How does depression, etc., fit into the definition of disability? [UK]

[braveheart]

I'm writing an article for an e-zine about mental health, work, and the disability discrimination act (DDA). [in the UK].

I have a very positive experience of my work being supportive and providing reasonable accommodations. My main medical diagnosis, Recurrent Depressive Disorder, comes under the DDA. Because it has affected me for - far more than - a year, and is recurring. [is there all the time, but yeah..]

There is one thing I still don't really understand. In the DDA, for an illness to qualify, it...

If your mental illness has a substantial, adverse and long-term effect on your ability to carry out normal day-to-day activities then you are likely to be covered by the DDA.

For example, someone with a mild form of depression with only minor effects may not be covered, while someone with severe depression with substantial effects on their daily life is likely to be considered as disabled under the Act.

http://www.direct.gov.uk/en/DisabledPeople/HealthAndSupport/MentalHealth/DG_10023351

So far so good. But...

The Disability Discrimination Act (DDA) defines a disabled person as someone who has a physical or mental impairment that has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities.
The definition
For the purposes of the Act:

substantial means neither minor nor trivial
long term means that the effect of the impairment has lasted or is likely to last for at least 12 months (there are special rules covering recurring or fluctuating conditions)
normal day-to-day activities include everyday things like eating, washing, walking and going shopping
a normal day-to-day activity must affect one of the 'capacities' listed in the Act which include mobility, manual dexterity, speech, hearing, seeing and memory.

http://www.direct.gov.uk/en/DisabledPeople/RightsAndObligations/DisabilityRights/DG_4001069

Definition of Mental Impairment.
A point of contention with observers of the development of the DDA, has been the definition of "Mental Impairment". For purposes of definition;

It is legally recognised that the term mental impairment as implied by the DDA includes memory or ability to concentrate, learn, or understand.
The recognition of a mental impairment or illness being covered by the DDA, is required by a respected body of medical opinion.
Mental health problems ranging from schizophrenia and manic depression to panic disorders and various depressive conditions are within the scope of the DDA providing the meet the requirements as set out within this definition.
"Long-term" refers to a disability lasting at least 12 months.
Individuals disabled due to recurring or episodic conditions are covered if the substantial adverse effects are likely to recur beyond twelve months after the first occurrence.
For example: this could include someone with manic depression (or bipolar disorder), who has an episode lasting a few weeks followed by a period of recovery.

An individual whose symptoms are controlled by medication may also be covered.

http://www.wage.eu.com/articles/mh/mh_dda.html

Its the 'mental impairment' part that relates to mental health diagnoses.

And the effects on memory, concentration, learning and understanding that I don't get. How does that relate to depression?

I mean, I can relate it to my PTSD/dissociation/severe anxiety/painic, because my memory gets confused and I can, when triggered, feel like I am back in the past, and this on occasion has messed up working relationships and customer care.

[my work is in in public libraries, and I had a transfer to the stock support office as my reasonable accommodations under the DDA. I am now gradually entering back into work with the public a bit at a time...]

But how does that connect with depression?
For sure, my concentration isn't always amazing. It does vary. And I don't have as much energy as I used to/would like to have. [although we're working on this...]

I wouldn't be so far on in my recovery now, had it not been for the stability and peace and safety provided by my transfer, under the DDA guidelines. But I don't understand how the DDA guidelines actually technically apply to my illness!

 

[sister-ray]

Re: how DOES depression etc fit into def. of disability? [UK]

Braveheart,

Ive never really read this before so will have a look later at the site, I dont work and the only issues I have is with the assessments by the DSS here in the UK ,regarding mental health issues and being fit to work, sometimes these rules are beyond me!!

 

[braveheart]

Re: how DOES depression etc fit into def. of disability? [UK]

Thanks. I just can't seem to get it to 'add up'. Maybe I have a kind of mental block, maybe its some denial. I'm not fully sure.

 

[David Baxter PhD]

Its the 'mental impairment' part that relates to mental health diagnoses.

And the effects on memory, concentration, learning and understanding that I don't get. How does that relate to depression?

Those are symptoms of major depression. I would say that anyone who meets the criteria for major depressive disorder (DSM-IV-TR) should also meet the criteria for disability, using the stated time criteria.

 

[Halo]

Those are symptoms of major depression. I would say that anyone who meets the criteria for major depressive disorder (DSM-IV-TR) should also meet the criteria for disability, using the stated time criteria.

I guess what I don't understand is if someone has been diagnosed with Major Depressive Disorder but they are not on disability and have never stopped working because of it, then could the diagnosis be wrong? Is the person just maybe able to handle the depression better by working? Are they just trying to fool themselves and others into thinking they are better than they really are?

 

[David Baxter PhD]

Point taken. I should rephrase my previous post to read as follows:

I would say that anyone who meets the criteria for major depressive disorder (DSM-IV-TR) could also meet the criteria for disability, using the stated time criteria.

There is generally some degree of impairment of sustained concentration and short-term memory in major depression but you are correct - in some people, depending on the nature of their jobs and probably the severity of the depression, they may still be quite capable of continuing to work.

 

[Halo]

Okay I got it. It is like saying that someone may be able to still function at work even though they have been diagnosed with major depressive disorder although probably not at 100% (i.e. their concentration and memory may be affected but not to the point that they cannot do their job).

 

[braveheart]

...which is why 'reasonable accommodations/adjustments' are made for folks like that.

One doesn't have to register as disabled to be entitled to adjustments under the DDA.

Maybe I'm just confused because I've been depressed for so long that I don't know what its like to not have the lack of concentration etc. *scratches head*

 

[David Baxter PhD]

http://www.behavenet.com/capsules/disorders/mjrdepep.htm

Criteria for Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either
(1) depressed mood or
(2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.

(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

(4) Insomnia or Hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

(6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet criteria for a Mixed Episode (see p. 335).

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

 

[braveheart]

..... thanks David.... for the reminder... curious.. reading the criteria make me want to ... cry ...

I can tick yes to all of those, although less insomnia now, and I am actually much better than a year or even 6 months ago.

I go to work, but I'm not always fully ... there ... [although haven't had a panic attack at work since last October .. ] which is why they utilsed the DDA guidelines to transfer me away from general public for most of the time.