descriptor in your claim pack, these should be mentioned in a Mandatory Reconsideration, or if appealing further. You need to say regarding the difficulties you face, when did it happen, what happened, why, who witnessed it, what if any, were the consequences of attempting/doing the activity?

About therapy, from the PIP Assessment guide Part 2. See: https://www.gov.uk/government/publications/personal-independence-payment-assessment-guide-for-assessment-providers/pip-assessment-guide-part-2-the-assessment-criteria#daily-living-activities

'This activity considers a claimant’s ability to:

i. appropriately take medications in a domestic setting that are prescribed or recommended by a registered doctor, nurse or pharmacist;

ii. monitor and detect changes in a health condition; and

iii. manage therapeutic activities that are carried out in a domestic setting that are prescribed or recommended by a registered doctor, nurse, pharmacist or health professional regulated by the Health Professions Council'

Again from the Benefits & Work Guide to Pip:

“Supervision” means the continuous presence of another person for the purpose of ensuring your safety.
The guidance issued by the DWP to Capita and Independent Assessment Services is that:
‘Supervision is a need for the continuous presence of another person to avoid a serious adverse event from occurring to the claimant. The risk must be likely to occur in the absence of such supervision. To apply, supervision must be required for the full duration of the activity.'

It's this supervision to ensure your safety that you should really concentrate upon.

Ross_Alumni

Hello @dulede

Welcome to the community and thank you for telling us about yourself and what you've been through.

Firstly, I'm sorry to hear about the passing of your dad in 1994, that must have been a very sad thing to go through and it seems as though it impacted you at the time, understandably. Did you ever seek some support for your grief? I appreciate that it's a long time ago, but I just wanted to clarify whether you received support for that at the time.

You and your wife have clearly been through a lot together, I appreciate you say that therapy didn't work for you but I'm curious whether at any point you and your wife have had any kind of couples counselling? I'm glad that, as you say, everything is stable at the minute, that must provide an awful lot of reassurance to you, and it's good that the arrangement is working. Were the police ever involved following the situation where you say your wife assaulted you in 2006?

I acknowledge that you have a care plan in place at the minute, but please ensure you continue to consult with your GP and other medical professionals if you feel as though your mental health is becoming harder to manage, I'm sure they would be happy to support you. You mentioned attempting suicide a number of years ago, and I just wanted to check if you have experienced suicidal thoughts since then? If you ever feel as though you might harm yourself, you should contact 999 right away or attend your local A&E. 

You can also use services like Samaritans (which you can access by calling 116 123) or Shout "by texting Shout to 85258) if you want to speak to someone at any time, and there is helpful information available from Mind.

Is there any support that you receive, or you and your wife receive, that you haven't already mentioned? For example, have you ever had a needs assessment by your local authority's social care team, to determine how they could help you with things like daily tasks?

Regarding your benefits, I just wanted to signpost you to a couple of useful resources that you might wish to consider, aside from the super advice already given by our members:

• Advice Local 
• Welfare Rights
• Citizens Advice

[Deleted User]

Sorry. In respect of pathological jealousy. My wife is necessary to prevent the symptoms of pathological jealousy. She is with me all the time to prevent suspicion and jealousy. 

By experience the issues with pathological jealousy are immediate overwhelming psychological distress. Massive outbursts of violence from which my wife has needed to defend herself. She would do again. 

Nothing matters apart from my wife not being able to be unfaithful. The means would not be restricted by moral or legal grounds. She would have to ring the police or stab. Both of which she has done. This is not a nice condition. I went through 8 years of counselling for it.

Imagine a dangerous dog. You know it can be kept safe by training or being kept on a close leash. That is what constant knowledge of what my wife is doing, by being with me does. I'm safe in these circumstances. 

Otherwise I can react explosively. I dont want that and our lifestyle keeps it from happening. I'm ashamed of this illness but in this respect it is highly correlated to ADHD.

But I am completely safe in this situation. It should be clear that outside of this situation. Which the mental health team describe as a therapeutic lifestyle with my wife as a therapy. That I would immediately be unable to function. Nothing else matters. My only concern becomes her fidelity. All based upon fears brought on by pathological jealousy. It is a horrible life.

This has nothing to do with the diagnosis but the stopping of symptoms caused by a condition which has been diagnosed, I failed to respond to medication and only this lifestyle is maintaining a safe stable lifestyle. No glamour in it. But it works. 

It is like a person kept alive only through being on life support. The condition will always, no variation, deteriorate when the therapy, life support, is removed.

Monitoring doesn't come into it as the conditions under which death would occur are there all the time.

Save for the life support.

My pathological jealousy is the same, always there, but prevented doing damage by my wife being with me.

This is why I said at first post. For those who may  judge a person based on mental illnesses they are trying as hard as possible to control. I am not saying this is you.

Thank you for reply. 

[Deleted User]

Sorry if I've mistakenly posted on wrong thread above. This one was initially posted by mistake instead of on PIP, ESA, DLA but it is the one I had initial replies on. I have answered above a reply which basically points out that PIP is function and not condition based as DLA had been. 

I have had counselling and my wife and I went through couples counselling. I didn't have any grief counselling when my father died and the cancerphobia stemming from it was worsened as at the time I was a financial advisor talking to people daily regarding risks of cancer. There was police, social services and women's refuge involvement. 

