Domain 7 of 12

Psychological & Emotional Needs

Mental health, mood, anxiety, hallucinations, and emotional distress.

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What this domain measures

The Psychological & Emotional Needs domain captures mental-health needs — depression, anxiety, psychosis, hallucinations, and emotional distress — that have an impact on the person's health and well-being. The descriptor table has 4 levels (N/L/M/H). The descriptors turn on whether symptoms respond to prompts/distraction/reassurance, and whether the person has withdrawn from care planning and daily activities.

How it's scored (Annex C wording)

DST scoring levels for the Psychological & Emotional Needs domain, with verbatim Annex C descriptors.
Level	DST descriptor
No needs	Psychological and emotional needs are not having an impact on their health and well-being.
Low	Mood disturbance, hallucinations or anxiety symptoms, or periods of distress, which are having an impact on their health and/or well-being but respond to prompts, distraction and/or reassurance. OR Requires prompts to motivate self towards activity and to engage them in care planning, support, and/or daily activities.
Moderate	Mood disturbance, hallucinations or anxiety symptoms, or periods of distress, which do not readily respond to prompts, distraction and/or reassurance and have an increasing impact on the individual's health and/or well-being. OR Due to their psychological or emotional state the individual has withdrawn from most attempts to engage them in care planning, support and/or daily activities.
High	Mood disturbance, hallucinations or anxiety symptoms, or periods of distress, that have a severe impact on the individual's health and/or well-being. OR Due to their psychological or emotional state the individual has withdrawn from any attempts to engage them in care planning, support and/or daily activities.

Evidence that moves the score up

GP notes documenting depression, anxiety, or psychotic symptoms with dates and severity
Psychiatric medication chart — antidepressants, anxiolytics, antipsychotics, dose changes, response
Community Psychiatric Nurse (CPN) involvement records and care plan
Mental Health Act assessments if any have been conducted
Daily-records evidence of distress episodes — frequency, duration, response required
Specialist Old Age Psychiatry or Memory Service letters
Risk assessment for self-harm or suicidal ideation if applicable
Care plan section describing the de-escalation or psychological support routine

How ICBs commonly under-score this domain

Pattern: Assessor scored Low because depression 'responds to reassurance from familiar carers'.

Rebuttal: Low is the correct level only where symptoms do respond to prompts, distraction, and reassurance. Where symptoms do not readily respond, the Moderate descriptor applies — and where the person has withdrawn from most attempts to engage with care planning and daily activities, Moderate also applies on the second OR-branch. Argue Moderate with evidence of either pattern.

Source: DST Annex C Psychological & Emotional Needs Low and Moderate descriptors

Pattern: Assessor scored Moderate where the person has hallucinations or psychotic symptoms having a severe impact.

Rebuttal: The High descriptor explicitly covers 'Mood disturbance, hallucinations or anxiety symptoms, or periods of distress, that have a severe impact on the individual's health and/or well-being'. Hallucinations meeting that severity test ARE High by descriptor wording — not Moderate.

Source: DST Annex C Psychological & Emotional Needs High descriptor

Pattern: Assessor scored Moderate instead of High where the person has withdrawn from any attempts to engage in care planning.

Rebuttal: The High descriptor's second OR-branch explicitly covers cases where 'Due to their psychological or emotional state the individual has withdrawn from any attempts to engage them in care planning, support and/or daily activities.' Moderate covers 'most attempts'; High covers 'any attempts'. If withdrawal is total, the score is High.

Source: DST Annex C Psychological & Emotional Needs High descriptor (second OR-branch)

4-line rebuttal template

I disagree with the [LEVEL] score for Psychological & Emotional Needs. The evidence shows [SPECIFIC PATTERN — severe impact / withdrawal from care planning / non-response to reassurance] which meets the [HIGHER LEVEL] descriptor. On [DATE/PERIOD], [DESCRIBE: distress episodes, response to reassurance, psychiatric medication, withdrawal from care planning]. Per the well-managed needs principle (National Framework paras 162–166), the [antidepressant / antipsychotic / psychological support regime] is the intervention, not the absence of need. If [SUPPORT] were withdrawn, the present-day risk would be [DESCRIBE: relapse, harm to self, crisis admission]. I therefore request the Psychological & Emotional Needs domain be re-scored to [HIGHER LEVEL] with reference to the [SPECIFIC EVIDENCE: GP notes, psychiatric medication chart, CPN notes, distress log].

Psychological & Emotional Needs rarely secures eligibility on its own

The Case Strength Report (£47) maps your existing records against all 12 DST domains and tells you whether the combination is strong enough to pursue formal CHC assessment.

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