Mental Health Act 1983/2007. Section 117 and After Care Policy

Transcription

1 Mental Health Act 1983/2007 Section 117 and After Care Policy Between: London Borough of Hillingdon Hillingdon Clinical Commissioning Group FINAL DRAFT February 2015

2 Document Control Sheet Type of Document Document Purpose Scope of Document Consultation Approving Committee Section 117 and After Care Policy This document specifies the policy agreed between the London Borough of Hillingdon, Hillingdon Clinical Commissioning Group and CNWL NHS Foundation Trust for reviewing recommendations on aftercare under section 117 of the Mental Health Act (MHA). Hillingdon Council and Hillingdon Clinical Commissioning Group, CNWL Hillingdon ASC SMT Board & CCG Board Hillingdon ASC SMT Board & CCG Board Ratification and date V1 Author and Date Ian Kent & Sunny Mehmi, January 2015 Date of Last Review January 2015 Date of Next Review June 2015 Procedural Documents to Read in Conjunction With This Document Mental Health Act: Code of Practice Document Change History Changes to this document in different versions must be detailed below. Rationale for the change should also be given. Version Number/Name of procedural document this supersedes Type of Change i.e. Review/ Legislation/ Claim/Complaint Date Reviewer 1 Update in area 27 January 2015 Sunny Mehmi, LBH 2 Update in care act elements 28January 2015 Sunny Mehmi, LBH 2

3 1. Introduction 2. When does S117 apply? 3. What are After-care Services? 4. Health and Social Care Needs Assessment Eligibility 5. NHS Continuing Healthcare 6. S117 register 7. Reviews 8. Ordinary Residence 9. Discharge from S117 Procedure 10. Local S117 funding arrangements 11. Charges for After-care services12. Top up payments 13. Direct Payments 14. Transfer to another Local Authority 15. Disputes Resolution 16. References 17. Definitions 18. Appendices - 1 LBH/HCCG/CNWL Section117 Flow Diagram, - 2 LBH/HCCG/CNWL S117 DISCHARGE PROCEDURE and VARIATION OF SECTION 117 AFTERCARE - 3 CNWL CARE Programme Approach Documentation CPA Approach - 4 Service User Leaflet. 3

4 Section 117: Aftercare under the Mental Health Act 1983/2007 Introduction This document specifies the policy agreed between the London Borough of Hillingdon, Hillingdon Clinical Commissioning Group and CNWL NHS Foundation Trust for reviewing recommendations on aftercare under Section 117 of the Mental Health Act (MHA). It supplements the Section 117 Aftercare Procedure (CNWL CPA Policy and After Care Draft 2013) jointly agreed between CNWL NHS Foundation Trust and all partner local authorities and clinical commissioning groups, which sets out the legal and operational requirements for assessing, providing and reviewing aftercare. The procedure also offers guidance on recommendations to Local Authorities and Clinical Commissioning Groups about varying aftercare packages and discharging service users from S117 aftercare Section 117 places joint responsibility on Clinical Commissioning Groups (CCGs) and Local Authorities to provide after-care to people who have been detained under certain specified provisions of the MHA. Section 117 applies until both the local authority and CCG are satisfied that the service user no longer needs such services. Scope Mental Health legislation is underpinned by the Human Rights Act, duties under equality legislation, and Community Care Legislation. 1.1 The Mental Health Act 1983, Section 117 (S117) provides: "... It shall be a duty of the Primary Care Trust [now CCG] or Local Health Board and of the local social services authority to provide, in co-operation with relevant voluntary agencies, after-care services for any person to whom this section applies until such time as the Primary Care Trust or Local Health Board and the local social services authority are satisfied that the person concerned is no longer in need of such services..." 1.2 S117 is a free-standing duty which places upon Clinical Commissioning Groups (CCGs) and Local Authorities (LAs) a statutory joint duty to work together, in co-operation with relevant voluntary agencies, to provide after-care services for all service users with S117 rights. National Health Service England (NHSE) depending on the nature of the services commissions: secure services and specialised services, page 5 Who Pays? August 2013 contains guidance on which the Clinical Commissioning Group is responsible see paragraphs. 33, S117 is not a gateway section to services provided under other community care legislation such as the National Assistance Act 1948 or the National Health Service Act Social Services and Health Bodies should establish jointly agreed policies on providing services under this section setting out clearly the criteria for deciding which services fall 4

