Bipolar Support Groups.com blog

Bipolar Disorder and your mood can change dramatically. Your mood can swing between an extreme high (mania) and an extreme low (depression).You may feel ok between these times.
When your mood changes, you might see changes in your energy levels or how you act. Symptoms of bipolar disorder can be severe and can affect areas of your life such as work, school and relationships.
You usually develop bipolar disorder before you are thirty years old, but it can also happen later in life.1 You can have symptoms of bipolar disorder for a while before a doctor diagnoses you.2 A doctor might say you have something else such as depression before you get a bipolar disorder diagnosis.

2. What are the symptoms of bipolar disorder and how it is diagnosed?
You can only be diagnosed by a psychiatrist who will do a full psychiatric assessment. A doctor will assess if you have symptoms of bipolar, which are described below. You would need to have two or more times when you experience these symptoms.
Symptoms of mania can include:3
 feeling happy or positive even if things are not going well for you.
 feeling more active, energetic or restless
 being more irritable than normal
 feeling much better about yourself than usual
 talking very quickly, jumping from one idea to another, racing thoughts
 being easily distracted and struggling to focus on one topic
 not needing much sleep
 thinking you can do much more than you actually can
 making bad decisions
 doing things you normally wouldn’t which can cause problems, such as going on spending sprees, being sexually promiscuous, using drugs or alcohol, gambling or making unwise business decisions
 being much more social than usual
 being argumentative, pushy or aggressive
The symptoms of depression can include:4
 low mood
 having less energy, feeling tired or “slowed down”
 feeling hopeless or negative
 feeling guilty, worthless or helpless
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 being less interested in things you normally like doing or enjoying them less
 difficulty concentrating, remembering or making decisions
 feeling restless or irritable
 sleeping too much or not being able to sleep
 feeling more or less hungry than usual and/or losing or gaining weight when you do not mean to
 thoughts of death or suicide, or suicide attempts
Psychosis
Sometimes you can have psychotic symptoms during severe episodes of mania or depression. Symptoms of psychosis can be:
 hallucinations – hearing, seeing, or feeling things that are not there.
 delusions – believing things that are not true and that other people find unusual.
Psychotic symptoms in bipolar disorder can reflect your mood. For example, if you are in a manic episode you may believe that you have special powers or are on a special mission. If you are in a depressive episode, you may feel extremely guilty about something you think you have done. You may feel that you are worse than anybody else or feel that you don’t exist.
Hypomania
Hypomania is similar to mania but is less severe. You can get the same sort of symptoms but they are not as intense or as strong. Treatment for hypomania is similar to the treatment for mania.

3. What are the different types of bipolar disorder
There are several types of bipolar disorder.
Bipolar I disorder
A diagnosis of bipolar I disorder means you have times when you have mania. You may also have periods of depression between these times.
Bipolar II disorder
With bipolar II disorder you will have periods of depression broken up with periods of hypomania. Your hypomania may not cause so many problems or affect your day-to-day life.
Cyclothymic disorder/cyclothymia
You may experience regular hypomanic and depressive episodes if you have cyclothymic disorder. Your symptoms of depression are not as severe as major depression. However, your low mood can still affect your day-to-day life.
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Rapid cycling bipolar
A doctor may diagnose you with rapid cycling bipolar if you have four or more depressive, manic, mixed or hypomanic episodes in a 12 month period.
You can change from mania to depression on a monthly, weekly or even daily basis. This is called ultra rapid cycling bipolar.
Mixed bipolar state
You may experience symptoms of mania and depression at the same time which is called a mixed bipolar state. You may feel very sad or hopeless but feel extremely energized at the same time.

4. What causes bipolar disorder?
The cause of bipolar disorder is not completely clear. It seems that a combination of different things can increase your chances of developing bipolar disorder. 5
Genetics (Physical)
If someone in your immediate family (parents, brother or sister) has bipolar disorder, you are five to ten times more likely to develop bipolar disorder than someone who has no family history.
The physical, genetic, cause of bipolar disorder is not clear-cut. Researchers have not found any exact genes that cause bipolar disorder. Different genes have been linked to the development of bipolar disorder.
You can find out more about how mental illness runs in families in our ‘Does mental illness run in families?’ factsheet. You can download it for free from http://www.rethink.org or call 0300 5000 927 and ask us to send you a copy.
Brain chemicals
If you have bipolar disorder, you may have uneven levels of particular brain chemicals. Different chemicals affect your mood and behavior and could make you develop mania or depression.
Environmental and social factors
Life events can trigger symptoms of bipolar disorder. Stressful or distressing events, such as childhood abuse, can increase your chances of developing depressive episodes. Too much stress can trigger symptoms of bipolar disorder.

5. How is bipolar disorder treated?
Medications
Your doctor may prescribe you different medications to treat your symptoms.
There is medication that can help to treat mania. These medications are often called mood stabilizers. The National Institute of Health and Care Excellence (NICE) that recommends the treatment for bipolar disorder call them “anti manic medications” and “prophylactic medication”.6
Anti manic medication is used to treat symptoms of mania. Prophylactic medication is used to prevent symptoms of mania and to keep you stable.7 Doctors can use the same medications as both anti manic and prophylactic medication. They will use different dosages and combinations.
Commonly prescribed medications include:
 Lithium
 Semisodium valproate
 Olanzapine
 Quetiapine
 Respiridone
Your doctor might give you antidepressants to treat depressive symptoms. If so, your doctor should also prescribe you antimanic medication because antidepressants on their own can cause mania.8
Psychosocial treatments
As well as medication you can manage your symptoms with psychosocial treatments.9
Psychosocial treatments include:
 Cognitive Behavioral Therapy (CBT) – this is mainly recommended for the depressive episodes of bipolar disorder.
 Psycho-education – this involves learning about your illness, your treatment and how to recognize signs of becoming unwell again so you can prevent a full-blown episode. Psycho education may also be helpful for anyone who is supporting you, such as family, a partner or a trusted colleague.
 Family therapy – this works on family relationships to improve how you feel. This can help reduce any problems in the family which add to, or are because of, your symptoms.
NICE recommends long term preventative treatment because bipolar disorder is a recurring illness.
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It is possible to manage your symptoms with treatment, even if they are severe. However, sometimes the treatment you are getting might not be helping you. You and your doctor may try different combinations of medication or explore how talking therapy can help you. You might not respond to the treatment for mania or depression. You may need to try different combinations of medications. Your psychiatrist should also look at any other medications you are taking, such as antidepressants. You may also need to have a look at the amount, or type of, talking therapy you are getting.
It is important to talk to your doctor or any of your other health professionals to make sure you are getting the best out of your treatment. You should feel confident talking about anything you are concerned about and your treatment.
You can find out more about:
 Mood stabilisers
 Antipsychotics
 Antidepressants
 Medication – choice and managing problems
 Talking therapies
at http://www.rethink.org. Or contact 0300 5000 927 and ask for a copy to be sent to you.

6. What treatment should I be offered?
The National Institute for Health and Care Excellence (NICE) writes guidelines on how the NHS should treat bipolar disorder.10 Local services do not have to follow this guidance but it is best practice if they do.
Knowing about the guidelines can help you make sure you get the right treatment. Some key recommendations are:
 Your doctor should ask the Community Mental Health Team to see you if:
o you have had mania for four days or three depressive episodes in a row with a history of being overactive or impulsive
o you are a danger to yourself or others when experiencing mania or depression
o your symptoms are getting worse even though you are getting treatment from primary care services (your GP)
o you have become unwell many times You find it hard to work with doctors or other health professionals to treat your bipolar disorder.
 You and your friends or family should know who to contact in a crisis.
 Your mental health team should consider admitting you to hospital if you are might hurt yourself or other people.
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 If your depressive symptoms keep returning, your mental health team should consider structured psychological therapy. They should also give you information about exercise, healthy sleep, diet and what activities might help you.
 If your symptoms are stable but you still have mild to moderate symptoms your team should consider arranging one to one psychological therapy for you.
 Your doctor or mental health team should regularly check how you are feeling and how you are coping day-to-day.
 Your GP should review your physical health every year.
 Your mental health team should offer you support to help with training or returning to work. Your mental health team should also think about other activities you are interested in or would help you if you can’t work at the moment.
NICE has produced a copy of this guidance particularly for you and your friends, family or care. You can download a copy for free from the NICE website and see the different versions at http://www.nice.org.uk/CG38.

7. What if I am not happy with my treatment?
If you are not happy with the treatment you then you can:
 talk to your doctor about your treatment and ask for a second opinion if you feel it would help,
 get an advocate to help you speak your doctor,
 contact Patient Advice and Liaison Service (PALS) and see whether they can help,
 make a complaint.
There is more information about these options below:
Second opinion
You should talk to your doctor about your treatment first and see if you can resolve the situation with them. You can mention the NICE guidelines if you feel they are not offering you the right treatment.
If your doctor does not think of any other treatment options you could ask for a second opinion. You are not legally entitled to a second opinion but your doctor might agree to it if it would help with treatment options.
Advocacy
An advocate is someone who is separate from the mental health service but understands the system and your rights. They can come to a meeting with you and your doctor and make sure you get what you are entitled to. Advocates help you make sure you are being heard. You can search
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online to see if there are any local advocacy services in your area or the Rethink Mental Illness Advice Service could search for you.
‘PALS’
The Patient Advice and Liaison Service (PALS) at your NHS trust can try and help you with any problems or issues you have with an NHS service. You can find your local PALS‟ details at http://www.nhs.uk/Service-Search/Patient-advice-and-liaison-services-(PALS)/Location Search/363.
You can find out more about:
 Second opinions
 Advocacy
 Complaining about the NHS or social services
at http://www.rethink.org. Or contact 0300 5000 927 and ask for a copy to be sent to you.

