Additional guidance on eligibility

Vignettes 1

Mary is 29 years old. She went to schools for children with Special Educational Needs from the age of 9. It appears that this was mainly due to emotional and behavioural difficulties, rather than a significant learning disability. However she did have some specific learning difficulties (dyslexia, dyspraxia and dyscalculia). She found lessons difficult, and her attendance was poor, with no encouragement from her parents to attend as they expected her to stay at home and look after her younger brother. She left school with no qualifications. She is the survivor of childhood sexual abuse. Her parents are separated and she has no contact with her father. She lives with her mother, but has a very difficult relationship with her. She has never lived independently. She has had a few jobs over the
years (eg. sweeping up at a local hairdressers, and helping in her Auntie’s shop) but has
never been able to keep a job for long.

She is presenting with relational and emotional regulation difficulties that might be suggestive of a Personality Disorder. However she has not received a diagnosis as yet; this is her first time she has attended an assessment in secondary mental health services. She has previously cut herself and ended up at A&E, but did not follow advice given at that time to access psychological therapy through primary care. She is quiet and sits with her head down when professionals talk to her. However she had been able to answer the questions when interviewed by the liaison psychiatry service and they thought that she would probably be able to access mainstream mental health services.

Vignettes 2

Sanjit is 35 years old. He went to a mainstream primary school, and started mainstream secondary. However aged 13 his needs were reviewed as he was finding it increasingly difficult to manage socially and academically. An Autistic Spectrum Condition (ASC) was diagnosed around this time, and he was transferred to a school for children with Special Educational Needs which specialised in working with young people with ASC. He left with no qualifications. He started an Access course (for young people with additional learning needs) aged 19, but was asked to leave due to his behaviour. He has since been at home with his parents.

His mother and sister took him to the GP, concerned that he is becoming increasingly anxious, agitated, spending most of the day in his bed, but not sleeping for more than a few hours each night. He no longer joins the family at meal times since his maternal grandmother – who lived with the family – died after a long illness. He was referred to KMPT through the SPOA. When CMHT clinicians assessed him he was accompanied by his sister, who answered all questions on his behalf. It was therefore decide to split the assessment session for the second half, with one clinician staying with his sister, whilst the other talked to Sanjit 1:1. Even without his sister’s presence, Sanjit appeared unable to answer any of their questions, or to give any insight into the difficulties from his own perspective.