[2024] UKUT 191 (AAC)

The first ground of appeal asserts that paragraph 35 of the Tribunal’s reasons discloses a material mistake of fact. The Appellant’s submission is that there is a flat contradiction between the Tribunal’s findings respectively that the Appellant (a) “has not received any formal psychological treatment” (paragraph 35) and yet (b) “has completed 12 sessions of Cognitive Behavioural Therapy [‘CBT’]” (paragraph 36).

This contradiction is at best superficially apparent and is certainly not for real. I am entirely satisfied that the expression “formal psychological treatment” is not being used in any highly technical sense. This much is clear both from the ordinary meaning of the words and from the context of Dr Cahill’s report.

So far as the ordinary meaning of the words is concerned, there has been no suggestion that the substantive phrase “psychological treatment” requires unpacking or further elucidation. Rather, it is the qualifying adjective “formal” which Ms Skander takes issue with. The dictionary definition of “formal” includes “officially sanctioned or recognised” and “done in accordance with convention”. So, on the face of it at least, “formal psychological treatment” simply means no more and no less than e.g. “relevant approved psychological treatment”.

As regards the context of Dr Cahill’s report, and on a fair reading of the passage discussing the Appellant’s treatment (see paragraph 11 above), it is tolerably clear that Dr Cahill was referring to PTSD-specific treatment. In the first two paragraphs of that passage the consultant summarised the Appellant’s limited treatment to date (including assessments and pharmacological intervention). This stands in stark contrast to what Dr Cahill describes (in the third paragraph), namely that “The treatment requirement for PTSD is trauma-focussed therapy in the form of either Trauma Focussed Cognitive Behavioural Therapy or Eye-Movement Desensitisation and Reprocessing (EMDR)” (emphasis as in the original). Dr Cahill then referred to the preparatory psychological work that would be needed before engaging in such specialist treatment.

It is plain from its reasons that the Tribunal was adopting the same approach as Dr Cahill. As such it was drawing a distinction between non-formal types of psychological treatment (e.g. psychological preparation, help with coping strategies and other limited interventions) and formal treatment (being the trauma-focussed CBT or EMDR highlighted by Dr Cahill. Given that broad categorisation, and given the evidence the FTT received as to the low-level nature of the CBT sessions attended by the Appellant, it is both reasonable and entirely understandable that the Tribunal did not regard the CBT sessions that the Appellant completed as meriting the description of being “formal psychological treatment”. In a nutshell, it was not trauma-focussed therapy. At best it could be described as a form of psychological preparation for such advanced therapy.

I should add that there was some debate at the Upper Tribunal oral hearing as to whether it was appropriate to have regard to the NICE guidelines on treatment for PTSD. I simply observe that in the event I have not needed to consider those guidelines. I am satisfied that the Tribunal’s findings were open to the panel on the basis of Dr Cahill’s report and the other evidence it received.