Adjourned Tribunal in 2 Weeks, Please Help

I understand that this is very late in the process to be reaching out for help, as mistakes will have already been made, but I am running out of time and really need some help and feedback on my tribunal appeal. Apologies if any of the following is superfluous, particularly the medical and employment history, I can add any relevant information requested if this receives any replies.

Medical and Employment History

I have a diagnosis of Anxiety with Co-morbid depression. I was originally diagnosed with 'Low Mood' in my first year of university in 2014, then the actual diagnosis of depression followed around a year later when I dropped out and returned home.

I got on my feet again at the end of 2015 and began work with an insurance company as an agent. After around six months in this role my mental health declined significantly. Similar to my experience at university, I became physically withdrawn, disconnected from family and suicidally depressed and anxious. After 1-2 months of sick leave, prolonged because of an unsuccessful prescription of Sertraline, I returned to work as my new prescription of Citalopram seemed to reduce my anxiety and I was able to leave my house and function at work, although I felt that underlying problems were still there. I continued taking the medication and self referred for talking therapy, however after a significant waiting period and my own fear of the process, I didn't actually sit down face to face with any kind of therapist until 2018.

I self referred again for talking therapy in my local area in June of 2017. Towards the end of September 2017 my mental health had again declined unbearably. I had an even longer period on sick leave and tried Citalopram again, this time with no positive effect. I was prescribed Fluoxetine and my condition worsened, after which I reverted back to Citalopram with the advice of my GP. I continued to wait for talking therapy but would ultimately wait 14 months from my original self referral to be seen by a CBT practitioner. I have lost any faith at all in SSRI's as a treatment option, but I am being continually prescribed them.

I was asked to attend a meeting at my place of work in January 2018 and could not attend on the day due to severe anxiety. My employer sent a letter in the post advising me that my contract had been terminated and I continued to be suicidally depressed for months afterwards. I considered pursuing an employment tribunal but I did not have the mental energy or confidence to go through with it. I have been unemployed ever since.

In early December 2017 I had contacted the crisis team in the City I live and communicated to them the distress and pain I was living with. Following this and only after repeated attempts and persistence largely from my partner my GP eventually agreed to refer me to a psychiatrist, whom I ultimately spoke to in February 2018. He prescribed me with Paroxetine which also did not work. His letter to my GP advising on my condition was forwarded with my PIP claim. This has worked against me rather than in my favor as the fact that my partner prompted me to wash and dress well and supported me on the day of the appointment has been noted as evidence by the assessor that I am usually this way. I spoke to him again in April and communicated to him that my condition had worsened which he acknowledged in the corresponding letter to my GP. He increased my dose of Paroxetine to 40mg from 20mg and I continued to take this for two weeks. Again, this made me feel worse and upon consulting with my GP I stopped taking SSRI's altogether.

Between May and September 2018 I had completely lost faith in the NHS. I took no medication for my mental health in this period and continued to struggle with anxiety, depression and thoughts of suicide. I was finally offered CBT in September 2018 and attended a few sessions with some positive results, but continually I would have days where I was unable to get out of bed due to poor mental health. I was ultimately discharged from the service for non attendance.

This has been a theme throughout my mental illness. I have missed countless GP appointments, UV light treatments, Psychiatrist appointments, CBT sessions and even routine dental checkups. I can function on a Tuesday and summon the mental strength to do things and then completely crash into a suicidal depression the following day. As well as my mental illness, I have endured countless severe and debilitating eczema break outs, episodes of IBS and sleepness nights. There is not a chance on earth that I would have been able to hold down a job in the period covering my original PIP application in February of 2018 up until now. No employer would tolerate it. I feel consistently undermined by the health professionals I have spoken to, with a few exceptions who have been really helpful.

PIP Claim

My PIP assessment took place in May 2018 and I was not awarded enough points for either the daily living or the mobility components. My partner and I sent an appeal letter for mandatory reconsideration, after which the decision was changed and I was awarded 4 points for the daily living component and 12 points for mobility. To say that this surprised us would be an understatement. The descriptor corresponding to 12 points for mobility is:

Cannot follow the route of a familiar journey without another person, an assistance dog or an orientation aid

It is accurate to say that I cannot take public transport or walk where there are other people without it causing me significant distress, unless I am with my partner. We felt I should be awarded 10 points for this. For 12 points to be awarded to me, the information we provided would have to be interpreted with subtlety from a wider reading of the information I disclosed in my claim, a level of nuance somehow not applied to the answers for daily living activities. As an example, I was only awarded 2 points for 'Engaging with other people face to face', which on my worst days causes me overwhelming psychological distress and should award 8 points. The same distress and resulting mental trauma apply to both descriptors, yet they have awarded 12 points for one and just 2 for the other. We cannot wrap our heads around this.