8. Self care and management
You can learn to manage your symptoms by looking after your self care. Self care is how you take care of your diet, exercise, daily routine, relationships and how you are feeling.
The healthcare professional who is working with your should give you advice about exercising and diet.11 If you feel you are becoming manic it can help to keep regular sleeping patterns and avoid excessive stimulation such as caffeine or stressful situations.
Learning to spot early signs of a mania or depression is important in self-management. It can take a while to learn how to spot these changes but there guides that can with this. You can ask your healthcare professional to make one with you or ask them for a template of one.
Rethink Mental Illness has created “Staying Well With Bipolar”. This is a guide based on information from people who have bipolar disorder or support someone with it. You can download it for free from http://www.rethink.org. Or contact 0300 5000 927 and ask for a copy to be sent to you.
Some local NHS Primary Care Trusts may fund „Expert Patients Program Courses‟. These are courses for people who have long term health conditions. The „New Beginnings‟ program is a self-management course for people with a mental health condition. These are not available everywhere, but you can visit http://www.expertpatients.co.uk or call 0800 988 5550 to find out what is available in your area.

9. Risks associated with bipolar disorder
You are more likely to try to take your own life during depressive episodes of bipolar disorder.12 It is important that you get the right treatment for your symptoms of depression and have a good crisis plan. You can find information on how to cope with suicidal feelings in our ‘Dealing with suicidal feelings’ factsheet.
People with bipolar disorder have a higher rate of physical illnesses such as diabetes and heart disease than the general population. NICE recommends that you have a physical health check every year.13 You can find out more about how to look after your physical health in our ‘Good health guide’.
You can download all our information at http://www.rethink.org. Or contact 0300 5000 927 and ask for a copy to be sent to you.
Rethink Mental Illness is running the Stop Lethal Discrimination campaign. This campaign highlights how important it is to look after the physical health of people who have mental illness. For more information on this please visit http://www.rethink.org/campaigns.

10. Information for family, care and friends
Support for you
Whether you are a care, friend or family member of someone living with bipolar disorder you can get support.
You can get peer support through care support groups or sibling support groups. You can search for local groups in your area or the Rethink Mental Illness Advice Service can search for you.
You can ask your local authority for a care assessment if you need more practical and financial support to help care for someone. As a care you should be involved in decisions about care planning. There are rules about information sharing and confidentiality which you need to be aware of.
You can find out more information about:
 Care Assessments
 Caring for yourself being a care
 Confidentiality and information sharing – for care, friends and family
 Welfare benefits for care
at http://www.rethink.org. Or contact 0300 5000 927 and ask for a copy to be sent to you.
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Supporting the person you care for
You might find it easier to support someone with bipolar disorder if you understand their symptoms, treatment and self management skills. You can use this information to support and encourage them to get help and stay well.
You should also be aware of what you can do if you are worried about someone‟s mental state or risk of self harm. You should have details of their mental health team and also discuss a crisis plan with them.
You can find out more information about:
 Supporting someone with a mental illness
 Getting help in a Crisis
 Helping someone with suicidal thoughts
 Dealing with unusual thoughts and behaviors
at http://www.rethink.org. Or contact 0300 5000 927 and ask for a copy to be sent to you.
Bipolar Disorder – The Ultimate Guide by Sarah Owen and Amanda Saunders (One world Publications, 2008)
This is a guide to bipolar disorder (manic depression) answering basic questions in an easy to read format.
When someone you love is bipolar: Help and support for you and your partner by Cynthia G Last, PhD (The Guildford Press, 2009)
Dr. Cynthia Last shares her insights as a therapist, researcher and someone affected by bipolar.
Bipolar UK
This is a user led charity working to enable people affected by bipolar disorder to take control of their lives
Tel: 020 7931 6480
Address: Bipolar UK, 11 Belgrave Road, London, SW1V 1RB
Email: info@bipolaruk.org.uk
Website: http://www.bipolaruk.org.uk/