5 under S117 and which authorities should finance them. After-care provision under S117 doesn t have to continue indefinitely (HSC 2000/003: LAC (2000)3, para.3). 1.5 This updated Policy replaces previous versions and has been developed in collaboration between London Borough of Hillingdon, Hillingdon Clinical Commissioning Group and Central and North West London NHS Trust. 1.6 Central and North West London NHS Trust (CNWL) are commissioned to operate mental health services in Hillingdon. The Trust has a section117 policy which governs their activities in relation to section 117 duties. This policy is consistent with CNWL section 117 policy (Reference CNWL Draft 2013). 2.0 When does S117 apply? 2.1 The purpose of S117 is explained in the Mental Health Act Code of Practice 2015 chapter 33. Its aim is to support patients to regain or to enhance skills in order to cope with life outside of hospital minimising the risk of re-admission to hospital. 2.2 S117 after-care services only applies to patients/service users who: Have been detained in hospital for treatment under Section 3 MHA Were admitted to hospital by an order of the Court made under Section 37 MHA (with or without a Section 41 Restriction Order) Were admitted to hospital by a direction of the Court under Section 45A MHA Have been transferred from prison or remand centre to hospital in pursuance of a transfer direction under Section 47 or Section 48 MHA Were detained for treatment and then made subject to a Community Treatment Order under Section 17A MHA Were detained for treatment and then granted Leave of Absence under Section 17 MHA Were detained for treatment but remained as voluntary Were detained for treatment and then placed on Guardianship under Section 7 MHA S117 does not apply to patients who have been detained in hospital under any other section (for example Section 2, 4, 5(2), 5(4), 135 or 136). 3.0 What are After-care Services? 5

6 3.1 The Act does not specify definitively what constitutes after-care services from either the CCG or the Local Authority. However the MHA Code of Practice provides: "... After-care is a vital component in patients overall treatment and care. As well as meeting their immediate needs for health and social care, after-care should aim to support them in regaining or enhancing their skills, or learning new skills, in order to cope with life outside hospital..." 3.2 S117 services are not concerned with support in general but are those which are required to meet an assessed care need that arises from a person s mental disorder and are aimed at minimising the need for future re-admissions to hospital for treatment for that disorder see R (Mwanza)-v- LBs Greenwich and Bromley [2010] 3.4 The Care Act 2014 inserts a new subsection 6 to section 117 enshrining the principles set out in the Mwanza case in legislation. From April 2015 onwards section 117(6) will read as follows: (6) In this section, after-care services, in relation to a person, means services which have both of the following purposes (a) meeting a need arising from or related to the person s mental disorder; and (b) reducing the risk of a deterioration of the person s mental condition (and, accordingly, reducing the risk of the person requiring admission to a hospital again for treatment for mental disorder). 3.4 The services may include: - Provision of domiciliary services - Access to accommodation and welfare rights - Social work support - Day services e.g. support with employment, social inclusion and relationships - Medical supervision and psychological support - Specialist Welfare Rights and Housing benefit advice - Advice on employment 3.5 Services providing care or support for a physical disability, illness, substance misuse problems, and common needs not arising from the patient's mental health disorder cannot be provided under S117. These must be met under separate health and community care legislation. 3.6 Although accommodation can be provided under S117 the need for accommodation must be a direct result of the reason that the patient was detained for in the first place. As a matter of law ordinary accommodation can never be a free after-care service under S117 Mental Health Act. 3.7 In R (Afework) -v- London Borough Camden the court set out three requirements which must be met for accommodation to be provided under S117. They are: 6