Letter Requesting Mandatory Reconsideration

The following is the letter we sent following the first assessment. I have removed names for confidentiality:

To whom it may concern,

I am writing in response to the decision letter awarding me no rate of Personal Independence Payment, which I received on 08/06/2017. I have been heavily assisted in the writing of this letter by my partner who was present at the assessment. I would like to request a Mandatory Reconsideration Notice to have my claim reconsidered. I have attached to this letter a copy of detailed notes that were acquired by my partner during the assessment (pages 4 to 10), and a list of points we believe have been overlooked (pages 2 and 3). I feel very strongly that either the notes taken by the assessor were not comprehensive enough, or that the information contained in the notes was not interpreted in line with the descriptors and points available corresponding to each activity. I would also like to advise you that appropriate allowances were not made for the assessment. Four days before the assessment I was under significant psychological distress and my partner called to ask that a home visit be arranged. We were informed that this was not possible, and further, that if I was to miss this appointment my claim would be terminated. I have since learned that with the written advice of my G.P. it would indeed have been possible to have my assessment completed at home. This information was never communicated to me and contributed to an assessment where I was overcome with emotion and anxiety, making it more difficult to clearly define how my illness affects me in the face of an assessor who was clearly time constrained and routinely interrupted my answers. Furthermore, my partner (whom I brought both for emotional and practical support) was dissuaded from speaking when I asked her for details that I had forgotten, and kept being interrupted by the assessor when she tried to add more information to my answers.

Despite this, the answers I gave were supportive of my claim and should have resulted in a higher points total. However, this is at odds with the decision letter I have received. Particularly troubling is the inclusion of information in the decision letter that was never clarified in the assessment, for instance the statement that I “eat three meals a day” or that I was able “to talk in detail about (my) household outgoings”. This is false and was never part of the communication with the assessor, as can be seen in the notes my partner took during the assessment. Several other points (such as my inability to leave my room most days due to social anxiety, or my distress when trying to discuss my therapy/medication) seem to have been completely omitted from your consideration, as has been the fact that my partner is in complete charge of my therapy and medication, as I cannot organise GP/appointments, attend them, or even pick up my prescriptions and take them without her. Finally, I would also like to be sent a copy of the assessors notes to be cross checked with our own. Please let us know if you would want to see a copy of my partners original hand written notes as well as the typed copy we are attaching. Kind Regards

Points we believe have been overlooked:

DAILY LIVING ACTIVITY
Preparing food: As stated in lines 165-170, most days I can’t cook, and on my best days (once a week) I will only make things like toast. The reason for this is my social anxiety, which stops me from being able to leave my room due to fear of seeing anyone, such as seeing a housemate while I cook. This was clearly advised to the assessor. I received 2 points (equivalent of ‘Needs prompting to be able to prepare or cook a simple meal’). But not being able to prepare/cook food actually corresponds to 8 points.

Taking nutrition: As stated in lines 168, 175-177 and 179-180, I need prompting from my partner to be able to eat, I need the food to be made and placed in front of me. When my partner is not there to encourage me to eat I do not eat. At no point during the assessment was I asked if I eat three meals a day (the majority of the time I do not, since I only eat when my partner encourages me to and she does not live with me and works full time), I am very worried about the fact that this has been stated in the the letter I have received. More worrying than this is the fact that the assessor herself acknowledged that my partner prompts me to eat in line 175. I received 0 points, but, needing prompting to be able to take nutrition corresponds to 4 points.