We know how worrying it can be to hear about changes
to benefits, but not get all the details. That’s why we’ve put
together this pack, so that everyone we support knows what is
happening when and where to get more support.
Inside you’ll find out about the four biggest changes affecting everyone:
• Changes to Housing Benefit (also known as the ‘bedroom tax’).
• What is happening to Council Tax Benefit.
• The end of the social fund.
• The beginning of Personal Independence Payment, replacing DLA.
We hope that with this information, you will feel more confident about the changes
coming and more able to press for what you need. Remember you can:
• Get more information about all benefits at http://www.rethink.org. If you want information
and don’t have access to the internet, please call us on 0300 5000 927 and we can
post information to you.
• Talk to others about your experiences at http://www.rethink.org/talk
• Phone our specialist advisers – now open for longer, Monday to Friday, 10am to 2pm
on 0300 5000 927.
This is just the start. As well as extending the hours that you can call our advisers, we
are also producing information about Universal Credit and changes to the appeals
system. Go to http://www.rethink.org to sign up for emails and you will receive all this
information as we produce it. Universal Credit is only being piloted in a few areas and
won’t be rolled out across the country until late 2013.
And we are campaigning for better benefits tests so that people with mental illness get
fair assessments from benefits staff.
I hope this information helps you, your family and friends to get the support that you
all need.
Paul Jenkins
Chief Executive
Introduction
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Changes to Housing Benefit –
‘the bedroom tax’
The changes in a nutshell
If you live in a local authority or Housing Association house or flat and you
have more bedrooms that the Government thinks you need, your Housing
Benefit could reduce from April 2013.
But if you rent a flat from a private landlord, your Housing Benefit will stay
at the same rate. If you are over the pension age, then your Housing Benefit
won’t change.
You are most likely to be affected if you:
• Are single and live in a house or flat with 2 or more bedrooms.
• Have adult children, who have moved out.
• Have a child who visits but doesn’t permanently live with you.
• Are in a couple and you have a ‘spare’ room that you use when one
of you is ill.
The rules say that:
• All adults and couples need a bedroom to themselves.
• Boys under 16 should share a room.
• Girls under 16 should share a room.
• Boys and girls under 10 should share a room.
• Disabled people who need someone ‘extra’ to stay overnight to provide
care need an extra bedroom for this person.
If you have more bedrooms than the rules say you need, you will be classed
as ‘under-occupying’ and your Housing Benefit will be reduced.
How much will my benefits go down by?
If you have one more room than the rules say you need, your Housing Benefit will
reduce by 14%. If you have two or more rooms than the rules say you need, your
Housing Benefit will reduce by 25%.
On average, people living in local authority housing will lose £14 per week. People
in Housing Association housing will lose £16 per week.
This is a lot of money for someone living on benefits to lose.
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Example
A mother with a history of mental health problems has raised two
children in a 3 bedroom house and lived there for 30 years. When
the adult children move on, the woman will be only entitled to one
bedroom under the rules. Her Housing Benefit will reduce by 25% as
the rules say she is under occupying the property by 2 bedrooms.
What can I do?
The Department for Work and Pensions (DWP) has suggested that you could:
• Move house.
• Take in a lodger (check your tenancy agreement, likely to need permission from
the landlord).
• Increase hours of work or look for work to increase your income.
• Apply for other benefits, if you can.
• Pay the difference out of any money you have if you can.
• Borrow from friends and family.
• Apply for a Discretionary Housing Payment.
You can read the Department for Work and Pensions guidance at
http://www.dwp.gov.uk/docs/a4-2012.pdf
What are Discretionary Housing Payments?
If you claim Housing Benefit and you can’t pay your housing bills and your tenancy
is at risk, you can ask for extra financial help to meet these costs. Local councils
administer Discretionary Housing Payments (DHP). Each local council has a fixed
pot of money for each financial year.
Each local council decides who to give a discretionary housing payment to.
Usually councils will only give you a payment for short period, for example up to 6
months. We don’t know how easy it will be for people with mental health problems
to get these payments, but it could be worth checking.
Will the local authority find me a new house?
National Government has said local councils should consider finding new homes
for people who are ‘under-occupying’. Each local council will decide how to do
this in practice. In some areas there may not be any smaller accommodation
available. Finding a new home may not, in reality, be helpful. The local council
could suggest that you move to a completely different area, far from friends and
family. The local council could also find you a place in the private sector – this
could mean that you are responsible for more maintenance issues than in local
council or Housing Association homes.
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What should I do if I am affected?
Try and maximize your income
You could apply for Disability Living Allowance (DLA) or, depending on where you live,
Personal Independence Payment (PIP) if you haven’t already. DLA or PIP would help
to increase your income and help you pay any extra rent you need to pay because of
Housing Benefit reducing.
If you already claim DLA, you could check to see if you are eligible for a higher rate.
Applying for a higher rate though will mean a new assessment, which could leave you
with a higher or lower amount – it is impossible to tell which. So you should consider
this carefully before applying.
Check that you are receiving all other benefits and tax credits you may be entitled to.
Take in a lodger?
If you are thinking about taking on a lodger in the future to increase your income, you
could see if you have a family member or a trusted friend who is looking to move in the
near future. This could make looking for a lodger much less stressful. You should also
check your tenancy agreement and ensure that your landlord agrees.
Use other money if you can?
If you have any other money available to you, such as a trust fund, contact the Trustees
of the fund and tell them about these changes – you could send on this information to
them. You could then ask them to give you extra funds to help you cover the extra rent
you need to pay.
Work out your budget?
If your local authority or Housing Association has told you that you will need to pay extra
towards your rent we would recommend you complete a personal budget sheet listing
all of your income and essential outgoings, including the amount you are being asked to
pay towards your rent.
Rent is a priority payment as you risk losing your home if rent arrears build up. So it is
important to budget for the extra you are being asked to pay. This might mean looking
at what else you spend your money on and seeing if you can make savings.
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Council Tax Benefit changes
The changes in a nutshell
From April 2013 Council Tax Benefit will no longer exist. Instead your local
authority will run a ‘Council Tax Support’ scheme, but the budgets for these
schemes is 10% less than the previous budget for Council Tax Benefit.
What is Council Tax?
Council Tax is a tax which households have to pay to local councils. People receive the
bills each year, but usually pay the tax in 10 chunks, starting in April. How much you pay
will depend on how much your property is worth and the number of people living in it.
Usually councils assume that at least two people live in each property. If you live alone
or with someone who is seen as exempt from the tax, then you can pay less council tax.
How has Council Tax Benefit worked up to now?
Until now, if you were on a low income you could make a claim for Council Tax Benefit.
Depending on the level of income, capital and savings that you and people living with
you had, you could receive some Council Tax Benefit to reduce your council tax bill. As
a result, you might not have paid any council tax at all or you might have paid a smaller
amount. Usually people made a claim for Council Tax Benefit through their local council
at the same time as applying for Housing Benefit. National rules set out who could
receive Council Tax Benefit and how much people could receive.
What will happen now?
As they are all getting less money than previously, all councils will be trying to save
money and so will be looking at different ways they could do this.
Some local councils have already said that they will charge everyone of working age
some council tax even if under the previous system the person would have been
received full Council Tax Benefit and therefore didn’t have to pay any Council Tax at all.
Other councils may change the thresholds for capital and savings when assessing
for Council Tax Support so people who have less than £16,000 savings and
previously received Council Tax Benefit may have to pay something or more towards
their council tax bill.
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Some other councils may look at your income differently when they decide how
much support to give you. For example, in the past, they ignored some benefits when
adding up how much income they thought you had. Now they might think that these
benefits are ordinary parts of your income and decide to give you less Council Tax
Support as a result.
Check with your local council to find out how they will run the Council Tax Support
Scheme in your area.
Is this affecting everyone?
These changes will only affect you if you are of working age. If you are above the
‘Pension Credit qualifying age’, you will still get Council Tax Benefit as you have up
to now.
When is this happening?
April 2013.
How can I find out what is happening in my area?
Your local council may already have contacted you to tell you about the changes and
ask for your opinion on their new scheme.
If you have access to the internet you can check what system your council has decided
to use on their website.
If you do not have access to the internet you could telephone your local council and
ask to be put through to the team who can tell you about the new Council Tax Support
scheme in your area.
How important is paying council tax?
Council tax is a priority payment. If the local council can prove you are wilfully refusing
or neglecting to pay your council tax you could be sent to prison, however in practice
this is quite rare.
More commonly, the local council will pass any council tax debt to local bailiffs who
will try to collect the debt from you directly. As long as you don’t let them in to your
home they can’t break in, however being visited by a council tax bailiff can be scary and
upsetting.
What is the difference between Council Tax Benefit/Council Tax
Support and Council Tax Exemption?
If you currently receive Council Tax Benefit (or will receive some Council Tax Support)
you are still liable to pay council tax at the property you live in, however the amount you
pay is either covered in full or in part by Council Tax Benefit/Council Tax Support. In
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practice you may pay nothing at all towards your Council Tax bill but only because the
amount you should be paying is covered by the benefit.
If you are exempt from Council Tax you have no legal liability to pay it. This means you
are not billed and your council cannot ask you to pay any Council Tax. You do not need
to apply for Council Tax Benefit or Council Tax Support because you don’t have any
Council Tax to pay.
Could my property be exempt from Council Tax liability?
If someone (or many people) who are ‘severely mentally impaired’ or students only live
in your property, you will not have to pay Council Tax on your property.
Being severely impaired means you have ‘a severe impairment of intelligence and social
functioning (however caused) which appears to be permanent’. You would need your
GP or another doctor to confirm you have a severe mental impairment.
You also need to be receiving one of the following benefits:
• Incapacity Benefit.
• Employment and Support Allowance.
• Severe Disablement Allowance.
• Income Support (with a disability premium paid because of incapacity for work).
• High or Middle Rate Care Component of Disability Living Allowance.
• The Daily Living Component of Personal Independence Payment or
Attendance Allowance.
Most local councils have a form you can fill in to apply for one of these exemptions.
I am going to be affected by the changes, what can I do?
If you find out that you are going to have to pay more for council tax because of these
changes and you are worried about this, you could check:
if you are exempt from council tax liability altogether?
• If you have a severe and enduring mental illness and you receive some welfare
benefits you may be exempt from council tax liability under the ‘Severe Mental
Impairment’ rules. You can find out more in our ‘Welfare Benefits and Mental
Illness’ factsheet.
if you can get a discount on your council tax bill?
• If you are the only adult living in your property you should get a 25% ‘single
person’s discount.
• If you are living with someone who is either a student or is exempt from council tax
because they have a Severe Mental Impairment (see above) then you should receive a
25% discount on your council tax bill.
• If you are a care and:
– provide 35 hours of care on average per week,
– live in the same property as the person you care for,
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– are not the partner of the person you care for,
– are not caring for a child who is under 18 and
– the person you care for gets either the Care Component of Disability Living
Allowance at the Highest Rate or the higher rate of Attendance Allowance
then you may also be eligible for a discount on your council tax bill.
The rules are complicated so you may want to speak to a local welfare rights adviser
if you can increase your income
• You may want to check that you are getting all the welfare benefits, tax credits and
discounts that you are entitled to.
• You should be able to get a ‘welfare benefits check’ at your local welfare rights
service, such as your local Citizens Advice Bureau.
if you can change the way you spend your money
• You could complete a personal budget sheet and include council tax in this. Council
tax is a very important payment to make.
• Our factsheet ‘How to Deal with Debt’ explains how to draw up a personal budget
sheet and also gives options for dealing with any debts you may have.
What if I fall behind with my council tax?
You should seek the help of a money adviser as soon as possible. They will be able to
advise how to deal with any arrears or any action the local council are taking against
you. You can find advice and how to find a money adviser in our ‘How to Deal with
Debt’ factsheet.
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The changes in a nutshell
At the moment JobCentre Plus can give people interest-free loans, grants and
payments to help people get through emergencies or pay for long-term costs like
new furniture or kitchen or disability equipment.
From April 2013, Job Centre Plus will help fewer people with emergency loans and
it will take repayments from your future benefits payments. Local councils will
have to help other people with emergencies and with longer-term grants instead
of Job Centre Plus.
Changes to the Social Fund
How has the discretionary Social Fund worked until now?
The discretionary Social Fund has helped people on low incomes manage large items
of expenditure and cope with emergencies. It includes crisis loans, community care
grants and budgeting loans.
Until now, if you needed money in an emergency, you could get an interest-free
Crisis Loan from Job Centre Plus. You could get one if you needed help with
‘emergency costs’ like food, rent, electricity or gas or travelling expenses. You did not
need to be claiming benefits to get one of these loans, though many people claimed
them if their benefit payments had been delayed.
Community Care Grants (CCGs) are not loans, but grants and they are only for people
receiving income-based benefits. They were available to help people:
• Move from hospital / prison or community care.
• Avoid a stay in hospital, prison or community care.
• Move to suitable accommodation.
• Visit someone who is unwell.
• Attend a funeral.
Budgeting Loans were interest-free loans for people receiving benefits to help pay for
big items over a longer period. People often used them to help pay for: Furniture and
household items, like fridges or cookers:
• Clothing.
• Rent in advance and other removal costs.
• Some travelling expenses.
14 Rethink Mental Illness.
What is changing?
Crisis loans, budgeting loans and Community Care Grants will end. Instead there will be
three options:
1. If you are waiting for a benefits claim to come through, you can apply
for a Short-term Advance.
If you have just claimed for benefits, but you haven’t received them yet and you need
money for essentials like food or rent, you can ask for a short term advance. You can
also do this if your circumstances have changed and you expect to get more benefits
as a result, but your claim hasn’t been processed yet. Your future benefits will then
go down by the amount of the loan – we are not sure what the rate will be yet. The
Government says they want people to pay back this money over 3 months or 6 months
in exceptional circumstances.
2. If you have an emergency for any other reason, your local council will
decide how to help you.
There are no rules about what support a local authority should provide, how to organise
it or who should receive it. There has been some discussion on how local councils
might develop local services that will replace Community Care Grants and Crisis Loans,
but the information we have is minimal.
Local councils could:
• Give cash grants as Job Centre Plus does now.
• Offer goods instead of cash (e.g. referral to food bank).
• Give vouchers or coupons.
• Do a combination of all three.
3. If you have a big ‘one off’ cost, you can apply for a Budgeting Advance.
If you claim Universal Credit on the lowest income, you can apply for a ‘budgeting
advance’. This is an interest free loan from the Department for Work and Pensions.
The Government wants people to be able to use these interest-free loans for essentials
instead of getting loans at high interest rates.
We don’t yet know how big these advances can be. It will depend on whether you are
claiming the benefits above yourself or as a couple and whether you have children. It will
also depend on what savings you have. You will not be able to get a Budgeting Advance
if you already have one that you haven’t yet paid back.
You could use the money to pay for:
• Furniture and household items.
• Clothing.
• Rent in advance and other removal costs.
• Some travelling expenses (for employment).
• Some maternity costs.
Rethink Mental Illness. 15
If you get a Budgeting Advance, then your benefits will go down by the amount of the
advance. Government say they want people to repay these advances in 12 months or
18 months in exceptional circumstances.
You can still apply for the old style budgeting loan if you are receiving:
• Income Support.
• Income related Employment and Support Allowance.
• Income based Jobseekers Allowance.
What should I do if I need emergency financial help
after April 2013?
If you need money because you are waiting for some welfare benefits to be paid to
you, you should apply for a ‘Short Term Advance’ from JobCentre Plus. Otherwise, you
should contact your local council and ask what help they can offer.
Where can I find information on my local ‘Food Bank’?
Food Banks can provide 3 days worth of food. You usually need your GP, CAB staff the
police or a social worker to refer you. They will give you a food voucher which you can
exchange for a food parcel. You can search for a local ‘Food Bank’ on the following
website: http://www.trusselltrust.org/map
16 Rethink Mental Illness.
Rethink Mental Illness. 17
Changes to
Disability Living Allowance
The changes in a nutshell
From summer 2013, you can no longer make a new claim for Disability Living
Allowance. Instead, if you are aged 16 to 64 and you need to claim benefits to
help with disability costs, you will have to claim Personal Independence Payment.
This could include a face to face assessment.
But if you already receive Disability Living Allowance and your circumstances stay
the same, nothing will change for you until 2015.
How DLA worked in the past
Disability Living Allowance (DLA) gave people extra money to be able to pay for extra
things they needed because of disability, including mental illness. You could apply for
DLA if you were 16-64 and you received a different amount depending on how much
care you needed and how mobile you were, up to about £150 per week. To apply,
most people had to complete a paper application form but not go to a face to face
assessment. You could get DLA no matter how much money you earned or had saved.
What is different about PIP?
More people with low care needs probably got DLA in the past than will get PIP in the
future. More people will also be asked to go to face to face assessments instead of just
completing a paper form. Atos and Capita will conduct the face to face assessments
and report the results to the Department for Work and Pensions (DWP).
I’m already on DLA – what should I do?
You do not need to do anything different from usual. If your circumstances change –
either for the better or worse – you should tell DWP so that they can see if you need
more or less DLA. In 2015, DWP will contact you to arrange an assessment for PIP
instead of DLA. We will produce more information at that time when we know exactly
what you’ll need to do.
If you have a child under 16 who receives DLA, they will still receive this until their
16th birthday. Then they can make a claim for PIP instead.
If you are 65 years or over (or above pensionable age whichever is higher) or you
claim Attendance Allowance you will continue to receive this as normal. You do not
need to do anything different.
18 Rethink Mental Illness.
How will Government decide if I can get PIP?
To work how much you will get, benefits assessors will look at different activities and
how able you are to do these. If you are unable to do some of them, you will get points.
If you get 8-11 points for either daily living or mobility activities, you will get the standard
rate. If you get 12 points or more, you will get the enhanced rate. You will get both daily
living and mobility payments if you have 8 or more points for both. These are similar
rates to DLA, though for DLA there was also a third, lower rate for daily living.
Daily Living activities are:
• Preparing food.
• Taking nutrition.
• Managing therapy or monitoring a health condition.
• Washing and bathing.
• Managing toilet needs or incontinence.
• Dressing and undressing.
• Communicating verbally.
• Reading and understanding signs, symbols and words.
• Engaging with other people face-to-face.
• Making budgeting decisions.
Mobility activities are:
• Planning and following journeys.
• Moving around.
To decide this, the Department for Work and Pensions can look at:
• The answers you put on the application form (PIP003).
• Any evidence provided by the health and social care professionals who work with you.
• A report produced from a face-to-face assessment.
Will I have to travel to an assessment centre?
You may have to attend a face to face medical assessment with a healthcare
professional who you don’t know. Depending on where you live in the country, these
assessments could be carried out by healthcare professionals working for either
Atos or Capita.
The assessment may take place at a centre or in your home. An assessment in your
home is more likely if you are unable to get to the assessment centre because of your
health condition. You can have someone with you for support and they are allowed to
take an active role in the discussion.
Rethink Mental Illness. 19
How much will PIP pay me?
You will get a different amount depending on how much the Department for Work and
Pensions thinks you need to help you with daily living and mobility.
If you receive PIP, you will get the money every 4 weeks directly into your bank, building
society or post office account.
Is PIP for people with mental illness?
Yes. It is just as much for people with mental health problems as for physical health
problems. People can get it for schizophrenia, bipolar disorder, personality disorders,
severe and ongoing depression, anxiety or phobias.
My illness is different on different days – can I still get PIP?
When deciding how many points to give you in the assessment, the benefits assessor
should consider if you will be affected in this way on more than half of the days over
one year. They should also think about whether you can do each activity safely; to a
necessary and appropriate standard; repeatedly; and in a timely manner. They also have
some flexibility to give you points even when you can do more or less on some days.
How do I apply for PIP?
If you need to make a new claim for PIP, go to http://www.rethink.org to read our full
information on it. Or phone 0300 5000 927 and ask for a free copy through the post.
From April to June 2013, only people in some areas will need to apply for PIP – everyone
else will continue to apply for DLA. The places where you will need to apply for PIP
before June are:
• All postcodes beginning with: BL, CA, CH (not CH5, CH6, CH7, CH8), CW, DH, DL
(not DL6, DL7, DL8, DL9, DL10, DL11), FY, L, LA, (not LA2 7, LA2 8, LA6 2, LA6 3), M,
NE, PR, SR, TS (not TS9), WA.
After June, everyone who needs to make a new claim for disability support will need to
apply for PIP, not DLA.
For mobility, you could receive:
• £21.00 weekly, the standard rate.
• Or £55.25, the enhanced rate.
For daily living, you could receive:
• £53.00 weekly, the standard rate.
• Or £79.15 weekly, the enhanced rate.
20 Rethink Mental Illness.
Registered in England Number 1227970. Registered Charity Number 271028. Registered Office 89 Albert Embankment, London, SE1 7TP. Rethink Mental Illness is the operating
name of National Schizophrenia Fellowship, a company limited by guarantee. © Rethink Mental Illness 2013.
Leading the way to a better
quality of life for everyone
affected by severe mental illness.

