ATOS & HMC&TS Appeal

[estellyn]

1) OK. First thing I can see, is although he has stated he had a psychiatric inpatient admission 6 weeks previously, and is awaiting his first appointment with a psychiatrist, this has been assessed by the evaluating nurse as 'no current mental health input'. Two days of hospital admission so recently, with psychiatric assessment while there, and referral for ongoing treatment, to me, is arguably 'current mental health input' - it's not his problem that he has to wait due to waiting list issues - where I used to live he would already have seen a psychiatrist (initial assessment a few weeks after referral), and where I currently live there is a huge wait. So I would argue he requires current input, he just hasn't got it yet. Oh also it states he attempted suicide with glucose - which I assume should be insulin.

 

2) There isn't really anything about aggression on the initial assessment section apart from a short sentence about 'flying off the handle with girlfriend' which could be anything and isn't elaborated on. This needs to be, so for instance 'The report states that 'he can be short and fly off the handle at his girlfriend' - the type of behaviour this actually refers to is.....

 

3) It also states he hasn't been in trouble with authorities since last year, is this true? If not, correct it, and be specific about how long before the assessment. If it is true, last year could be 3 months or 14 months before the assessment.

 

4) On the description of functional ability, is any of that innacurate?

 

5)On the functional ability, it only mentions that he goes to places which I assume are familiar to him. Can he go to unfamiliar places alone? The first time he went to see the addiction nurse, did he go alone?

 

6) It states he keeps in touch with family via email and skype - is this due to distance, or due to difficulties being in their presence - for instance aggression or anxiety issues?

 

7) To what extent does he 'interact' with the friends he lives with - is interaction initiated by him, or by the housemates (how many are there). Does he hide away or avoid social situations frequently, or occasionally.

 

8) Under social interaction it states friends do household shopping for him, why is this?

 

9) How old is he, and does this mean he needs to share a house due to necessity - not being able to afford or claim benefit for a studio or 1 bed. How much does he socialise with housemates - does he find living in this situation difficut due to anxiety, depression or aggression?

 

10) How does he cope in AA meetings - does he go and chat with people and share with group, or is he sitting alone and listening but not interacting (at the time of the assessment).

 

11) Did he make a special effort for the assessment above how he would normally be - for instance bathing, making sure he looked presentable, wearing nice clothes? How is he normally?

 

12) How was his anxiety level on the day of the assessment - the assessing nurse makes it sound like he found it a breeze (no rocking, sweating, shaking), and I find that unlikely.

 

13) How long did the assessment last?

 

14) Does he still have suicidal ideation, and what sort of anxious thoughts does he have?

 

15) I would argue that the nurse's assessment of recently giving up alcohol, recently having attempted suicide, still having some suicidal ideation and requiring psychiatric treatment suggests the early stages of a very fragile recovery, and that the additional stress of having to look for, interview for and take up work, would indeed create substantial risk to health, and has a high probability of causing a relapse and possible escalation to suicidal intent, especially in light of the fact that he is currently not receiving the specialist psychiatric treatment he needs. Also worth mentioning if you are dealing with the appeal because he is unable to.

 

16) The ability to deal with a short assessment by a nurse, that you know will only take a short time, that you can take days to prepare for and recover from, and have the direct support of a friend through the whole process, does not indicate the ability to mentally deal with high stress interview situations and the day to day stress of a workplace, during what is a fragile recovery, so recently after attempting suicide - only 6 weeks.

[CerberusSco]

Thanks for looking at that. I'm going to answer them as best as I can 1 by 1.

 

1. Allow me to clarify something about his referral. After he was discharged from hospital, he immediately went to his GP who then started to prescribe 7 days of anti-depressants so he couldn't overdose on them. At this time the GP mentioned a psychiatric referral. He's still waiting for that and is due to see his GP on Tuesday to get medical evidence, so he will mention the referral to his GP on Tuesday to see what's happened or what is happening with that. If the GP has forgot to make a referral then he can't be held accountable for that as it's out of his hands.

 

He tried committing suicide by take Co-Codamol, overdosing on Glucose/Sugar (to increase his blood sugar) and Insulin/Glucagon.

 

2. He can fly off the handle at the slightest of things, such as the bus stopping or receiving a SMS. He tends to be quite aggressive as a result of his lack of sleep (doesn't take sleeping tablets as he is diabetic, more harm than good), side effects from his medication, his diabetic control. hese all have an effect.