Managing therapy or monitoring health condition: As stated in 117-118, I have been unable to receive certain treatments (light therapy) because having to attend the hospital results in psychological distress for me. As stated in lines 125-126 I need my partner to attend GP/psychiatrist appointments with me. As stated in lines 139-146, I need my partner to make calls to doctors/crisis teams for me, because I find it too stressful. And as stated in line 234 I need my partner to prompt me to take my medication. As stated in 89-109, I cannot pick up my prescriptions when they are prescribed since I usually can’t leave the house on my own, this point in particular was extensively discussed with the PIP assessor, who even brought it up again at the end of the interview to encourage me to leave the house to pick up my beta-blocker prescription (lines 231-234). Furthermore, in lines 83-109 my distress when having to think and remember what medication I am taking is evident, and eventually my partner needs to step in and answer for me, due to my emotional distress. To clarify once again: Most days I can’t leave the house even with my partner, which means I sometimes don’t collect prescriptions for a long time; and I need my partner to remind me to take my medicine. Therefore I need assistance to monitor my health condition AND prompting to manage my therapy/medication. Needing prompting to manage therapy corresponds to 2 points.

Washing and bathing: As stated in 183-186, I need my partner to prompt me to take a shower. I shower a lot less than I used to. As stated in 183-186, this is because leaving my room is difficult due to my social anxiety. My partner encourages me to wash when I have to attend appointments (such as my psychiatrist appointment), which is why I was was described as “clean and well kept” the first time I saw my psychiatrist on January. Needing prompting to be able to wash or bathe corresponds to 2 points.

Managing toilet needs: We agree.

Dressing and undressing: We agree.

Communicating verbally: We agree.

Reading and understanding signs, symbols and words: We agree.

Engaging with other people face to face: As stated in 123-126, 165-170 and 183-184, my social anxiety usually prevents me from leaving my room and house, because the fear of having any interaction with people results in overwhelming psychological distress (such as panic/anxiety attacks and thoughts of self harm). As stated in 125-126 too, even in my good days I still need my partner to be with me to be able to leave the house and go to appointments where I need to interact with people (social support). The fact that I can’t be in the same room as anyone else is further discussed in 222-225. The signs of distress (such as crying) are pointed out by the assessor in lines 121-122. The anxiety attacks are discussed in 129-134, and my thoughts of self harm and a suicide attempt are discussed in lines 151-156. In my good days (1-2 a week) I need social support (my partner’s presence) to be able to engage with other people, which corresponds to 4 points. But most days (5-6 a week) I cannot engage with other people due to such engagement causing overwhelming psychological distress, which corresponds to 8 points. I was only awarded 2 points.

Making budgeting decisions: As stated in 216-219, I find budgeting too anxiety-inducing, so my partner needs to do it for me. As stated in 195-196, my anxiety stops me from being able to keep up with any post (such as bank letters), and my partner needs to do that for me too. In lines 201-206, the only payment that I can mention making is rent, which comes out directly as a direct debit, so I don’t have to make any decision about it. I am very concerned about the fact that the letter I received states that I “was able to talk in detail about (my) household outgoings”, since the only payment I talked about was rent (failing to remember many other payments that I have to make and that my partner handles, such as bills), and the fact that I stated my partner has to keep track of my bank account for me because I find it too distressing (216-219). Not being able to make any budgeting decisions at all corresponds to 6 points.

MOBILITY ACTIVITIES:
Planning and following journeys: The letter I have received awards 4 points, which corresponds to a claimant that “needs prompting to be able to undertake any journey to avoid overwhelming psychological distress”. The psychological distress I feel as a result of journeys or any public interaction was evident on the day of the assessment (the signs of distress, such as crying, are pointed out by the assessor in lines 121-122), but also covered in detail in lines 117-118, where I advised I have been unable to go to the hospital to receive light treatments due to my illness; also lines 89-109, where I advised I cannot pick up my prescriptions on my own since I usually can’t leave the house on my own; and lines 125-126 where I advised I need my partner to attend GP/psychiatrist appointments with me. All of the above examples of making a journey have previously resulted in anxiety attacks, which are discussed in 129-134. Most days I cannot even leave my room, as stated in lines 165-170, due to my social anxiety, which makes me fear being around anyone. This prevents me from even getting to the kitchen in my own house. This corresponds to I “cannot undertake any journey because it would cause overwhelming psychological distress”, section (e.) of descriptors in Mobility Activities and worth 10 points.

