Employment and Support Allowance (ESA)
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Parent in bad way after a failed ESA assessment, need advice

chris_simschris_sims Member Posts: 10 Listener
Hello, a few years back my mum was on esa for a while suffering from various mental and physical illnesses such as anxiety, chronic depression, anorexia, insomnia, copd, back pain, body aches, alcoholism and others and needs proper help and failed her assessment around the end of 2016 so subsequently hit rock bottom and tried to take her life and she was admitted in hospital for it overnight and after coming home she had a massive mental breakdown because she didn’t want to drink again so she was taken back in a few days after coming out for a big detox and mental breakdown. 

She was in hospital for 8 days and obviously claimed a new esa claim because of how bad she got and after going back and doing another assessment she was put into support group and ever since been trying to get better but it takes time especially after such traumatic events. Now last month on the 26th Aug she failed her assessment and got 0 points partially because certain questions esp regarding her mental health were not asked or were asked/assessed in a way she didn’t understand as she hides/cant be herself around strangers and new places especially as she was off her medication for 3 months prior because they kept mucking up her prescription and asked her to visit gp to redo them etc and as the docs is so far away she gave up as she was too scared to push it so was a bit unfair. 

Now she has hit rock bottom again and feels suicidal and is having the dark thoughts, hearing voices, sleep deprivation, all other symptoms and illnesses she suffers from have gone up and she had a breakdown again the other night and dialled 111 and after a long night we saw the doctors the next day who said they would refer her to mental health/crisis team. So the same afternoon they rung her and she couldn’t understand the person or the approach in questions as she needs help with mental issues and he was saying stuff like "have you tried a drugs group etc" so my mum ended up putting down the phone as she got into a state, again because of her mental condition. 

We are going for a MR naturally and adding notes from her and me best describing the real conditions and how they effect her ability to work and we argue against many points saying the real picture and she has a 3 month fit note already sent in and that’s pretty much all we have. What we would like to know is who do we contact or how do we go about pushing for proof of her mental and physical conditions like letters or diagnosis for them etc to help fight this and if MR likely fails and we go to tribunal does she satisfy for a basic rate of pay during this as technically its a new claim and without a doubt her conditions have worsened and she believes she has others not previously mentioned so again how can we prove that and who do we push for help as she will try bad things again or end up in hospital for some reason, any and all advice and help appreciated, thanks

Replies

  • Pippa_AlumniPippa_Alumni Scope alumni Posts: 5,851 Disability Gamechanger
    edited September 2018
    Hi @chris_sims, thank you for sharing this with us. It sounds as though you and your mum have both had a difficult time throughout your assessment experiences- I really hope we can help. 


    If your mum is having immediate thoughts of suicide, it is important that you discuss them with someone who is qualified to help. Please call the Samaritans on 116 123 (free) or email them at [email protected]. If you feel that she may be an immediate danger to yourself, please call 999 or go to your local hospital right away.

    Regarding pushing for medical evidence, is this something you've discussed with your GP since your mum's more recent assessment? Hopefully our community will be able to offer some guidance.

  • chris_simschris_sims Member Posts: 10 Listener
    We tried and went docs but was told it wont help and to go through the process so this is why i want to push for proper help with her medical state of mind, would a doctors note help if we could try and get one?
  • BenefitsTrainingCoBenefitsTrainingCo Member Posts: 2,692 Pioneering
    chris_sims,

    A doctor's note would definitely help, plus any other medical evidence you can provide. MRs are, unfortunately, not usually successful, but when they are it is often because of new medical evidence. What you need to focus on in addition to that is what points your mum should have scored and why - so be clear that she should have got 15 points across whichever you think are the relevant activities.

    In addition to that, there are 2 regulations (called reg 29 and reg 35) which I think are relevant here. These are regulations about the RISK of being found capable for work & in your mum's case also found capable of work-related activity. I think that in this case you can clearly show that there is a huge risk (that having to do any work/work-related activity is a risk, but that simply the threat of having to do this has also proved to be harmful). There is a case which says that simply the threat of having to jobseek can lead to stress and that should be taken into account.

    If these regulations apply then it's arguable your mum should simply be 'treated as' having limited capability for work and work-related activity (support group). 

    Both the points test & the risk routes are covered by the ESA self-test, so it can be helpful to go through this to decide what you are going to argue for.

    Although whilst what matters is her condition at the date of her ESA decision (not later), on the other hand, what happened afterwards shows that there was a huge risk to her health from being found capable of work.

    I'd also suggest seeking help from your MP. We need to get MPs involved to urgently change this system, and your MP's constituency office may also have a caseworker who can help (CABx or local disability information centres are another source). 

    You haven't mentioned whether your mum is thinking of claiming any benefits in the meantime. I'd advise against claiming Universal Credit for now if that has started in your area. It's better to wait, if possible, for the outcome of the MR. If she needs to appeal she can go back on her ESA (without the support component) once the appeal is lodged & until it is heard.

    As regards not getting help from the doctor's, I can only suggest that you are upfront with them - we know that medical evidence makes a difference. We know that without it, MRs often don't lead to a change to the decision. The latest stats say that 22% of decisions were changed at MR stage. That is not zero - there is a chance - but contrasts to 65% of decisions being overturned at appeal. From that point of view, I would not spend too long on the MR. It is best to get that in with the month. You can still send in medical evidence if you get it later on. The DWP have power to change the decision at any stage before the appeal so don't feel that the MR is your one chance to tell them things. It may be more important to get the MR in so that, if it is not successful, you can quickly lodge an appeal and get your mum onto the 'appeal pending' rate of ESA.

    I echo Pippa's advice about your mum too; don't hesitate to seek professional help for her if it is needed. And I would also consider, if you can face it (not necessarily now) a complaint to the DWP and Maximus. I also wonder if you might have a complaint about your mum's GP here as well (not so much refusing to provide evidence now, but the mucking up of the prescription which you mention). That's not something I can advise on but I wouldn't rule it out. There is a responsibility here for how bad your mum has got.

    Good luck - and let us know how you get on.

    Will


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  • chris_simschris_sims Member Posts: 10 Listener
    Wow many thanks for the detailed response Will, my mum is currently being seen and put on treatment by the mental health team via home visits and she is seeing doctors and psychiatrists who are putting her on a course of medication etc and the doctor said he is going to sign her off and help write a letter for dwp and told us not to worry as my mums health and wellbeing is much more important than benifits and money but this is what im helping with while she gets the help and support she needs as its all i can do because this is all new to me too.

    Im certain reg 35 and other points definatly matter for my mums condition and because shes on a treatment of many pills etc im sure they cant force her out there because she is sleepy and needs time to get better so would be a danger to herself and others. Fingers crossed but we will push and fight as long as we have too because she is deserving of the help and support so wl get it. Many thanks for the nice detailed message, i took it all in.
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