 

3. Hasn't been in trouble with the police since April 2011 which was prior to being diagnosed with depression, anxiety and long before his medical/WCA.

 

4. Description of functional ability (page 3?) Yes, it's true. Although he stopped seeing the addictions nurse after a few appointments as he saw it as a complete waste of time and wasn't being told anything different than what he was at Alcoholics Anonymous. He didn't have suicidal ideation at the time, but has had on a few occasions since the WCA. Does have low mood, still reduced appetite sleep problems and still has anxiety episodes and more recently with this appeal hanging over his head.

 

5. The places that he goes to (AA & GP) are all within walking distance of his house. He could literally spit out of his window and hit these buildings. He went to see the addictions nurse for the first time with his partner, but as above stopped going due to not being much different from AA. He used to go into Glasgow all the time, but the last time he was there he had a panic attack. However, he thought it was a hypoglycaemic attack (low blood sugar) and drank a small bottle of lucozade which then obviously raised his blood sugar levels. The panic attacks have similar symptoms to those of hypoglycaemia.

 

6. Due to distance. His auntie lives in Canada and his Dad lives in Newquay. His mum sadly passed away in 2009 and he has no other immediate family near him.

 

7. He will interact with his friends only to say that he's going out to the corner shop or to the doctors. More often than not though his friends (2 of them) will initiate interaction. He keeps himself to himself in the back bedroom (his room). He avoids social situations as much as he can. He feels ashamed of his alcohol abuse and the fact that he tried to kill himself. He used to go to his girlfriends brothers (technically his brother in laws) quite a lot, but hasn't been there for over a year. He doesn't go to the cinema, swimming, library, meet ups with his pals, obviously not the pubs/clubs. He likes to stay at home more often than not.

 

8. I think this is more convenience. However, he hates shopping, he hates going to the supermarket. Used to go all the time with his girlfriend, now he finds it frustrating and it makes him anxious.

 

9. He's 37. I think he likes to keep himself to himself. Will more often than not watch films, play his PS3, chat on Facebook rather than watch TV in the lounge with his house mates. I have to go there to his house to chat with him, or call him on his mobile. I'm not sure why he doesn't live on his own. I think he met his girlfriend 11 years ago and moved from Lancashire to Glasgow to live near her and stays with his friends as they offered him a room so that he was able to move to Glasgow. I know he's mentioned this before, he wanted to move in with his girlfriend, but she was worried about her council tax going up and he was worried about his JSA/ESA being cut when he wasn't working. Something along those lines. He has worked quite a bit before, but there have been times when he has been in between jobs, there have been times when he has been between jobs and he hasn't claimed.

 

10. At first he just used to sit there and listen in. He did that for the first few months. When his 3rd lot of anti-depressants started to help (he's been on 3 different meds) he would have a bit more courage to talk about his alcohol abuse. He only talks to a select few people though at these meetings and doesn't go as much as he did when he first started. He's done well on the alcohol front and has been dry for over a year now.

 

11. He only wore a shirt and tie for the assessment. 9 times out of ten it jeans, or joggies, with t-shirts. He's is very clean and showers everyday.

 

12. He was anxious before he went and especially afterwards. He was also very angry after the assessment. He didn't feel as though he was being listened to correctly or his condition was taken in account enough. He's told me that the registered nurse who did the WCA was more interested how he goes about things when he was ok and before the depression started. Also more interested about the good days and trying to focus too much on them as opposed to his current situation. The nurse didn't see him in the waiting room before hand when he was shaking, sweating, tapping his foot, feeling very tense and his heart was beating fast. (Only going off what he told me about that, I wasn't there) I've seen him do this before, just by waiting for a bus or his GP appointment.

 

13. Approximately 30-45 mins he said.

 

14. He has the odd day where he has suicidal ideation, but this has improved greatly over the past 6/7 months or so. He doesn't feel happy within himself. He feels as though something wants to come out, but he has trouble trying to get it out. He's negative about things. Seems to think that because he's 37 and suffers from diabetes that he won't be alive in 10 years time. Dreams about his death sometimes. He really has clammed up and changed. He was one of the most enthusiastic person I have ever met until Nov 2012, which was a month or so after he and his girlfriend had lost their baby. (She was 3 months pregnant).

