7 September 2005
Doctors carrying out DLA and AA medicals are being trained in a new method of assessing claimants which claims to discover if they are “genuinely living the life of a disabled person”. An example of a new Biopsychosocial assessment seen by Benefits and Work resulted in a claimant with Chronic Fatigue Syndrome losing his higher rate mobility component on the grounds that his condition was 60% “psychosocial”. The new system will be aimed particularly at claimants with “medically unexplained” conditions such as ME/CFS, fibromyalgia, low back pain and IBS.
Confirmation that Medical Services have adopted the Biopsychosocial Model for assessing not just claims based on incapacity for work but also DLA and AA came in the July edition of Decision Maker’s Exchange (DME), the monthly newsletter for DLA and AA decision makers. (Decision Makers Exchange can be downloaded from the members area). An item in DME explained that:
“Medical services have recently introduced a change in the way that they assess a customer's disabilities and the effect it has on their lives. The Biopsychosocial Model aims to address how a persons disability has an effect on that individuals life”.
The newsletter features an article by Mansel Aylward, former Chief Scientist at the DWP, self-effacingly entitled “Professor Aylward endorses the Biopsychosocial Model of Disability”. In it, the Professor asks, but doesn’t actually answer in any tangible way, the questions:
"Why is it that in disability assessment medicine we see two individuals, of the same age and with the same illness or pathological condition, but with very different resulting levels of disability? How, as medical disability analysts, do we assess the level of disability in people with conditions whose effects are predominantly or wholly subjective? People with "medically unexplained symptoms" - conditions for which there is limited or no recognised pathological basis, such as chronic fatigue, fibromyalgia, chronic low back pain - feature regularly in disability assessments for state benefits. How do we evaluate and reasonably validate the functional limitations that affect people with such conditions?"
Whilst not giving any clear explanation of how it is to be applied, the Professor does explain that the Biopsychosocial Model is the answer to the disability analyst’s plight.
Just sitting around
The Biopsychosocial model was first set out by psychiatrist George Engel in 1977. It attempts to reconcile the medical model of disability, which says that people’s impairments disadvantage them, and the social model which says that it’s society’s failure to accommodate people’s impairments which disadvantages them.
In its original form, the Biopsychosocial model seeks to look at people in the round, considering individuals’ health conditions, their beliefs about them and society’s attitudes towards them. The – not entirely helpful - example given by Professor Aylward is of two people with back pain. One person knows that activity makes his back hurt and therefore believes that any activity must be making his back problems worse and so decides that he must rest. His beliefs mean that his condition is more disabling than that of someone who knows that being active tires him but also knows that “just sitting around isn’t doing me any good either” and so draws up a plan of activities with which he can cope.
Whatever the philosophy behind the model, Medical Services doctors are now being taught that the most important test to be applied to DLA and AA claimants is whether they are “genuinely living the life of a disabled person”. Doctors are being taught to look for evidence of:
“Consistency of disability within a typical day” – for example, someone with chronic fatigue might be expected to have a disturbed sleep pattern, often needing to sleep during the day.
“History involving chronic pain management” – this might be referral to a pain clinic, cognitive behavioural therapy, appropriate medication, physiotherapy or alternative therapies such as acupuncture.
“Home adaptations and adaptations to daily living” – this might include things such as the regular and consistent use of raised chairs, walking aids, a commode and a downstairs room for sleeping in.
“Appropriate intervention from a carer” – this might be assistance with things such washing and bathing, dressing, etc.
It’s nearly all in your mind
In theory, such an assessment which would require a more detailed and holistic assessment by doctors. In practice, it seems likely to be used to dismiss a large part of a claimant’s needs as not physical but “psychosocial”.
Benefits and Work has seen one recent medical report in which a DWP doctor explicitly stated that he had used the Biopsychosocial model. The claimant has Chronic Fatigue Syndrome and was seeking renewal of an award of the middle rate of the care component and the higher rate of the mobility component. His condition had deteriorated since his last award over two and a half years ago. The doctor who visited him recorded that:
“There are few significant findings other than subjective tenderness and stiffness. But the customer is clearly living the life of a disabled person and I have applied the Biopsychosocial model.”
The doctor then stated, without explaining how the conclusion had been reached, that the claimant’s condition was just 40% physical and “60% psychosocial: dependence on family members, depression and pain”. This allowed the decision maker to conclude that the claimant’s award of higher rate mobility was no longer appropriate as the primary reason for his virtual inability to walk was psychosocial rather than physical.
Blame the claimant
The Biopsychosocial model, as interpreted by Medical Services, with its concentration on the importance of the use of aids and adaptations, clearly fits in well with the new supersize DLA claim pack being piloted in Bootle and Manchester. It is equally clearly a useful tool for creating quasi-scientific justifications for blaming claimants for the degree of their impairment and depriving them of benefits as a consequence. Whether it is right that a multinational business such as Atos Origin should be able to play such a leading role in changing the way in which DLA and AA claimants are assessed is less clear. And whether tribunals, where a third of the doctors are Medical Services trained, will be prepared to accept the new “genuinely disabled” test only time will tell.
Free training materials
Meanwhile, claimants and advisors who wish to prepare themselves to challenge Biopsychosocial medicals can copy and paste a Freedom of Information email from the members area in order to receive free copies of over 100 pages of Atos Origin training materials on using the Biopsychosocial Model in incapacity for work, DLA and AA assessments.