[2024] UKUT 311 (AAC)

Dr Holt reported that—

“Ms [H] informed me that the index abuse has had a fundamental impact on her role as a parent, for example, her own fears and anxiety have led her to restrict her sons’ activities and stop them from doing certain things. She gave the example of them not being allowed sleepovers (whether at home or someone else’s home), and she summarised that her sons have ‘no freedom to go out and play’ and do ‘not have many friends’. Ms [H] described how her role as a mother can bring a constant source of anxiety and fear, providing a recent example of her making (unfounded) assumptions that one of her sons may have been sexually harmed and a general hypervigilance related to their safety and well-being” (paragraph 6.2.9.3, page C352);

“Ms [H] informed me that she ‘hate[s] going on days out’ with her sons due to her dislike of being in unfamiliar places and with other people” (paragraph 6.2.9.3, page C352); and

“she also conveyed sadness when recognising that she has ‘missed out on things’ due to her low mood, symptoms of agoraphobia, and disrupted sleep pattern (including the need to sleep during the day when her sons are awake)” (paragraph 6.2.9.3, page C352).

Dr Holt also reported that—

“As already outlined, Ms [H] described limited intimacy and sexual contact within her relationship with [W]; she informed me that sometimes he sleeps on the sofa and sometimes they sleep in the same bed, but this depends on whether or not she feels about to be physically close to him … Ms [H] made a direct link between the index abuse and patterns in her current sexual relationship; she stated that during times of intimacy she has had upsetting thoughts and memories of the index abuse. She described thinking ‘I did this when I was eight’ and the fact ‘[I] don’t’ want to be back in that place’” (paragraph 6.2.9.4, page C352); and

“Ms [H] did also detail a more general tendency to avoid intimacy, and explained that this is directly related to the index abuse” (paragraph 6.3.4.2, page C355).

This was clearly a report that intimacy is impacted by the abuse and so by the disorder that the abuse had caused.

Dr Holt reported at paragraph 6.3.2.1 that Ms H had reported: little interest or pleasure in doing things, disturbed appetite, sleeping difficulties and difficulties concentrating (page C354). Those, as distinct perhaps from negative self-concept and depressed mood which Dr Holt said Ms H had also reported, are clearly a report of difficulties with activities. Having little interest or pleasure in doing things suggests that hobbies and leisure activities (for Ms H’s own leisure and pleasure) are adversely affected. Sleeping difficulties mean there is a difficulty performing the activity of sleep. Difficulties concentrating mean there is a difficulty with any activity requiring concentration. Dr Holt was not in my judgment required to list each such activity. Disturbed appetite suggests a difficulty with eating properly.

Dr Holt reported at paragraph 6.6.3.1 that Ms H had reported not being able to stop or control worrying and that she had reported having persistent difficulties relaxing (page C354). Not being able to stop or control worrying will impact all activities. Difficulties relaxing impair activities aimed at achieving relaxation.

Dr Holt reported that—

“[W] is practically supportive and ‘does everything’ in the house and with regards [sic] their children’s care” (paragraph 6.2.9.4, page C352)

“Ms [H] described how she is unable to consistently complete most of the domestic / childcare tasks required and she is reliant upon her partner to perform most of these duties on a daily basis” (paragraph 7.5.1, page C357).

Having set out various limitations on day-to-day activities, Dr Holt drew the threads together at paragraphs 7.5.1 and 7.5.2. Those paragraphs came directly under the question about day-to-day functioning. But those paragraphs were not the sole extent of Dr Holt’s answer to that question. Indeed, she started paragraph 7.5.1 with “The index abuse has had a diffuse impact across all areas of Ms [H’s] functioning”. Dr Holt went on, in that paragraph and the next, to refer back to other parts of her report.

Dr Holt reported specifically, at paragraph 7.6.1, that—

“As already detailed, Ms [H] has been unable to sustain any form of paid employment throughout her adult life and it is my opinion that this is a direct result of her mental health needs resulting from the index abuse”.

Dr Holt also reported specifically, at paragraph 7.7.1, that—

“As already detailed, the symptoms directly attributable to the index incident are still present and experienced by Ms [H] on a daily basis” (page C357).