Part of pathological jealousy, a delusional disorder, is that you keep pressing for answers off your wife that you never get. No admissions of anything. You push and push and the eventual result through emotional torture is a reaction; in our case my wife stabbed me. But having been stabbed did not cure the pathological jealousy. Nor did the other times she stabbed me. Something had to change to bring it under control. 

The couple's counselling helped us form the lifestyle we currently live under. It has protected both of us from a mental illness that nobody expects, in my case, to ever go. But issues with self-harm, suicide ideation, violence in relation to pathological jealousy have all been stabilised. My GP, psychiatry team and my wife all know it is entirely reliant on our current situation and this is only ever threatened by each claim process. The means by which pathological jealousy is stabilised is by stopping any possibility of infidelity.

This is where it has become difficult to put across, in my mind firstly, on here and later I will need to do so in my claim. 

With medication and traditional therapies all failing the mental health team realised the only way of stabilising things was through my wife. She was invited in and over time, several years, things improved. She has been the only thing to act therapeutically on my pathological jealousy. My GP in his support letter has worded it thus.

‘I have recommended that they carry on living in this manner to prevent new suspicions. By doing so his wife acts as a therapy’.  

All involved with my treatment know the pathological jealousy is always there. As such it does not need monitoring. The result of a move away from our modified life, which could be brought on if we were severely financially restricted and my wife chose to look for work, she is currently also my carer. The result would, from experience, be suspicion and all that comes with it. But before the possibly suspicious activities occurred I would act in order to stop her leaving the house. This is what happened and is expected completely if she chose to walk out on me, go to work, or other aspects of life that are normal but due to my condition become dangerous.

There is no monitoring as such as the condition is permanent and never switches off. Hypervigilance is constant. Any functionality I currently have is based only on this modified lifestyle being in place.

As an example, since the introduction of nuclear energy there have been a number of ‘meltdowns’. Chernobyl being the most well-known. Nuclear power stations are initially functional and produce energy. They are monitored constantly for changes that risk dangerous consequences. This is how it is in a normal situation when necessary aspects of the power station are in place. You can monitor for changes in this respect.

But the necessary means by which the nuclear power plant is functional is also what makes it safe. If you were to inadvertently decide to build a nuclear reactor from memory and fail to add the coolant. Nobody would need to monitor the situation at the plant. As soon as it went on it would react by reaching meltdown in minutes. The coolant in this respect is a necessary therapy which always needs to be there. You may be able to manage a nuclear power plant by luck and go without monitoring or supervision. But you couldn’t ever let it run without the therapy to ward off its meltdown. The coolant.

My wife is the coolant in our situation. Without her being with me I would only be considering her unfaithfulness and be doing all I could to find her. I would not be eating, washing, sleeping, nothing. I have done all this when the pathological jealousy first happened. I became as dysfunctional as the nuclear power plant with no coolant. I could never be reasoned with in those situations. I just had to get my wife back. Functionality had automatically given way to the only expected thing, a massive deterioration in my condition. Functioning may be off a little even in our lifestyle but it is guaranteed to be a mess, if for instance she suddenly decided to leave me.

I hope this makes it clear how I perceive both condition and function. The condition doesn’t automatically produce dangerous situations in which functionality as normally perceived is lost. But removal of my wife as a stabilising permanent therapy would. No question on that at all.

It is a dangerous condition which we are currently controlling. I never wanted to be this way. But as it is we have had to deal with it. Prior to pathological jealousy I had been affected but always worked through other issues such as OCD and extreme health anxieties. Only pathological jealousy broke us.

As for how we have adapted to live safely, Upper Tribunal Judge Paula Grey at 47 in
[2017] UKUT 101 (AAC) EG v Secretary of State for Work and Pensions (PIP), said:

 “The PIP descriptors measure the level of disablement, and it is important that the extent of a person’s disability is captured in the context of normal daily life and not a sheltered version of it that the disabled person has imposed upon themselves to make their life easier.”

 “To assess the true effect of the disability in performing an activity, steps routinely taken to make that activity possible or easier must be filtered out; if that does not happen the descriptors that deal with the type of help needed are not being compared with the baseline criteria of a person without a relevant disability.”

I do not function in life, as would be anything toward normality, at all without our modified lifestyle.
Sorry for long text. This is something it took a long time to find and while there is older caselaw this was the most important for my issues. I’m hoping it can be seen as such by the DWP.

Sorry all for very long reply. This is a disturbing condition. So please anyone not able to discuss the topic without ‘hating me’ for suffering from it please do not answer.

Thank you all.
  

[Deleted User]

Thank you all so far for input. My case is difficult. It is by no means something which fits mainstream thought and due to this, I may find in the future that it needs to be seen through by way of the upper tiers of the judiciary. 

All I know myself is that I am currently stable. But each time I get to a claim, some idiot with a red pen decides I'm safe as a bug in a rug and denies my claim. Last time I went from 0 to 12 points. Just how is that reasonable? No other job could get away with such a discrepancy. 

I'm trying to get this one done without tribunal though as I don't think I can get through it this time. I attended tribunal last time but felt like I'd been run over by a steam roller. Sadly, not by the judge but by the doctor and disability specialist. It took a while to get over it.