(ESA) or Disability Living Allowance (DLA) before 28th October 2013.
 You disagree with Housing Benefit decisions made by your local authority.
For all other benefits appeal processes (including Personal Independence Payments (PIP) and Universal Credit (UC)) please see our factsheet on: ‘Welfare Benefits: Mandatory Reconsiderations and Appeals’.
This factsheet aims to provide information about what do to if the Department for Work and Pensions (DWP) or your Local Authority (LA) make a decision about your benefits that you don‟t agree with. This factsheet covers the revisions and appeals process. It also covers how to prepare your own case and represent yourself at tribunal.
This factsheet covers –
1. Challenging a Council Tax Support Decision
2. Challenging a Decision from the DWP/LA
3. I‟m out of time is there anything I can do?
4. The appeals process
5. Preparing your Appeal
6. Attending your Hearing
7. Tips for self-representation
8. Sample Letters
Whenever the DWP or LA makes a decision about your benefit they will inform you in writing. If you don‟t agree, you have one month in which to either ask for a revision or appeal. Some examples of the types of decisions you may disagree with are –
 You have been found capable of work and therefore refused Employment and Support Allowance (ESA).
 You have been placed in the Work Related Activity Group (WRAG) of ESA but you think you should be in the Support Group (or vice versa).
 You have been refused Disability Living Allowance (DLA).
 You have been awarded DLA but not the rate or component you believe you are entitled to.
 You want to challenge a decision made about your Housing Benefit.
 You disagree with the amount of Council Tax that you have been asked to pay.
If you‟re not sure what the decision letter means or the reasons why the DWP/LA have made the decision you can call them and ask for a verbal explanation or you can write to them and ask for a written statement of reasons.
1. Challenging a Council Tax Support Decision
The government has decided to give LAs the power to set Council Tax levels in their area. As a result LAs will need to set up their own system for appeals and there will no longer be a centralised system. This means that
The Welfare Benefits system is currently undergoing significant reform. This factsheet is correct at time of publication. However the factsheet will be reviewed regularly and updated with further information as soon as it becomes available. If you have received information that differs from the content of this factsheet, please contact us.
the appeals process for Council Tax Support is likely to vary from area to area.
As a result it is difficult to give an overview of the appeals process for Council Tax Support Decisions. We would recommend that you contact your LA and ask them for a copy of their appeals forms and the procedure that needs to be followed.
In general you are likely to need to get evidence such as bank statements, proof that people are living at other addresses, invoices and receipts that show money has been spent on essential items or any other evidence that proves the decision they have made about you is incorrect.
We would always recommend making you appeal in writing and keeping copies of any letters or paper work you send. Make sure that you stick to the time limits for appealing the Council Tax Support Decision, which are set by your LA.
Other LA administered benefits decisions, such as Housing Benefits, can still be challenged following the standard procedure, set out below.
2. Challenging a Decision from the DWP/LA
If you disagree with the DWP/LA‟s decision about your benefit you have the right to ask the DWP/LA to look at it again.
Currently you can choose whether or not to ask for a revision of the DWPs decision, if you disagree with a decision made about ESA or DLA before 28th October 2013. You can choose to ask for a revision and then appeal to the tribunal or appeal to the tribunal directly.
If you are appealing a decision made about your claim after this date, or if you want to appeal a decision made about PIP or UC you will need to follow a different procedure. This is set out in our factsheet ‘Welfare Benefits- Mandatory Reconsideration and Appeals’. It is available to download at http://www.rethink.org/factsheets or by ringing 0300 5000 927.
When you request a revision you are asking the DWP/LA to look at their decision again and change it. We would advise you to request a revision in writing, keep a copy and either send it recorded delivery or get proof of postage. This way you know it has been received within the strict 1 month time limit and you have a copy of what you have asked for.
If you have asked the DWP for a written statement of reasons the time limit is extended by 14 days as long as they send you the reasons within the month.
If you have asked the LA for a written statement of reasons the rules are different. The days in-between you asking for the reasons and the day they are provided are ignored when calculating the 1 month time limit.

