I have a very difficult client who had encaphalytis some years ago and as a result has cognitive problems, behavioural problems, depression, and a paranoid lack of trust. She also has arthritis. She is on DLA l/care l/mob but has deteriorated and we have requested a supersession. I have completed the forms with her but she is significantly unaware of the extent of her problems and would not let me reflect them fully. She insisted on taking the forms to the GP herself to complete the supporting statement and is going to get a friend to drive her to Blackpool (from Northumberland) to hand in the forms as she does not trust the post. I am sure this will not happen. I will have no problem getting medical evidence to support the supersession, but Blackpool are telling me they must have forms or a letter signed by the client otherwise they cannot carry out a supersession. I'm sure this is untrue. They supersede decisions downwards if they receive information that a client is carrying out activities inconsistent with his award after sending out an EMP, and somebody other than the claimant can complete and sign the claim form. I think they can make a supersession decision regardless of whom the information on the change of circs comes from or what form it takes, but can't find the reg or CD. Any ideas please?

To be honest, I think it's a bit iffy. I can understand your frustration but when push comes to shove it's her decision whether or not to go ahead with the supersession- it's not as though you're her appointee and I think there would be a confidentiality issue if you contacted DBC without her authority. If the client does return her supersession forms you could write in support of the supersession/gather additonal supporting evidence as long as you have her authority, but beyond that I really don't think you can go.

..and imagine how messy it would get if you contacted DBC & initiated a supersession without her authority and her existing award was downrated or removed..

Client has asked us to help with supersession and signed specific form of authority. It's just that she is pargely unaware of her problems in DLA terms and wont let us deal with the forms in our usual way.

It sounds as if there are two issues here. Firstly, making an application for a supercession and secondly getting the most helpful evidence to the decision maker.

Assuming that Blackpool accept her hand-delivered forms the first issue is dealt with.

The second part is harder. I recently visited a young man in hospital with mental health problems to assist with a DLA application. He refused to admit to any care or supervision needs, despite prompting from his parents, and the interview became quite difficult. In the end I wrote what he wanted on the form, then got his nurse to write a more pessimistic bit on "person who knows you" part, stressing his lack of insight into his condition. I don't know the outcome of the claim, but I felt that at least I would have something I could use if he was refused and had to appeal.

Would your client let you collect medical evidence to send as a suplement to the claim pack, after she has delivered it? Although if she asked to see the medical evidence it could put you and her doctors in a difficult position if she didn't like it.

It's quite a dilemma but the way I get round lack of insight when dealing with mental health cases is to explain to the person that the medical and mental health experts have a different view of their needs and ask if they are willing to let me write a letter of support for their claim giving both viewpoints. Sometimes they agree, sometimes they don't but in the cases where they do agree the benefit is generally awarded at a higher rate. At the end of the day it is their claim and their decision - all you can do is what they want.

I agree with everything that has been said already, but would add that a change of approach, if appropriate, may be helpful.

By looking for ways to get things moving in ways that either the client doesn't know about or doesn't like, you aren't going do much good because the client will just end up not trusting you and her misplaced beliefs will be confirmed.

With lack of insight, it's totally pointless trying to persuade the client that she is going about it the wrong way or that she won't do any good. In these situations, I sit down with the client and find out all of thier concerns about all the issues. I then relate those concerns to the situation in hand and try to show how those concerns can be overcome. This aids in building understanding for the client and assists in establishing rapport between client and adviser. You are then in a much better position to have your way of doing things accepted by the client. This has to be an ongoing process, so as new concerns emerge you have deal with them. I also think it's extremely important to keep the client fully informed with what you are doing and what happens next, and also to empower the client.

Of course, this deals with the relationship between client and adviser and I don't know how you manage things, so this info might be useless. It's also possible, as is sometimes the case, that no amount of interview skills, empathy, trust, empowerment, etc., etc. will make any difference at all. In this case, I echo previous contributions - without an appointee, the client is ultimately responsible.