7 (i) (ii) (iii) The need for accommodation is a direct result of the reason that the ex-patient was detained in the first place ( the original condition ); The requirement is for enhanced specialised accommodation to meet needs directly arising from the original condition; and The ex-patient is being placed in the accommodation on an involuntary (in the sense of being incapacitated) basis arising as a result of the original condition. 3.9 In light of the above, accommodation provided under S117 will in most cases go beyond that which can be lawfully commissioned by a local authority. 4.0 Health and Social Care Needs Assessment- Eligibility 4.1 Service users entitled to statutory after-care under S117 should have their needs assessed and clarified as part of the Care Programme Approach (CPA), section 47 NHS Community Care Act 1990 (from April 2015 this responsibility will be covered by the Care Act 2014) 4.2 After-care planning should start as soon as possible after admission and should be service user focused (Appendix 1). 4.3 The service user s needs should be considered at Care Planning meetings this would entail: Contributors to the care planning process should be aware of the service user s S117 status and the additional statutory duty to provide after-care services that this entails All the service user s needs should be considered carefully, identifying which needs should be met under S117, and those which should be met under other legislation e.g. National Assistance Act Should needs be identified relating to a physical disability or illness which may require community care services, these may be chargeable, according to the service user s financial circumstances The care plan identifying the service user s care needs, should indicate very clearly which services are being provided under S117 and which are being provided under other legislative responsibilities The needs of the whole individual should be considered and not only mental health and social care needs (e.g. physical health needs) and a risk assessment and management process should be incorporated and monitored as part of the after-care planning Service users should be provided with the Service User Leaflet which explains their rights under S117, discharge process and how to complain should they need to (Appendix 4). 4.4 The needs assessment and any discussion and/or agreements should be well documented in the service user s notes. 7

8 4.5 The Care Coordinator should ensure that the service user s GP receives a letter from the Responsible Clinician advising of a service user s S117 after-care support plan. 4.6 No person is legally obliged to accept the after-care services that are offered. An unwillingness to receive after-care services should not be equated with an absence of a need for such services. A patient s continued refusal to receive after-care services should be confirmed by professional inquiry at appropriate intervals and clearly recorded e.g. CPA Review meetings, and on CNWL Jade and LBH Protocol. 4.7 If a person continually refuses aftercare services the professionals involved with their care may want to consider whether they should be discharged from S117 and hold a review. 5.0 NHS Continuing Healthcare 5.1 If all the required after-care services are to be provided under S117 MHA it may not be necessary to assess eligibility for NHS continuing healthcare (CHC) funding. 5.2 However, a service user in receipt of S117 after-care services may also have needs for continuing care not related to their mental health and this will not therefore fall within the scope of S117. An example would be a person already receiving care in relation to physical health problems before being detained under a treatment section of the MHA and whose physical health problems remain on discharge. In such a case a CHC assessment may be necessary to establish how these needs will be addressed. 5.3 In the absence of agreement between funding bodies, an assessment would be required to determine whether the service is to be paid for out of a CCG or Local Authority budget. It is important for the NHS to be clear in each case whether the individual is being funded under S117, NHS CHC or any other powers if a common budget is in place to fund both S117 and CHC. The use of the following could assist in resolving the: Hampshire NHS/Partnerships/County Council Guidance Notes and Matrix Formula 2013 for CHC assessments. 6.0 Section 117 Register 6.1 There will be one S117 Register maintained by the CPA Co-ordinator/Team Manager. 6.2 The Mental Health S117 register will be maintained by the Team Manager and this will be collated monthly. 6.3 The team responsible for managing the person's after care will use existing channels with Hillingdon Local Authority finance department to ensure the data updated on the Register is cross referenced with finance records. 8

9 7.0 Section 117 Reviews 7.1 The Care Coordinator/Care Manager will arrange a review of the Care Plan within the first 3 months and thereafter at intervals of no longer than 12 months. However, it is expected reviews will take place at more frequent intervals. 7.2 Each review must include explicit decision on whether the person continues to need After care and in which type of care provision. 7.3 The identified CPA Co-ordinator and Team Manager will maintain an up-to-date Register of service users on S Any changes in S117 status of the service user (or patient as referred to in the Act) will be immediately recorded on the register (i.e. transfers/discharge). 7.5 This information will be regularly updated and shared with the ABT Section 75 Monitoring Group and the Funding Panel. 7.6 The S117 Register can be used as part of the process for reviewing individual status for Section 117 and provide updates to the Funding Panel in relation to changes in care packages or discharges from funded care packages on identified timescales. 8.0 Ordinary Residence 8.1 Under the current legislation the term resident in the MHA is not the same as ordinarily resident in the National Assistance Act 1948 and therefore the deeming provisions about ordinary residence are not transferable. From April 2015 the Care Act will amend S117(3) to provide that the responsible local authority will be that in which the patient was 'ordinary resident' prior to admission. 8.2 Who Pays? Determining Commissioning Responsibility August 2013 provides that if a person is placed in a different area upon discharge then the CCG in the patient's new area will become responsible for their care. 8.3 Therefore from April 2015, responsibility for provision of S117 after-care is determined by the 'ordinary resident' status for local authority funding and the location of the GP that they are registered for CCG funding. 8.4 Decisions about Ordinary Residence may in some cases be difficult to determine and as such Legal Guidance should be sought from the appropriate authority Legal Advisors. 8.5 The provision of care under S117 must be needs led. It is not acceptable to identify a service first and then attempt to fit the patient's needs to it. Applying the guidance in ex parte Hall and Who Pays? This means that where a patient is resident in Hillingdon prior to being admitted, London Borough of Hillingdon and Hillingdon CCG will be responsible for the provision of aftercare services. If, after completion of an assessment and CPA Care Plan it is determined that the patient's needs can only be met in a provision outside of the 9