The letter you send them should explain why you think the decision is wrong. If you have any evidence to back up your opinion you should send that too.
Someone from the DWP/LA who has not looked at your claim before will then review the decision that has been made. The DWP/LA will then look at all the information you have given them and decide whether to stick with their original decision or change it. They will then write to you with their amended decision. If they have changed their minds, any change in benefit should be backdated to the date of the original decision.
It is important to send in medical evidence to support your claim, as the DWP are more likely to reverse their earlier decision if they have evidence that shows that the original decision was wrong.
If the DWP/LA look at the decision again but decide to stick with it and you still disagree with them, you can appeal the decision to a tribunal. This is explained in more detail later on in this factsheet. You have one month from receiving the DWP‟s revision to lodge an appeal.
Example
John made a claim for ESA but this was refused. The decision maker at the DWP said he only scored 6 points (but he needed 15 to qualify). They sent him a letter on the 1st February. John wrote a letter within the 1 month time limit to the DWP asking them to look at this decision again. He explained he felt it was incorrect because he has great difficulty in coping with change. He sent in a letter from his psychiatrist which confirmed this.
A different decision maker at the DWP looked at all the information about John‟s claim again. They looked at his original questionnaire, the medical report from the DWP doctor and also the information given by John and his psychiatrist in the revision letter.
The DWP wrote to John with a new decision on the 8th March. They decided that he did qualify for ESA and was to be placed in the Work Related Activity Group.
John was given the extra „work related activity component‟ money backdated to the 1st February.
3. I’m out of time is there anything I can do?
The DWP/LA may accept a request for a revision after 1 month if they think it is reasonable, there could be a prospect of success and the delay in asking for the revision was due to special circumstances. Not knowing the law or the time limits is not enough. If you were very unwell and in hospital for example, this could be a good enough reason. You should make the request in writing as usual but also explain why you are asking outside of the 1 month time limit.
You can only ask for a late revision up to 13 months after the original decision. The later your request for a revision or reconsideration is, after the 1 month time limit, the more compelling your reasons will have to be.
4. The appeals process
What are the time limits?
If you disagree with a decision you can either appeal within 1 month of the decision being sent or, if you have first asked for a revision, within 1 month of the revised decision being sent.
If you are outside of the 1 month time limit but there were special circumstances why you missed the deadline, then you can ask the DWP/LA to consider still taking the appeal. Special circumstances could be that you or your partner was seriously ill. As with revisions, any late appeal must be within 13 months of the original decision.
How do I submit an appeal?
If you decide to appeal after asking for a revision, or if you decide to make an appeal as soon as you receive the decision, the appeal must be in writing. There is a form known as a GL24, it is also called „If you think our decision is wrong‟, which you can use for appealing decisions made by the DWP. You can ask for this at your local Jobcentre Plus office or view it on-line at the following web address.

Click to access dg_201702.pdf

If you want to appeal a decision made by the LA, you can ask them for their own appeals form.
You can appeal just by writing a letter, however if you use the specific appeals forms you can be sure you are giving the DWP/LA all the information they need. Again, we would advise keeping a copy and ensuring you get proof of postage or send it recorded delivery.
If you lodge an appeal it is automatically treated as a request for a revision first. The decision is reviewed locally and is passed to a different decision maker to look at the case again. Unless you are providing evidence as to why the original decision was wrong then the decision is unlikely to be changed at this stage. The case will then be passed to the tribunal service for a full appeal
What happens to my benefits whilst I am appealing?
Due to the number of appeals currently being processed by the Tribunals Service it can take 12 monthsi from the date that the appeal is submitted for the case to be heard. If the original decision is not changed, at the point of revision, by the DWP you could be living off reduced income or having to make further outgoing payments for quite some time.

If you are appealing an ESA decision that you are „fit for work‟ then you will be paid ESA at the assessment rate. See our factsheet on „Employment and Support Allowance’ for more information.
If you are appealing an ESA decision that you have been placed in the WRAG when you feel you should have been placed in the Support Group you may have already been referred to Jobcentre Plus or a Work Programme provider for work focussed interviews and to engage in work related activity. If you want to get the money you receive for being in the WRAG then you will need to attend the work focussed interviews and abide by the requirements of the work provider.
If you do not take part in the activities required of you by the Jobcentre Plus or the Work Programme provider you may have part of your ESA stopped. This is known as having your benefits sanctioned. The DWP have the power to sanction part of, or the whole of the basic allowance of ESA. This sanction is made if you cannot provide a good reason for why you have not taken part in the activities asked of you.
If you appeal before you are referred to the Work Programme, you should not be referred to the Work Programme whilst your appeal is ongoing.
How can I find support for my appeal hearing?
You could try and get help from a specialist welfare rights adviser at your local Citizens Advice Bureau, independent advice agency or Local Authority Welfare Rights Service to help you with your appeal.
You can usually find details of local services in the telephone book, Yellow Pages or on the internet.
What if I have to represent myself?
Due to cuts in funding for voluntary sector services and changes to legal aid, many people are struggling to find a local organisation that can help with an appeal and provide representation at the hearing.
You may, therefore, need to consider either preparing the appeal yourself or getting help from a friend or family member to prepare the appeal with you. Many people find the thought of preparing the appeal and representing themselves daunting however it is possible.
Whilst it is helpful to have representation, if this is not possible, it is important to remember the tribunal system was set up so that people could represent themselves. Many people without representation successfully represent themselves every day. You can improve your chances of being successful at appeal by being well prepared and knowing what to expect from the process.
5. Preparing your Appeal
Getting Supporting Evidence
It can be very helpful to get medical evidence to support your appeal. It is worth attempting to get supporting evidence if you can.
You can submit evidence along with your appeal form. However don‟t worry if you can‟t get the evidence in time, you can always send it later. You are also able to submit evidence on the day of the hearing, at the tribunal venue. However if you submit a lot of evidence, this may delay the hearing, as the tribunal panel will need time to read it.
The tribunal will not write to medical professionals (e.g. your GP, psychiatrist or social worker) to ask for evidence. You will need to speak to the medical professionals involved in your care and ask them if they are prepared to support your request for a revision or appeal and if they would provide a letter/report that backs up your claim. You should be aware that some GP‟s may try to charge you for this. It is important to state from the outset that you are not in a position to pay if this would cause you hardship.
Rethink Mental Illness has drafted some letters that could be sent to your medical professionals in relation to benefits appeals to request the necessary supporting information. These can be found at the end at this factsheet in the „Sample Letters‟ section.
If a carer or relative has important information about your condition then we recommend that they make a written statement about your needs and condition(s) and submit this in advance to the tribunal.
It is important to make copies of the medical evidence that you send to the tribunal so that you can refer to it during the hearing.
Making arguments to counter the DWP/LA’s decision
Once you have gathered all the medical evidence that you want or have been able to get and have sent back all the forms, the next step is to consider writing a submission which sums up your arguments. It is not a requirement to do this but it is something that most welfare rights advisers do, as it can help to focus the tribunal on the matters that are important to you in the appeal.
In order to be successful at your hearing you need to show the tribunal that you meet the assessment criteria for the benefit. Written submissions are a good way of explaining which parts of the DWP/LA decision you disagree with and countering the DWP/LAs arguments by explaining how you meet the assessment criteria and how your evidence backs up your appeal. You can also highlight important information that you would like the tribunal to consider.

It is important not to use your written submission as an opportunity to criticise the DWP/LA or Atos. You will not be successful at appeal by simply critisising an earlier decision. Instead you should stick to facts and explain why the decision is wrong.
When writing your submissions, do not feel that you have to complete them in one go. Splitting the submission into issues and focusing on one at a time can help.
Due to the legal rules that govern the tribunal, the tribunal panel are only able to consider facts and examples about your condition that were true at the time that the decision about your benefit was made. So for example if your hearing takes place in June 2013, but the original decision about your benefit was made in September 2012 the tribunal can only consider evidence about your condition, as it was in September 2012.
If your condition has deteriorated or improved since the decision about your benefit was made, you will have to give examples and evidence based on your condition as it was previously. It may be difficult for you to remember what you condition was like. Therefore it is advisable that you spend some time thinking about this. You may also find it useful to ask friends or family to remind you, if you cannot remember.
Tips for writing your submission
 Look at the paper work sent to you by the DWP/LA. There should be reasons given for why your benefit claim was not allowed.
 Look at the eligibility criteria for the benefit you are applying for. See Rethink Mental Illness‟s factsheets on ‘Disability Living Allowance (DLA)’, ‘Employment and Support Allowance (ESA)’ and ‘Work Capability Assessment (WCA)’ for more information on the eligibility criteria for these different benefits.
 If you disagree with the way that you have been assessed and the decision that the DWP/LA has reached, you need to explain what you disagree with and why.
 Deal with each point of disagreement individually.
 Refer to medical evidence and evidence from carers or family that backs up your argument.
Example Submission: Limited Capability for Work and Work Related Activity
The DWP has stated that I was awarded 0 points when assessed on my awareness of hazards or danger. Therefore I was assessed as not needing supervision to keep myself safe.
This is inaccurate. I need supervision to keep myself safe the majority of the time. For example, I always need to be supervised when taking my medication as I would always take the wrong amounts, if I was not supervised.
This is evidenced by the letter from my GP, Dr Roberts, dated 12th April 2013, which I attach to this submission. In the letter Dr Roberts confirms my need for supervision when taking medication.
Furthermore, the statement made by my partner Ms Jane Smith, dated 10th April 2013, which I attach to this submission, confirms that she has to supervise me when I take medication every morning and evening.
Therefore, I contend that I should have been awarded 15 points when assessed on my awareness of hazards or danger.
You are not required to write submissions and you can simply go to the tribunal hearing and give your evidence orally.
If you decide not to make written submissions we would recommend making notes in the days before the appeal hearing and taking them with you so that you remember everything you want to say. It can be easy to forget something important due to the stress and strain of a hearing and this is your last opportunity to mention it.
Making Arrangements for the Tribunal
If you have any communication needs, such as requiring a translator to understand proceedings, it is important that you let the Tribunal know in good time, so that one can be arranged. Family members are unlikely to be allowed to act as your translator during the hearing.
If you would like someone to accompany you to the hearing you should ask them, in good time, whether they are willing to accompany you and available on the date of your hearing.
It is also important to plan how you will get to the tribunal. Make sure you know where the venue is and you have worked out how you will get there.

