Post by Patrick Torsney on Jan 3, 2011 21:37:04 GMT 1
Here is a case study from an adviser at an organisation specialising in mental health, welfare benefits and the legal problems that arise when both collide. It is about a young woman called Jane (her name has been changed to protect her identity)
Jane was referred to us with an ongoing welfare benefits issue. She had previously been employed, but could no longer cope with her job due to her mental health issues. The Department for Work and Pensions (DWP) were disputing her entitlement to benefit, saying she was fit for work regardless
Jane explained to me that she had been abused by her father as a child, and that this was causing her major distress still. She explained that she hated herself, and that she believed that she was worthless. As a knock on effect to this, Jane told me that her anxiety levels felt uncontrollable, and that her sleep patterns were disrupted. She also disclosed that her eating habits were not as they should be, and that she was either not eating at all or was bingeing at times
I felt that Jane began to trust me as she opened up about the issues in her childhood that she felt impacted on her current mental health issues
The first issue we tackled was the beliefs that Jane had about herself. This involved challenging Jane’s negative beliefs and thoughts about herself. We spent an hour determining the beliefs that Jane had about herself, and looking at where she thought they had come from. We then looked at if there was any evidence to back up these negative thoughts, and then at what positive thoughts she could come up with to replace the negative ones. As this was not going to be resolved within the hour, this exercise was, and has been, repeated in several of the following sessions
We then looked at Jane’s anxiety levels. She explained that she felt that she was dying when her anxiety levels rose, and that she couldn’t control this. I took this opportunity to talk through what actually happens to the body physiologically when a panic attack occurs in the hope that this would reduce the fear Jane has when she panics. We then looked at some breathing exercises, including square breathing and elephant breathing. Jane found the square breathing concept easier to follow, and explained she would try and put it into practice when she felt anxious. Jane’s erratic eating habits were another issue that needed tackling
Bibliotherapy is a well-used therapeutic intervention, which involves giving the client some literature around their difficulties. I took this opportunity to give Jane the ‘Healthy Eating and Depression Booklet’, and talked through how erratic eating can have an impact on a person’s depression
Challenging negative thoughts is an intervention that will continue throughout our sessions, and Jane continues to use the breathing techniques when feeling panicky
With regards to very serious issue of the abuse Jane suffered as a child I began the work but felt she needed more specialist and targeted help and support. With Jane's agreement, I completed a referral to [organisation] for the next steps in dealing with these particular issues
To this date, Jane has progressed dramatically. Her original PHQ91 score was 24, and GAD72 was 18. This has now reduced to PHQ9 = 17 and GAD7 = 11
Oh yes, our publicly funded case in respect of the welfare benefits that Jane had been denied... Jane won her appeal and her benefits were awarded in full
Jane is now attending college to complete a qualification in law and she is doing voluntary work at a local solicitors firm and also with Victim Support. Jane has a long way to go. One day, she hopes she will feel 100% but she says she would be happy with 80. Jane says she has a future now and is taking it one step at a time
We received our standard fixed fee from the Legal Services Commission of £167 + VAT for Jane's 'case'
There was never anything unusual about this young woman. Many of us experience some form of mental health problem during our lives. Many of us don't even realise we are experiencing it when it happens - it isn't always contingent upon an event in childhood, for instance. What is crucial is that the help is there when it is most needed and when we are at our most vulnerable
1PHQ9 is a Patient healthcare Questionnaire that the patient uses as a self assessment tool for mild to moderate mental illness
2GAD7 is General anxiety disorder scoring system to assess the level of mild to moderate mental illness
Jane was referred to us with an ongoing welfare benefits issue. She had previously been employed, but could no longer cope with her job due to her mental health issues. The Department for Work and Pensions (DWP) were disputing her entitlement to benefit, saying she was fit for work regardless
Jane explained to me that she had been abused by her father as a child, and that this was causing her major distress still. She explained that she hated herself, and that she believed that she was worthless. As a knock on effect to this, Jane told me that her anxiety levels felt uncontrollable, and that her sleep patterns were disrupted. She also disclosed that her eating habits were not as they should be, and that she was either not eating at all or was bingeing at times
I felt that Jane began to trust me as she opened up about the issues in her childhood that she felt impacted on her current mental health issues
The first issue we tackled was the beliefs that Jane had about herself. This involved challenging Jane’s negative beliefs and thoughts about herself. We spent an hour determining the beliefs that Jane had about herself, and looking at where she thought they had come from. We then looked at if there was any evidence to back up these negative thoughts, and then at what positive thoughts she could come up with to replace the negative ones. As this was not going to be resolved within the hour, this exercise was, and has been, repeated in several of the following sessions
We then looked at Jane’s anxiety levels. She explained that she felt that she was dying when her anxiety levels rose, and that she couldn’t control this. I took this opportunity to talk through what actually happens to the body physiologically when a panic attack occurs in the hope that this would reduce the fear Jane has when she panics. We then looked at some breathing exercises, including square breathing and elephant breathing. Jane found the square breathing concept easier to follow, and explained she would try and put it into practice when she felt anxious. Jane’s erratic eating habits were another issue that needed tackling
Bibliotherapy is a well-used therapeutic intervention, which involves giving the client some literature around their difficulties. I took this opportunity to give Jane the ‘Healthy Eating and Depression Booklet’, and talked through how erratic eating can have an impact on a person’s depression
Challenging negative thoughts is an intervention that will continue throughout our sessions, and Jane continues to use the breathing techniques when feeling panicky
With regards to very serious issue of the abuse Jane suffered as a child I began the work but felt she needed more specialist and targeted help and support. With Jane's agreement, I completed a referral to [organisation] for the next steps in dealing with these particular issues
To this date, Jane has progressed dramatically. Her original PHQ91 score was 24, and GAD72 was 18. This has now reduced to PHQ9 = 17 and GAD7 = 11
Oh yes, our publicly funded case in respect of the welfare benefits that Jane had been denied... Jane won her appeal and her benefits were awarded in full
Jane is now attending college to complete a qualification in law and she is doing voluntary work at a local solicitors firm and also with Victim Support. Jane has a long way to go. One day, she hopes she will feel 100% but she says she would be happy with 80. Jane says she has a future now and is taking it one step at a time
We received our standard fixed fee from the Legal Services Commission of £167 + VAT for Jane's 'case'
There was never anything unusual about this young woman. Many of us experience some form of mental health problem during our lives. Many of us don't even realise we are experiencing it when it happens - it isn't always contingent upon an event in childhood, for instance. What is crucial is that the help is there when it is most needed and when we are at our most vulnerable
1PHQ9 is a Patient healthcare Questionnaire that the patient uses as a self assessment tool for mild to moderate mental illness
2GAD7 is General anxiety disorder scoring system to assess the level of mild to moderate mental illness