10 borough then Hillingdon CCG will approach the CCG in the new area to transfer responsibility. The London Borough of Hillingdon will liaise with the new CCG in respect of the provision of aftercare services upon them accepting responsibility for the patient. 8.6 If, after placing a patient in area outside of the borough, there is a dispute between CCGs as to who is responsible, Hillingdon CCG shall continue to fund services for the patient on a without prejudice basis until the dispute is resolved. 8.7 Where a patient is detained in Hillingdon and it is not possible to identify where he was resident (or, after April 2015, ordinary resident) prior to his admission, London Borough of Hillingdon will act on a without prejudice basis as the Local Authority of the moment to provide aftercare services. 8.8 In circumstances where there is a dispute between following local authorities following a patient being placed within the London Borough of Hillingdon, it shall be the responsibility of the placing authority to continue providing support pending the resolution of the dispute. 9.0 Discharge from S117 Procedure 9.1 After-care under S117 MHA does not have to continue indefinitely. It is the joint responsibility of the health and social care authorities, in consultation with the service user, to decide whether after-care services should end. 9.2 The authority responsible for providing the particular services should take the lead in deciding whether the services are no longer required (LAC 2000(3), para. 4). 9.3 A patient should not be discharged from care solely on the grounds that: They have been discharged from the care of a Responsible Clinician or Specialist Mental Health Services An arbitrary period of time has elapsed since care was first provided The provision of care is successful in that the service user is well settled in the community or residential care They are no longer subject to Supervised Community Treatment or S17 leave They have returned to hospital as informal patients or under Section 2 of the Mental Health Act They have a Deprivation of Liberty Safeguards Authorisation. 9.4 S117 services must be provided until both the health and social services authorities are satisfied that the service user is no longer in need of such after-care services by virtue of their mental disorder. 10

11 9.5 The ending of S117 after-care does not necessarily mean discharge from health services. For instance, a service can continue to be provided under a different legislative framework, e.g. under the Chronically Sick and Disabled Persons Act The decision to end S117 after-care services must only be taken at the arranged Multi- Disciplinary Team S117 Discharge meeting (Appendix 2). The patient should be fully involved in the decision making process. 9.7 If S117 after-care ends, it cannot be re-started if the service user becomes mentally ill once again. They can only receive S117 services if they are re-admitted to hospital under a treatment section of the MHA as in 2.2 above. 9.8 S117 services cannot be terminated for service users subject to after-care under supervision (S37 with a S41 MHA Restriction Order) until the respective orders have been discharged. 9.9 S117 services may not be terminated for a patient still subject to Section 17A Community Treatment Order Discharges from Secondary Care with Continuing Section 117 Aftercare. In exceptional circumstances, individuals may remain on Section 117 and require after care services that are available from primary care for example medication where prescription charges are may be funded under section 117. CNWL s Care Programme Approach (CPA) Policy and Section 117 Aftercare Procedure (Draft 2013) 10.0 Local S117 funding arrangements 10.1 The MHA is clear that services provided under S117 are a joint duty and, even though there are no set criteria on apportionment of funding for each authority, there is a requirement that the authorities should establish a jointly agreed policy for deciding funding arrangements (LAC 2000 (3)/HSC 2000/003) Section 117 funding responsibilities can mean that the persons care package is either: Fully funded by Local Authority Fully funded by the CCG Jointly funded by Local Authority and the CCG S117 does not provide local authorities with additional powers to provide health services. This will not change with the implementation of the Care Act in April It remains the case that it is unlawful for local authorities to provide services which might be provided by the NHS. 11