6. Attending your hearing
What happens when I arrive at the tribunal building?
It is important that you arrive at the tribunal in good time. The buildings
that are used for hearings vary throughout the country. When you arrive at
the building it is important to go to the right place. The location of your hearing should be stated in the letter you received telling you about the date of your hearing. You should report to reception to let them know that you have arrived.
It is likely that you will then be directed to a waiting room. The panel involved in the tribunal will try and make sure that hearings run to time. However in some situations there may be delays. You may want to bring along something to read. You may also consider bringing along a drink and some snacks, as refreshment facilities may be limited.
A tribunal clerk will come and ask you if you have any last minute evidence (such as medical reports) that you want to submit to the panel. This is also an opportunity to ask any questions you have about procedures for the tribunal.
What is the appeal hearing like?
Your appeal hearing will take the form of a tribunal. It is important to remember that attending a tribunal is not like going to court and is without the majority of formality you would associate with court.
For appeals regarding Disability Living Allowance, the hearing will be in front of a judge, a doctor and a „disability member‟ (this is someone who has an understanding of disabilities but is not a medical practitioner, they could be a social worker, nurse or occupational therapist for example).
For Employment and Support Allowance or Incapacity Benefit appeals it will be in front of a judge and a doctor.
For appeals in relation to Housing Benefit it will be in front of a judge only.
The people deciding your case will be wearing suits, not robes or wigs. The tribunal will not take place in a court room and there will be no witness box or jury. Instead the tribunal will take place around a table. The tribunal panel will make notes on what questions they ask you and what you say in response. There may be computers on the table that the panel will use. There may also be a tribunal clerk who sits at the back of the room. The clerk may carry out administrative duties, related to the hearing.
The style of proceedings is “inquisitorial”. This means that the panel will ask you questions in order to get a better understanding of your condition and the process should be co-operative. This is unlike cases in criminal courts where the style is “adversarial” and lawyers seek to discredit the other side. The panel is trying to work out the facts and should not act aggressively or make accusations against you.
The DWP may also send a representative to the hearing, although this is happening much less often at present. They are known as a presenting officer and their job is to represent the DWP and put their case across. They have the right to ask you questions about your condition, illnesses or situation and you will be expected to answer them. They can also make legal arguments to the tribunal.
How long will my hearing last?
The hearing will last around 30 to 40 minutes. The tribunal will be conducted in plain English and there should not be unnecessary use of legal jargon or reference to the law. The tribunal will be based on the facts of your claim. You do not need to know the law in order to represent yourself.
When will I know what the decision of the tribunal is?
Usually the same day. They may ask you to step outside the room for a few moments whilst they decide. If they cannot make a decision straightaway they will send the decision to you by first class post. If you still disagree with their decision you should ask for a written statement of reasons. Decisions made by the tribunal can only be changed in limited circumstances. You should always seek specialist welfare benefits advice.
You can search for a local welfare rights adviser, who may be able to help with an appeal, by contacting Civil Legal Advice on 0845 345 4 345 or by doing a search on their website – http://legaladviserfinder.justice.gov.uk/AdviserSearch.do
7. Tips for self-representation
 Take your time when answering questions and ask for additional clarification or a short break if needed.
The panel will ask you questions about your medical condition and about what you can and cannot do. It is important that you take your time when answering. If you do not understand the question that is being asked do not be afraid to ask them to repeat themselves or to phrase the question in a different way.
It is important to be polite to the panel. If you feel that you are finding it difficult to stay calm or you are becoming upset you can ask the panel to allow you to take a short break.
 Answer the panel’s questions as fully as you can and honestly
When giving your answers it is best to be as open and honest as possible. It is often hard to talk about medical problems and the help that you need.

If you think it is likely that you will be asked about something you find difficult to speak about, you may want to plan what you want to say before hand and practice saying it out loud. Alternatively you may want to write it down in your written submission and then refer to your written submission, instead of speaking directly about it.
 Give relevant examples
Mentioning relevant examples of how your condition affects you is a good way of explaining the impact your condition has on you. It may be helpful to take some written notes of practical examples so you don‟t forget what you want to say. If you found it difficult to get to the venue and needed help and support to do this, you could mention this.
You will often be asked to describe your typical day. It can be hard to describe a „typical‟ day if you have mental health problems as your mood or health could vary from day to day- try to explain this to the panel. Let them know what you can do on a good day but also how you manage on a bad day and how often you tend to have bad days.
 Consider taking along a friend or relative
You are entitled to take along a friend, care or relative for support. They can also help you during the tribunal by asking you questions, to prompt you to mention facts that you may have forgotten.
Whoever you take with you will not be expected to speak on your behalf as you are expected to answer the questions put to you by the tribunal yourself. If a representative or someone providing support attempts to give evidence to the tribunal on your behalf then they are likely to be stopped by the tribunal chair and not allowed to continue. This person can however ask you questions about things that you may have missed or are important to the case. You could then provide evidence by answering these questions. They would usually be able to ask their questions when the panel have finished asking questions. Your friend or relative may find it useful to bring a pen and paper with them, so they can write down points that they would like to ask you questions about.

8. Sample Letters
Example letter requesting supporting evidence from a health care professional for challenging Limited Capability for Work and Limited Capability for Work Related Activity decisions
To: (add name of professional)
Address: (add address of professional)
Date: (add date)
Dear Sir/madam (delete as applicable)
Re: Name: (add your details)
Address:
D.o.B:
I am currently appealing a decision regarding an Employment Support Allowance (ESA) claim and I am writing to ask if you would provide some evidence which may help my case.
It has been established that evidence from medical professionals involved with the diagnosis, care and treatment of a patient can be extremely useful in helping decision makers at the Department for Work and Pensions (DWP) to make decisions that are appropriate to the patient‟s needs and conditions.
I would be very grateful if you could answer all the questions that you think are relevant to my condition from the list below and return them to me in the envelope provided. Please be aware that I am not in a position to pay for any report or information.
Please note that the appeal is in respect of a decision made in (add date mm/yy) so I would be grateful if you could provide information based on my condition at that time.
I have downloaded this letter from Rethink Mental illness. The information contained therefore focuses on mental rather than physical health needs. If there is information regarding my physical health needs in addition to my mental health needs that you think is relevant, then please include this at the end of the form.
Yours sincerely
1. Please state what condition(s) I suffer from and what medication(s) and treatment(s) have been prescribed.
2. How is my ability to learn simple tasks (e.g. setting an alarm clock or operating a washing machine) affected by my medical condition(s)?
3. How is my awareness of everyday hazards, (e.g. Boiling water or sharp objects), affected by my medical condition(s)? Does this pose a significant risk to my safety or other‟s?
4. How is my ability to initiate and complete personal tasks affected by my medical condition(s)?
5. How is my ability to initiate and cope with change affected by my medical condition(s)? Does this affect my ability to manage my day to day life?
6. How is my ability to get to places affected by my medical condition(s)? Do I need supervision to get to familiar or unfamiliar places?
7. How is my ability to cope with social engagement affected by my medical condition(s)? Am I caused distress by social engagement and does this preclude social engagement?
8. How is my behavior affected by my medical condition(s)? Do I show signs of aggressive, uncontrolled or disinhibited behavior? And could this be considered unreasonable in a workplace?
9. If I am required to attend work focused interviews or job programs. Would this have a detrimental affect on my health? If yes, how would I be affected?
10. Is there any other information that you think is relevant?
Signature Date Hospital/Surgery Stamp
Thank you very much, in advance for any help you can provide towards my appeal
Example letter requesting supporting evidence from a health care professional for DLA Appeals and Revisions
To: (add name of professional)
Address: (add address of professional)
Date: (add date)
Dear Sir/madam (delete as applicable)
Re: Name: (add your details)
Address:
D.o.B:
I am currently appealing a decision regarding a Disability Living Allowance (DLA) claim and I am writing to ask if you could provide some evidence which may help my case.
It has been established that evidence from medical professionals involved with the diagnosis, care and treatment of a patient can be extremely useful in helping decision makers at the Department for Work and Pensions (DWP) to make decisions that are appropriate to the patient‟s needs and conditions.
I would be very grateful if you could answer all the questions that you think are relevant to my condition from the list below and return them to me in the envelope provided. Please be aware that I am not in a position to pay for any report or information.
Please note that the appeal is in respect of a decision made in (add date mm/yyyy) so I would be grateful if you could provide information based on my condition at that time.
Yours sincerely
1. Please state what condition(s) I suffer from and what medication(s) and treatment(s) have been prescribed.
2. To what extent do my condition(s) physically affect my ability to walk outdoors?
3. Do I require guidance and supervision whilst outdoors in connection with my medical condition(s)? If yes, what support is needed?
4. To what extent do my condition(s) affect my ability to care for myself at home? E.g. wash, dress and bathe, prepare and cook a main meal, remember to take my medication, dress myself appropriately or keep my self safe?
5. Do I need someone with me throughout the day to provide supervision, for example in order to keep me safe or to provide me with support and reassurance due to my medical condition(s)?
6. Do I have any history of falls or seizures? If yes, how does this affect me and how often do they happen?