 

15. Something that I was looking into

 

16. Something I completely agree with. I think if he had to go back to work at that time then it would of set his recovery back. He could of gone back to drinking, again could of attempted a further suicide.

 

I personally feel he likes the safety, security and comfort of his home and will only go to places that are extremely local to him. He is anxious, he taps his foot a lot when waiting for a bus or a GP appointment, shakes, sweats quite a lot too. He wants to work and kind of feels obliged to. He saw his GP a couple of months back and his GP basically said you're 37 isn't it time you got back to work or did something voluntary! So he feels obliged to work, but not only that he wants to work. He doesn't like the way he is just now and it's frustrating for him.

 

Also, just a quick couple of questions:

 

1. The fact that he's self harmed and has had suicidal ideation would that qualify him for Exceptional circumstances 29 and/or 35

 

2. Is he likely to be put in WRAG or Support Group if he wins his appeal?

Edited July 6, 2013 by CerberusSco
Adding info & questions

[estellyn]

By answering all of those questions, you now have a lot of info for the submission in attacking the assessment. Just remember, everything you write is about how he was at the time of the assessment - even if he's doing better now, the tribunal are only looking at the date of the assessment.

 

1) yes if his gp said he was going to refer him, then he obviously requires psychiatric help, so important to point out this out on the submission. Was he still getting a week's antidepressants at the time of the assessment?

 

2) & 3) What form does the aggression take? You mentioned something about an incident at his girlfriend's and the police were called - when was this?

 

4) Important to point out that he stopped seeing the alcohol nurse after a few appts, and that just having to appeal, has increased his anxiety levels.

 

5) Important to mention the distance from his house of the places he goes, and consider whether he would have issues going somewhere unfamiliar alone, and if should score points for that.

 

7) All important things to mention in rebuttal of nurse's statements about him interacting with friends.

 

8) Mention that he doesn't go shopping as he hates it and it makes him anxious.

 

10) so at the time of the wca, though he was going to AA, he wasn't joining in or sharing or interacting with other members - be sure to point this out.

 

11) Be sure to mention this - he dressed up for the wca, it isn't typical of his normal dress.

 

12) That's all very good info, make sure you include all of that

 

15 & 16) Make sure you make the points on the submission.

 

Sounds like your friend needs a GP better at dealing with mental health issues!

 

Regarding your questions:

 

1) Yes, that's basically what 15) was about - to cover both regs you'd also need to put in something about how he'd deal with doing work related activity, and whether this would substantially risk his health (if it would).

 

2) That all depends. You give the Tribunal as many options as possible on the submission to award points or exceptional circumstances and provide the medical evidence to back it up. The most likely scenario is wRAG, but he does have a chance at support group - but both are dependant on supportive evidence.

[CerberusSco]

Hi estellyn,

 

Just wondering how I can best explain his frequent aggressive behaviour. Would this suffice?

 

- (IBd) 17. Appropriateness of behaviour with other people, due to cognitive impairment or mental disorder - Frequently has uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace:

 

Mr X Frequently has uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace. The report states that 'he can be short and fly off the handle at his girlfriend.' He can fly off the handle at the slightest of things, such as the bus stopping receiving a SMS on his phone, someone he thinks is looking at him the wrong way. He tends to be quite aggressive as a result of his lack of sleep, side effects from his medication and his diabetic control with low levels of blood glucose in the body can make him more aggressive, as was discovered in a recent study. Diabetics often find it difficult to accept and adjust to having diabetes and this can cause changes in behaviour. With Mr X not really eating well as he doesn't feel like eating as a result of his depression, he does suffer from hypoglycaemia everyday and can often find himself taking insulin and not eating food immediately after. His aggressive behaviour has resulted in the police being called when an argument occurred recently with his neighbours and he directly blames them for the loss of his girlfriends baby. This frequent aggression occurs on an almost daily basis and would not be reasonable should Mr X be found capable of having to look for, interview for and take up work. Mr X's frustration at not being capable enough to work also frequently contributes to his aggressive behaviour.

Edited July 8, 2013 by CerberusSco

[estellyn]

Hi estellyn,

 

Just wondering how I can best explain his frequent aggressive behaviour. Would this suffice?