Decision to Appeal


I mentioned above that the decision was partially overturned and I was awarded 4 points for Daily Living and 12 points for Mobility. My partner and I made the decision to appeal this for two reasons. The first reason is that it is clearly a factually incorrect outcome. The points awarded for mobility should have also been awarded for daily living activities given that the explanation for my inability to psychologically cope applies to both. The second reason is that I hope within the next year that I will be able to make simple, familiar journeys without my partner, without reacting with the distress that I do today. I want to be able to take a walk in a park without being terrified about interaction with a stranger, in fact, my mental health requires it. My daily living difficulties are more complex and I may struggle to deal with all of them in the near future. I cannot help but think that the DWP have awarded me a more insecure, easier to verify mobility component that awards a lower financial amount, in order to placate me in the hope that I will desist with my claim.

Full Disclosure and Adjournment

I have not yet mentioned the fact that my partner, without my knowledge, recorded the assessment on her phone. We looked into recording the assessment with permission a couple of weeks before and discovered that expensive recording equipment would be required to do so. I was extremely disappointed with this as there would be no way for me to be able to afford it. I mentioned previously that I have a lack of trust in the NHS. If i'm being honest, this extends to the government and other organizations, particularly these private companies that are assessing people. It turns out that my partner is no different and she took matters into her own hands. She made me aware of this when the first rejection letter came through and she noticed inaccuracies in the assessor's notes. We made the decision to write a transcript based on the recording and submit it as a written account of the notes taken.

This brings me to the first tribunal that occured some weeks ago. My partner and I attended with her as my representative. In retrospect we were woefully unprepared and upon sitting in front of the panel we were intimidated. I began to cry and rock in my chair and I felt an anxiety attack coming on. My partner, who is not from the UK, was asked direct questions and was unable to respond confidently. The tribunal judge said something along the lines of "you should be aware, there is the likelihood that not only will you not receive a higher points total, you will also lose the points that have already been awarded to you". This is me paraphrasing, as I was overwhelmed and couldn't take everything in accurately. She allowed us a temporary adjournment of 5 minutes to discuss whether we would like to proceed. We went outside, I cried in my partners arms, and we decided to continue. As soon as we were seated again, the judge asked my partner directly if she recorded the original assessment. She said she did. The judge changed her tone at this point and advised that we would need to provide the recording and that she would need to contact the DWP to ask if they consent to it being added as evidence. She also asked for the handwritten notes to be sent in which we have now provided. The tribunal was then adjourned and we were told that we would receive confirmation of a new tribunal date in the post. We assume that the DWP have allowed for the recording to be used as the new tribunal date is scheduled for a couple of weeks.

This is where we are now. I am reluctant to share the full assessment transcript here as I am worried about sharing too much.

Final Thoughts and Request for Help

I am not a fraud. I am not seeking something that I internally know I am not eligible for. I have endured years of mental turmoil and I have a bleak outlook on my future that I cannot escape from despite the love and support of an amazing and resolute partner. I have simply read the activities and descriptors and matched those that correlate with my own personal experiences on most days. I do not care if a psychiatrist is impressed with my clean hair and clothes. I should not be punished because my loving girlfriend dragged me out of bed and into the bathroom on the morning of an appointment so that I can avoid the shame of feeling disgusting, nor should I be punished because the psychiatrist or the assessor are too negligent to clarify the reason for my cleanliness. They do not see the sleepless nights, the endless scratching and raking of skin or the incessantly negative internal dialogue that has dominated my life for nearly six years. They do not see the anxiety attacks, nor do they see the suicidal ideations and delusions that I simultaneously know are ridiculous, yet am completely convinced by. I feel that the endless discussions that i have had with health professionals are more about working out my cognitive capacities than they are about establishing my state of self worth, esteem or world view, and I am being made to jump through endless hoops because I am articulate and too ashamed to appear for appointments dishevelled.

I have asked my father to represent me at this tribunal, however I am at least partially reluctant due to his emotional attachment and age. I am worried he will not be able to argue my case as effectively as I would were I not overcome with anxiety on the day, as I surely will be. I question whether someone with mental health issues would ever be better off defending themselves. I have no idea whether or not to pay for a psychiatrist privately to assess me. I don't know what other evidence i can submit truth be told, I really thought my personal account of my daily struggles would be treated with more respect. I can only thank you for reading this and I ask for any help that anyone can offer.