© Rethink Mental Illness 2013
Last updated April 2013
Next update April 2014

This factsheet provides information about benzodiazepine medication. This is often used to treat anxiety. It is generally a short term treatment if you are very distressed because of your anxiety or if your anxiety has become very severe.
 Benzodiazepines are medications which are used to treat anxiety.
 You may experience side effects from taking this kind of medication. If you are experiencing side effects that are causing you concern, you should see your doctor.
 It is possible to become dependent on benzodiazepines. Therefore, it is recommended that they should not be used for longer than one month.
 When you stop taking benzodiazepines, you may experience withdrawal symptoms. It is important to seek advice from your doctor before stopping them. It may be better to stop them gradually, particularly if you have been taking them regularly for longer than one month.
 Whilst taking benzodiazepines, you may find that drinking alcohol makes you sleepier. They can also increase the effect of alcohol..
 Whilst taking benzodiazepines, your ability to drive may be affected.
This factsheet covers –
1. How do benzodiazepines work?
2. What different types of benzodiazepines are there?
3. What are the possible side effects?
4. What about stopping benzodiazepines?
5. How will my benzodiazepine affect other medication?
6. Will drinking alcohol affect my benzodiazepines?
7. Can I drive when taking benzodiazepines?
8. What about sex, pregnancy and medication?
Benzodiazepines
2
1. How do benzodiazepines work?
When you are anxious, your brain becomes more active. It may then produce a chemical messenger (or ‘neurotransmitter’) called GABA (short for gamma-aminobutyric acid) that makes you feel calmer. GABA is the brain’s naturally occurring ‘calmer’. The benzodiazepines make the action of GABA more powerful and this helps to calm people down.
Benzodiazepines are recommended as an emergency treatment that should not be used for more than 1 month. Benzodiazepines should not be used for panic disorder. They should not be used as a routine treatment for generalized anxiety disorder, except as a short-term measure during a crisis.1
These drugs are not usually helpful for conditions like schizophrenia or bipolar disorder but may be used in emergency situations needing rapid calming.
Top
2. What different types of benzodiazepines are there?
Types of benzodiazepines are normally grouped by the length of time over which they act (called a half-life), with shorter acting benzodiazepines called ‘hypnotics’ and longer acting benzodiazepines called ‘anxiolytics’.
Hypnotics are used for those experiencing difficulties sleeping (insomnia). Anxiolytic type benzodiazepines help to reduce anxiety, agitation and tension.2 For both of these types of benzodiazepine, using them should only be for the shortest amount of time possible. Drugs that fall into the category of benzodiazepines include3 –
Benzodiazepines – Hypnotic effects
Benzodiazepines – Anxiolytic effects
Flurazepam
Alprazolam
Loprazolam
Chlordiazepoxide
Lormetazepam
Diazepam
Nitrazepam
Lorazepam
Temazepam
Oxazepam
These drugs can come as tablets, capsules and liquids. They should start to work fairly soon after you take them.
For longer term treatment, other options such as talking therapy should be considered.

3. What are the possible side effects?4
Like many drugs, taking benzodiazepines can cause side effects in some people.
Common side effects are:
 drowsiness or sleepiness
 dizziness
A less common side effect is being unsteady on your feet.
Rarer side effects include:
 headache
 confusion
 low blood pressure (you might feel dizzy when standing up)
 problems with remembering
 feeling aggressive, excitable, talkative, unfriendly or disinhibited.
If you get a blotchy rash, you should stop taking your benzodiazepines and see you doctor immediately.
Not everyone will experience side effects from taking benzodiazepines, but if you are getting side effects that you are worried about or that are causing you distress you should talk to your doctor about this.
Top
4. What about stopping taking benzodiazepines?
If you have been taking benzodiazepines regularly for more than 4-6 weeks, it is best not to stop taking them suddenly. It is possible to become dependent on benzodiazepines (an addiction which can be physical and psychological). At least a third of people who use benzodiazepines long-term experience problems when they try to reduce their dose or come off them completely.5
Stopping gradually is also more likely to help you stop taking benzodiazepines than just stopping suddenly.6 It is important to get advice from your doctor before stopping your benzodiazepine medication.
Some of the more common withdrawal problems include7 –
Physical
 stiffness
 weakness
 stomach problems
 flu-like symptoms
 visual problems
Psychological
 anxiety
4
 insomnia (trouble sleeping)
 nightmares
 problems with memory and concentration
 depression
 experiencing things that are not there (hallucinations)
 fixed beliefs that may not correspond with other people’s reality (delusions)
Not everyone stopping benzodiazepine medication will experience these symptoms. For most people who do experience them, they usually stop after a few weeks. They can go on for much longer for a minority of people.
Top
5. How will benzodiazepines affect other medication?
This section is not exhaustive. You should tell your doctor of any medicines that you may be taking and also before starting or stopping other drugs. This includes herbal or complementary medications.
The effect of benzodiazepines to cause sedation or sleepiness can be increased with other medication with a similar effect. This can include among others, certain painkillers, antidepressants, antipsychotic medication, antihistamines, and beta-blockers.8
Top
6. Will drinking alcohol affect my benzodiazepines?
Drinking alcohol while taking benzodiazepine medication will make you more sleepy. This is particularly important to bear in mind if you may need to drive or operate machinery (see below). The medication can also increase the effect of alcohol, so it is best to avoid alcohol when taking benzodiazepines.9
Top
7. Can I drive when taking benzodiazepines?
Benzodiazepines can reduce your ability to carry out skilled tasks, such as driving or operating machinery. You may also feel drowsy the day after you take them. Until these effects wear off or you know how your drug affects you, do not drive or operate machinery. You should also take extra care, as benzodiazepines may affect your reaction times.10
You should inform the DVLA if you are taking medication that may affect your driving. You should also inform them if you have a medical condition that could affect your driving.
For further information on this, please see the Rethink Advice & Information Service factsheet ‘Driving and mental illness’ .This is available to download for free at http://www.rethink.org/factsheets or by contacting 0300 5000 927 and asking for a copy to be sent out to you.
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8. What about sex, pregnancy and medication?
Sex
Benzodiazepines do not have any known significant effects on people’s sex lives. Sleepiness or sedation caused by them may have an effect on sex life.11
Pregnancy12
Benzodiazepines probably do not cause problems with the physical development of the unborn child but are best avoided during late pregnancy. During the first three months of pregnancy, exposure to benzodiazepines is associated with an increased risk of oral clefts in newborns. Exposure during the last three months is commonly associated with the newborn baby being more limp than is usual. You are advised to contact your doctor to talk about options if you are planning to have a baby.
Breast feeding
The benefits and risks of breast feeding should be weighed up. Your options during this period should be discussed with your doctor or psychiatrist.
Diazepam is excreted in the breast milk from a nearly undetectable rate to nearly 14%. No adverse effects were noted for some babies being breastfed while their mother took diazepam, while others showed tiredness and weight loss. Lorazepam, temazepam and clonazepam are excreted in the breast milk in small amounts but few adverse effects are reported.13 It is strongly advised that you talk to your doctor about your options if you are planning to breast feed.
Council for Information on Tranquilizers, Antidepressants and Painkillers CITA is a service that provides a national helpline, support and information service for people affected by tranquilizers, antidepressants and painkillers. Their services can also be used by friends, family and professionals.
CITA
The JDI Centre
3-11 Mersey View
Waterloo
Liverpool
L22 6QA Helpline – 0151 932 0102 (10am-1pm, Monday to Friday, weekends and bank holidays) Email – cita@citap.org.uk Web – http://www.citawithdrawal.org.uk
6
1 National Institute of Health and Clinical Excellence. Generalized anxiety disorder and panic disorder (with or without agoraphobia). Clinical Guidance 113, http://www.nice.org.uk. 2011.

http://www.bipolar4lifesupport.co on line support group

Bipolar 4 life support is a non profit community that has been around for about 9 years all registers get a life time free SSA membership, http://www.bipolar4lifesupport.co on line support group

WE have a donation button but it is not necessary to do so it is a free environment with many empathetic people

We offer support to each other on a daily basis with no judgments. It is like my on line family. When I was at my most stable I felt why don’t I give something back and I started with a free on line yahoo group and have grown from there we have many features to use such as

BLOGS
GALLERY to share your life’s happenings
CHAT to get together and get to know each other but also a chat topic we have many games on the forum
we also have a ARCADE
PAGES
Poetry corner lots of topics
Photo Shop

We have the FORUM

we also have a new AWARDS system where u can send a image and a positive note to a friend/member we all become friends very quickly I do not put up with any clicks we are a free open to all each of us are equals and that is how the group is run in every way

Here is a little something:

Bipolar Disorder & other Mental Health & Wellness diseases not only affect the individual diagnosed it has a impact on the family as a whole. We welcome here @ Bipolar 4 Life Support family members dealing with their loved ones and support those individual diagnosed at the same time by sharing coping mechanisms, in hope’s to learn from each others struggles and possibly be able to lend a hand in helping someone else… Joining something that you can relate to, as me where I finally found a “place” to fit in where people understood me, really empowered me, to reach out more, it took a great deal of focus off of myself, and in return I started to feel, and still,much Gratification that my story, and or, struggles just may be for a “reason,” to help those struggling like I did, and in reaching out to those whom do not have a voice yet….