 

- (IBd) 17. Appropriateness of behaviour with other people, due to cognitive impairment or mental disorder - Frequently has uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace:

 

Mr X Frequently has uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace. The report states that 'he can be short and fly off the handle at his girlfriend.' He can fly off the handle at the slightest of things, such as the bus stopping receiving a SMS on his phone, someone he thinks is looking at him the wrong way. He tends to be quite aggressive as a result of his lack of sleep, side effects from his medication and his diabetic control with low levels of blood glucose in the body can make him more aggressive, as was discovered in a recent study. Diabetics often find it difficult to accept and adjust to having diabetes and this can cause changes in behaviour. With Mr X not really eating well as he doesn't feel like eating as a result of his depression, he does suffer from hypoglycaemia everyday and can often find himself taking insulin and not eating food immediately after. His aggressive behaviour has resulted in the police being called when an argument occurred recently with his neighbours and he directly blames them for the loss of his girlfriends baby. This frequent aggression occurs on an almost daily basis and would not be reasonable should Mr X be found capable of having to look for, interview for and take up work.

 

 

 

That all sounds good, you just need to add more specifics about the forms the aggression takes - for instance does he shout, threaten, throw things, hit walls, etc. Giving the example of the aggresive acts that happened at his girlfriend's house whenthe police were called, would also be useful.

[CerberusSco]

Thanks. I'll draft the personal statement later on this evening and post it up later on.

 

Thanks again.

[Nystagmite]

You can't use mental descriptors for physical descriptors and vice versa.

[CerberusSco]

You can't use mental descriptors for physical descriptors and vice versa.

 

I don't think I am

[CerberusSco]

Removed the draft. It is strewn with errors.

 

-Edit-

 

I've edited it and re-attached it

Edited July 9, 2013 by CerberusSco

[CerberusSco]

Took me ages to prrof read and re-edit. I hope this is better than my last one. Thanks

[estellyn]

That looks really good, you've done a great job. Just two points I would make:

 

If at all possible, look through the submission, and where relevant try to make it clear where ever possible that what he was suffering from was 'around the time of assessment', as there can be confusion in the hearing regarding then and now, with the added complication here of pre sobriety symptoms.

 

Make it clear somewhere on the submission that you have completed the submission, and compiled evidence as he was unable to.

[CerberusSco]

That's great, I will do.

 

Also, he went to see his GP today. They are going to do him a letter and waive the charge. They are going to talk about the initial dates he was diagnosed (November 2011), his hospital admission and suicide attempt and how he was feeling around the time of the initial assessment and mention that he was 'fragile' and to be deemed fit for work at that time would of most likely caused him to relapse. He will get the opportunity to look at the letter once completed and ask for any changes to be made if he isn't satisfied with the letter itself, but I think that will pretty much cover things for him.

 

If he is successful in his appeal he wants to make a small donation either to a charity of your choice or the CAG itself.

 

Also, I am aware that if he is successful his claim will be backdated to day 92 of his claim. Now my question is his assessment took place in March 2012 which is well past the 91 days from 12th November 2011. Would this still be the case or will it go from the assessment date (25th March 2012) or the date of the decision makers decision (19th April 2012) or the date of reconsideration which is Oct 2012? Or will this not matter and it will be backdated to day 92, which is Sunday 12th Feb 2012 by my calculation?

 

Thanks again.

[estellyn]

That's great, I will do.

 

Also, he went to see his GP today. They are going to do him a letter and waive the charge. They are going to talk about the initial dates he was diagnosed (November 2011), his hospital admission and suicide attempt and how he was feeling around the time of the initial assessment and mention that he was 'fragile' and to be deemed fit for work at that time would of most likely caused him to relapse. He will get the opportunity to look at the letter once completed and ask for any changes to be made if he isn't satisfied with the letter itself, but I think that will pretty much cover things for him.

 

If he is successful in his appeal he wants to make a small donation either to a charity of your choice or the CAG itself.

 

Also, I am aware that if he is successful his claim will be backdated to day 92 of his claim. Now my question is his assessment took place in March 2012 which is well past the 91 days from 12th November 2011. Would this still be the case or will it go from the assessment date (25th March 2012) or the date of the decision makers decision (19th April 2012) or the date of reconsideration which is Oct 2012? Or will this not matter and it will be backdated to day 92, which is Sunday 12th Feb 2012 by my calculation?

 

Thanks again.

 

 

Regarding the backdating issue, it should be to the 92nd day, but I believe there has been some issues where it is not backdated.

