The Parliamentary and Health Service Ombudsman (“PHSO”) and the Local Government and Social Care Ombudsman (“LGSCO”) have released joint guidance around aftercare of mental health in-patients.
The PHSO and LGSCO work together on complaints that involve health and social care bodies. The aim of the guidance alongside the legislation is to reduce the risk of a person’s mental health declining and needing further hospital admissions. This can include giving practical recommendations to councils and clinical commissioning groups (“CCG”).
Under Section 117 (“S.117”) of the Mental Health Act 1983 councils and CCGs are obligated to arrange free aftercare for adults, young people and children who have been detained under the Mental Health Act. Aftercare services are designed to meet needs arising from a person’s mental health. This can include: administering medication, social work, domiciliary services, psychiatric treatment, residential care, and supported living.
After a series of case studies the PHSO and LGSCO found that there were key misunderstandings between councils and CCGs when it came to aftercare and found failures most commonly occurred in the following areas:
- Assessing needs
- Care planning and support
- Arranging for S.117 aftercare in a timely manner
- Ending S.117 aftercare
- Local joint arrangements between organisations
Guidance
In their guidance, the PHSO and LGSCO have attempted to clarify these misunderstandings.
Assessing Needs & Care Planning
The needs are assessed using the Care Programme Approach (“CPA”), which is a system used to coordinate the care of people with mental health conditions.
The most important aspect of the CPA is the care plan, which needs to be created in partnership with the person affected so that it will reflect their needs and wishes. The care plan will also need to state whether the person is entitled to S.117 aftercare and which services will be funded by S.117.
Eligibility will need to be reviewed six weeks after discharge and then annually after that, or as needed when the needs change drastically for a person.
Care Support
According to S.117, councils and CCGs are responsible to arrange for free after care for eligible individuals. However, rather than providing services directly, councils and CCGs will commission an appropriate provider to provide these services.
The CPA plan will need to set out what type of accommodation will be required, if any, and the person should not be expected to claim a housing benefit in order to receive this care.
Arranging & Ending S.117 Aftercare
The guidance emphasises that the Code of Practice makes it clear that aftercare planning should begin as soon as a person is admitted to hospital so that appropriate services will be put into place by the time they are discharged.
This guidance should encourage councils and CCGs to proactively reach out to potential providers and work in partnership with them when designing the care plans to ensure that all of the individual’s needs and wishes are met.
S.117 aftercare then does not end until both the council and CCG are satisfied that care is no longer required. This will be made in line with the person’s circumstances and usually occurs when the person’s mental health has improved to the point where aftercare is no longer needed.
However, it should be noted that care should not be withdrawn solely because: the person has been discharged; an arbitrary period has passed since the care was started; the person is deprived of their liberty, the person has returned to hospital, or the person is no longer on a Community Treatment Order (“CTO”).
Impact on Providers
Hopefully this clarity will better allow councils and CCGs to work in partnership and provide better quality and timely care to those who need it. It should be noted that much of the responsibility is put on the councils and CCGs rather than providers to ensure that adequate care is provided.
However, they will still have a responsibility to ensure that any person who is put under their care has their needs and wishes met. This means they will want to ensure they read the CPA care plan carefully and incorporate that into any supplemental care plans they may create for the person upon admission into their service.
It seems the most important takeaways from the Ombudsmen’s joint guidance is that care plans will need to be thorough and planning will need to be started at the earliest possible stage. It will require collaboration and cooperation from both providers and councils and CCGs to do this.
