By Robin Loxton
Director, Advocacy Access
BC Coalition of People with Disabilities
The Advocacy Access program of the BC Coalition of People with Disabilities has been helping people qualify for disability benefits for over 20 years. For some of our clients the application process for the Persons with Disabilities (PWD) designation is relatively straight forward, but for others it can be very challenging. People with mental health and addiction issues have particular difficulty with the application process so, in this column I will look at the PWD application process with this in mind and address issues of potential interest for nurse practitioners.
Why would someone want to apply for provincial disability assistance (PWD)? The obvious answer is that one gets more money to live on: the single rate for someone on welfare is $610 per month and the single disability rate is $906 per month. A person on PWD also receives better health coverage, an annual bus pass, a higher earnings exemption, and they are not required to look for work as a condition of receiving benefits. Of course not every British Columbian with a disability can apply for PWD: a single person has to have an income of less than $906 per month and they have to have less than $5,000 in assets (besides a home and car).
The ministry that administers the disability assistance programs is the Ministry of Social Development and the definition of disability found in the Employment and Assistance for Persons with Disabilities Act has five criteria to meet. To qualify the applicant must (1) be over 18 years of age that (2) in the opinion of the ministry has a severe mental impairment that (3) is confirmed by a medical practitioner to likely continue for at least 2 years and (4) in the opinion of a prescribed professional directly and significantly restricts their ability to perform daily living activities either continuously or periodically for extended periods so that (5) they require significant help or supervision from another person or assistive devices. It should be noted that this definition does not require the applicant to prove that they are unable to work.
To illustrate how the PWD application process works (or not) for someone with mental health and addiction issues let me use a case example.
Susan is 42 years old, on welfare for three years, and lives in small housekeeping room in Vancouver. She has a long-standing mood disorder, PTSD, and Hepatitis C. She is also a heroin addict and is currently on the methadone program. She has been taking anti-depressants, on and off, for years and her primary care provider is a nurse practitioner.
The first step that Susan must take is to ask the ministry to give her a PWD application (we know she is eligible to apply because she is on welfare). For her PWD application to be adjudicated, the very least she will need to do is sign the application and take it to her nurse practitioner to be completed and then mailed (the application comes with a self addressed stamped envelop). It is surprising how many people with mental health disabilities who obtain a PWD application never submit the form to the ministry, or take several months to get it done. It happens a lot.
Let’s say Susan makes it to your office with the PWD application and asks you to complete the Physician Report (Section 2) and the Assessor Report (Section 3). It should be noted that the current requirement is that a physician must co-sign the Physician Report if it is completed by a nurse practitioner. The following are some considerations when you fill out her application:
- Although a “substance-related disorder” may be recognized as a mental impairment, our experience tells us that the ministry tends to give less weight to this kind of disorder. Therefore, in Susan’s case, we would recommend that more emphasis is placed on the mood disorder and the PTSD.
- How do the mental health and addiction issues overlap? Is Susan more likely to use drugs when she is depressed and anxious?
- It is important to describe the many ways in which her mental impairment impacts Susan’s daily functioning – and a person with a mental impairment is restricted in different ways than a person with a physical disability. For example, although Susan may be physically capable of preparing a meal, her depression and anxiety cause her to miss meals and/or not eat a balanced diet (assuming she can afford one), therefore, she is restricted in meal preparation.
- Is a restriction “periodic for extended periods” or “continuous?” In Susan’s case, if one considers all her conditions, there are both elements. If a restriction is indicated as “periodic” the ministry expects that the assessor explains how long and how often this restriction occurs
- As Susan is someone who does not get help and supervision on a regular basis, can she still qualify for disability benefits? The answer is yes. The legislation stipulates that it must be shown that the applicant “requires” help. A person who is mentally ill often shuns help, isolates themselves from other people, and lacks a support network. In these instances the assessor can describe the help and supports the applicant would need to live a full and more productive life. Susan, for example, would benefit from someone to oversee her medication because of her problems with compliance.
- Furthermore, an applicant who takes longer than normal to complete daily tasks can be deemed to require help. In these situations the ministry would like the assessor to estimate how much longer than typical it takes the applicant to do daily activities – this can be difficult especially when symptoms such as low mood, anxiety, and fatigue can vary from day to day.
Your job of completing the PWD application may be a lot easier if Susan is able to articulate her limitations and disability-related challenges, or if she has met with an advocate before seeing you. This does not always happen and it may be up to you to fill in the gaps. Generally speaking, the more detail you are able to provide, the greater the likelihood of success.
Even if you have done a good job of completing the PWD application, it is not unusual for a person with mental health disabilities and addictions to have their application denied. We urge people in these situations to seek the advice of an advocate. One must act quickly because the ministry only allows 20 business days to file an appeal (starting from the point the denial letter was received). Our advocates have a good success record with PWD appeals and you are welcome to contact the Advocacy Access program at 604-872-1278 or 1-800-663-1278 (toll free).
The BC Coalition of People with Disabilities website has a number of self-help materials on this subject that may be of interest to you and your patients. Go to: http://www.bccpd.bc.ca/money.htm
The Ministry of Social Development policy on the PWD application process can be found at: http://www.gov.bc.ca/meia/online_resource/persons_with_disabilities_designation/pwdapp/policy.html