 

Great news about the doctor being supportive, that is so, so important.

 

I'm sure cag would appreciate any donation, if your friend chooses to make one. It's a great forum that allows people to both get and give help.

[Nystagmite]

he was 'fragile' and to be deemed fit for work at that time would of most likely caused him to relapse.

 

There's criteria regarding this - something about how being found fit for work would either worsen his health (physical or mental) or cause problems for others.

[Zonker]

http://www.dwp.gov.uk/docs/wca-handbook.pdf

 

Page 36 onwards onto 37

"A claimant who does not have limited activity for work related activity as determined in accordance with regulation 34 (1)" (Support Group Descriptors) "is to be treated as having limited capability for work related activity if -

 

(a) The claimant "suffers from some specific disease or bodily or mental disablement and;

(b) by reasons of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if he were found not to have limited capability for work-related activity";

 

I think that is what nystagmite is referring to. I mentions on some page before that about alcoholism and drug abuse can be because of mental health.

[CerberusSco]

Is it wise to mention this? I don't want to come across like I'm telling the appeal tribunal how to do their jobs.

[**Margaret**]

:CerberusSco:

 

No, you don't need to mention the Atos handbook. You've already got a paragraph about regs 29 and 35. No need to over-egg it. :Zonker:'s post was probably a reference to the authority for the previous one.

 

Echoing :estellyn: the written submission needs an explanation of your input and the reason for it. Other than that, you've got there.

 

Margaret.

[estellyn]

Is it wise to mention this? I don't want to come across like I'm telling the appeal tribunal how to do their jobs.

 

As Margaret says,the info is already there, you don't need to mention the regs.

[CerberusSco]

Just an update. The appeal was adjourned. They adjourned it to consider the evidence supplied and the fact that he got a rep at the last minute (well last week). He has also received his first appointment for the community mental health team, so whether they wanted to take that into consideration as well.

 

He has to return in 6 weeks time.

 

Good job though as the panel were refusing people left, right & centre today. Seen people in tears because their appeals were refused.

 

I hope the adjournment is a good thing. Who knows (probably unlikely) it might be overturned before he has to go back.

 

So back to waiting.

[honeybee13]

Hello and thank you for the update.

 

Fingers crossed, I really hope this works out for him.

 

HB

[**Margaret**]

:CerberusSco:

Oh well, better an adjournment than a rushed tribunal that overlooks evidence or leaves an already stressed appellant without enough time to answer their questions. There's more than enough of that at Atos. Also, your friend may have time to get hold of his psychiatric notes. The panel will consider any letters or reports that are relevant to his mental function, or lack of it, around the time of his assessment.

 

Margaret.

[CerberusSco]

Well it's just another week away. If the decision goes his way can he send a letter and his decision notice to the decision maker via recorded delivery in the hope of speeding up his back pay and any new rate he is to be paid? Is there a template for such a letter?

 

Thanks.

[**Margaret**]

:CerberusSco:

 

I'm not aware of any template. Probably cos (short of terminal illness) there's no way to speed up the processing of tribunal decisions, most of which are currently taking upwards of six to nine weeks.

 

Tribunal decisions are notified to the appellant and Jobcentreplus at the same time. Apart from checking, after six weeks or so, that Jobcentreplus've got their copy it's a case of waiting until your friend's decision gets to the top of the decision maker's in tray.

 

Fingers crossed for next week, Margaret.

[CerberusSco]

Thanks for your reply. Sorry I was under the impression that whilst the appellant is notified straight away, the DWP won't receive notification for a week or two later. Hence why I was asking if there was a chance of speeding up any arrears owed should he win the decision. I suppose he could send the decision notification to the decision maker with a kind enough letter via recorded delivery and/or drop it into the local jobcentre plus to be emailed accross.

[CerberusSco]

A massive thanks to everyone that has helped regarding this. I am happy to say the appeal was won and he was awarded 15 points, but with support component.

 

 

 

I seriously CANNOT thank you enough.

 

Once backdated pay has been received then a small donation, as promised, will be made to this wonderful community.

 

He's been told that he will get everything backdated which apparently amounts to £35 per week had he been put in the support group originally and an enhanced disability premium, which is apparently another £15 per week on top. So that's roughly £50 per week since April 2012 until todays date. Should be a good amount he receives in backdated pay.

Edited September 20, 2013 by CerberusSco