That is why I opened
http://www.bipolar4lifesupport.co

Hope to see you there what have you got to lose :):)

OVRVIEW

Someone with a mental health condition may need support in the community. This section sets out how an adult over the age of 18 with a mental health condition can access ‘community care’ services from their local authority. This does not consider community care in relation to care or children.
•The social services department is part of your local authority (local council).
•To get help from adult social services, the first step is to find their contact details. You can then contact them and ask for a ‘community care assessment’. If your care is being managed under the ‘Care Program Approach’ (CPA), talk to your care coordinator about it.
•Social services are under a legal duty to assess anyone who may be in need of community care services.
•Your needs could include housing, employment, support at home and social needs.
•Once you have been assessed to see if you have any community care needs, an assessment will be done to see how high your needs are. If your needs are high enough to meet your local authority’s ‘eligibility criteria’ then you will have ‘eligible needs’.
•If your eligible needs are not already being met in some way (e.g. by a care) then your needs must be met by the social services department. If social services say you have eligible needs, it is unlawful for them not to meet these needs.
•You should be involved in deciding how your needs are met.
•If you have any problems during the process that you cannot resolve informally, you may wish to use the social services’ complaints process.

Why would I need community care services?

If you feel as though you are finding day-to-day life difficult, social services may be able to help. There are some problems that you may have that cannot be resolved by health services alone. For example, you may find it very hard to:
•Get out of the house
•Maintain social contact with friends and family
•Get a job or take part in education
•Clean the house
•Prepare meals or go shopping
•Keep safe
•Manage your money
•Engage in leisure activities

This is not a full list of things that social services might be able to help you with, and you should contact them for an assessment if you feel as though you are finding it hard to do things for yourself.

Some people feel embarrassed about contacting social services or think that social services are only meant to help children. Remember that there is a specific section of social services that helps adults with disabilities, and they are there to help people to be independent.

Who is entitled to community care services?

To receive adult community care services, you will need to:
•Be an adult over 18
•Be ‘ordinarily resident’ in the area where you are asking for an assessment (see ‘Frequently Asked Questions’ for more information) and
•Be assessed as having needs that meet your local authority’s eligibility criteria

•Early intervention services work with you if you are experiencing a first episode of psychosis.
•Psychosis is a term used if you experience a break with reality. This can include having unusual beliefs or seeing or hearing things that other people do not.
•If you have psychosis and do not get help for a long time, you may have more episodes of psychosis in the future.
•Early intervention services have been set up so people can get help sooner and try to prevent these problems.
•An early intervention team will be made up of staff such as a psychiatrist, psychologist, community psychiatric nurses, social workers and support workers.
•Your GP can refer you to your local early intervention team. In some areas, you may be able to refer yourself or your friends or family could refer you.

Who is early intervention for?

Early intervention teams treat and support people who are experiencing psychosis for the first time.

Psychosis is a medical term. If you have psychosis, you might see or hear things, or hold unusual beliefs, that other people do not. It is not a condition in itself, but more a set of symptoms present in conditions such as
•schizophrenia
•bipolar disorder
•schizoaffective disorder

If you have symptoms of psychosis, medication (known as antipsychotics) and cognitive behavioural therapy (CBT) can help.

The National Institute for Health and Care Excellence (NICE) recommends that if you are experiencing psychosis for the first time, you should be offered early intervention services, no matter how old you are. You get support from an early intervention team for a limited amount of time. This is usually three years, but can be longer.

If you have psychosis and do not get treatment for a long time, you are more likely to develop longer-term problems. This can include becoming unwell again with more episodes of psychosis and also problems with your relationships or being able to work or study. Early intervention services were set up so that people could get help for psychosis earlier and to try and prevent these problems.

An early intervention team is made up of different professionals who provide treatment and support.

Psychiatrists

A psychiatrist is a doctor who specialises in mental illness. They can give a diagnosis for symptoms of a mental health condition and also manage treatment, such as medication.

Social workers

A mental health social worker can give expert, practical help with your social care needs. This might be help with housing problems, educational issues or through giving general support and advice.

Community psychiatric nurses (CPNs)

A CPN is a qualified mental health nurse who works outside of hospitals. They can support you with taking medication, offer encouragement and help you to manage your health while living in the community.

Psychologists

A psychologist is a trained professional who can offer psychological assessment and therapy for mental health problems. They may specialise in treating particular conditions or providing a particular sort of psychological therapy.

Occupational therapists

An occupational therapist helps you to overcome difficulties with everyday tasks. They aim to help people be as independent as possible.

Other early intervention team professionals

Other people will also make up the team such as managers, psychotherapists and administrators.

These people work together closely and have regular meetings to discuss the progress of the people they support. You might hear these meetings referred to as ‘multi-disciplinary meetings’.

Access

Usually you will need a referral to access the early intervention team. A referral is when your details are passed to another team or service so that they can make an appointment to see you. Early intervention teams accept referrals from GPs and other mental health teams in the community. Sometimes local early intervention teams will also accept self referrals or referrals from friends and family.

After you have been referred

In most cases, your details will be passed on and someone will contact you to arrange an initial assessment. This is sometimes called a screening assessment or triage assessment. Although it is unlikely you will meet with the whole team, this assessment may take place with one or two different workers over the course of a few sessions. This is so that the team can work with you to plan how they can best support you.

They will discuss how you are feeling and what affects this. They will also discuss what sort of support you already have. They will ask you questions and together you will decide how best to move forwards with your treatment and care. You might get help from the team as a whole or just one person. The assessment and planning process should aim to meet your needs and choices. It should not just focus on what professionals and services can offer. It should address what you want and what you are good at as well as what you need or find difficult.

Because of the health complications that psychosis can cause, NICE recommends that:
•When you start taking antipsychotic medication, you should have a full range of physical health checks, including weight, blood pressure and other blood tests. These checks should be repeated regularly.
•Mental health professionals are responsible for doing these checks for the first year of treatment. Responsibility may then pass to your GP.
•You should be offered a combined healthy eating and physical activity programme by your doctor or mental health team.

Confidentiality

The team should not normally discuss your care or give information about you to people outside of the team without getting your permission to do so. This includes family members or carers. The only person that they will contact is your GP who should still be involved with your care and will work alongside the early intervention team. You can find more information in our ‘Confidentiality’ section.

If the team thinks that you have complex needs that need ongoing support, then you might be placed under the Care Program Approach (CPA). This is the framework that coordinates some people’s mental health care.

If you are eligible for CPA, then you should receive a care plan and regular reviews. You should also get a care coordinator who will be responsible for overseeing your care and support. A care coordinator can be someone from a number of backgrounds such as a social worker or Community Psychiatric Nurse (CPN). The eligibility criteria for CPA can differ depending on the area where you live. However, even if you are assessed as not needing CPA, then you should still be able to receive support from secondary mental health services. You can find more information about CPA in our ‘Care Program Approach’ section.

DISCHARGE

You usually get help support from an early intervention team for up to three years, but this can vary and can be longer. After this time, if you still need support for your mental health, your early intervention team can refer you to your local Community Mental Health Team (CMHT).

If you do not need the support of the CMHT, then you will be referred back to your GP who will be responsible for your mental health care.

You may be discharged from your early intervention team earlier if you have improved and are able to manage without their support. If this happens, you will be discharged back to your GP. You may not agree with your early intervention team if they are thinking about discharging you early or have already discharged you. If this happens, you could consider some of the options in this section, such as making a formal complaint.

You may prefer to be seen by a male or female professional within the early intervention team. Although you can request this, this may not always be possible. This would depend on who is available at the time. However this does not mean that you can’t ask for it if you feel it would help you.

If you have a care coordinator, then this person will have an overall responsibility for organising and monitoring your care. This is the person who you will probably have the most contact with. It is important that if you have a preference for a male or female care coordinator, the team consider this so you can build up a trusting relationship with him or her. If you have any cultural or religious needs, the team should also consider these.

Whether you are getting support from the whole team or only from particular people within the team, you should feel comfortable enough to discuss any issues that arise with them if you feel that there are any problems.

If you feel unhappy with how your care is being handled, then you could contact the Patient Advice and Liaison Service (PALS), who can try to resolve any problems or questions you have. Their details should be available to you through the early intervention team, but you can also find your local office details through this website.

If you are unhappy with your support then the help of an advocate can be useful. An advocate can help you to understand the mental health system and help you to be fully involved in decisions about your care. An advocate is independent from mental health services and can help to make your voice heard with problems you may come across. They may be able to help with writing letters for you or attending appointments or meetings.

There may be a local advocacy service in your area which you can contact for support. You can search online for a local service. You can find more information on advocacy in our ‘Advocacy’ section.

You could make a formal complaint if you are unhappy with your care from the early intervention team. If you wish to put in a complaint about the team then the Patient Advice and Liaison Service (PALS) at your local Trust could advise you on this. You can also get help with this from the Independent Complaint Advocacy Service (ICAS) who deal specifically with NHS complaints. You can find more information about complaining in our ‘Complaining about the NHS or Social Services’ section.

What about confidentiality?

The team should not normally discuss your care or give information about you to people outside of the team without getting your permission to do so. This includes family members or carers. The only person that they will contact is your GP who should still be involved with your care and will work alongside the early intervention team. You can find more information in our ‘Confidentiality’ section.

CARERS

If you are worried about someone’s mental health then you might be able to contact the local early intervention team and ask for a referral. Sometimes this can only be done after someone has visited their GP first.

Care should be involved with decisions about care planning. There are particular rules regarding confidentiality and care. Unless a person consents, confidential information about them cannot be passed on to others, including family members, friends and care. The team should seek permission and ask the person about what they are happy for others to know. This would also include any care plans that are drawn up. You can find more information in our ‘Confidentiality and Information Sharing – For Care, Friends and Relatives’ section.

As a care, friend or relative of someone living with mental illness, you might find that you also need support. If you feel you need additional support to care for your loved one you could ask for a care assessment. You can find more information in our ‘Care Assessments’ section. Our section ‘Supporting someone with a mental illness’ may also be useful.