12 10.5 In cases where it is considered that there should be a joint funded package by either Local Authority or the CCG the joint funding matrix form. The use of the following tool could assist in resolving the funding matrix: Hampshire NHS/Partnerships/County Council Guidance Notes and Matrix Formula 2013 for CHC assessments This tool should be completed by both a social care and NHS assessor. This should be jointly signed and considered by the appropriate funding panel e.g. Mental Health Complex Care Panel or the Older People Funding Panel or the Disability funding panel, which will make a decision on joint funding. If joint funding is to be considered at panel a senior member of both agencies need to be present to ensure that the decision is validated In the event that the panel cannot reach agreement the local continuing care disputes policy should be instigated. Who Pays? Determining responsibility for payments to providers August 2013 NHS England paragraph 9 page Charges for After-care Services 11.1 It is unlawful for any authority to charge for services provided under S117. Care Coordinators should ensure that the respective LA finance departments are aware of the Service Users S117 rights and clearly indicate which services fall under S117 and should not be charged for The provision of after-care services under S117 should not be confused with providing for the essentials of life, such as food, clothes, accommodation, heating etc. These remain the responsibility of the individual except in the very special cases where accommodation, heating etc., are provided as part of a residential placement (or supported living arrangements) and are an inseparable part of the placement Top up payments 12.1 As long as the Local Authority commits itself to providing a level of funding that will adequately meet the assessed needs of the service user for accommodation, there is nothing to prevent top-up payments being made by the patient or another person to fund accommodation that provides for a higher level of either service or accommodation The service user or their representative would at this point be entering into an independent arrangement with the service provider It will be the provider s responsibility to make substantial checks to ensure the third party 12

13 13.0 Direct Payments (Personal Budgets) 13.1 Direct payments can be made to people who are assessed as requiring services under S Local Authorities have a power (not a duty) to make direct payments to those requiring services under S117..The provision of a discretionary power is intended to give LAs greater flexibility in cases where they are concerned that there may be risks in making direct payments in respect of services which the person concerned may prefer not to receive LAs do not have the power to seek contributions for services provided under S117. Accordingly, where LAs make direct payments instead of providing services under S117 they may not seek payment, whether by way of reimbursement or a contribution Transfer or placement to another Local Authority area 14.1 Under the 'ordinary resident' guidance the duty to provide after-care services remains with the placing local authority even if the service user becomes resident in another area. The Care Coordinator should ensure that the necessary arrangements are in place to continue provision of services as indicated in the Care Plan Authorities can agree to a transfer of responsibility for providing S117 services. In this scenario the Care Coordinator should ensure that transfer of all after-care documents are completed and, in consultation with the Responsible Clinician, ensure appropriate transfer of care between the authorities 14.3 If a service user subject to S117 becomes resident in a new area and is then detained under one of the provisions in 2.2 the relevant CCG body for S117 responsibilities would be in the new area. Who Pays? Determining responsibility for payments to providers August 2013 NHS England paragraph In line with section 8.7 and 8.8, where a patient is resident in Hillingdon prior to being admitted, London Borough of Hillingdon and Hillingdon CCG will be responsible for the provision of aftercare services. If, after completion of an assessment and CPA Care Plan it is determined that the patient's needs can only be met in a provision outside of the borough then Hillingdon CCG will approach the CCG in the new area to transfer responsibility. The London Borough of Hillingdon will liaise with the new CCG in respect of the provision of aftercare services upon them accepting responsibility for the patient. 8.8 If, after placing a patient in area outside of the borough, there is a dispute between CCGs as to who is responsible, Hillingdon CCG shall continue to fund services for the patient on a without prejudice basis until the dispute is resolved Disputes Resolution 13

14 15.1 Any disputes about responsibility for funding Section 117 will be dealt with through the agreed Continuing Care disputes policy and NHS England in exceptional circumstances. Who Pays? Determining responsibility for payments to providers August 2013 NHS England paragraph 9 page 8 14

15 16.0 REFERENCES Department of Health, (2000). Aftercare under the Mental Health Act 1983: Section 117 Aftercare Services. HSC 2000/003: LAC (2000)3. London: Department of Health. Department of Health, (2008). Reference Guide to the Mental Health Act London: Department of Health. Department of Health, (2009). The national framework for NHS continuing healthcare and NHSfunded nursing care - (revised). London: Department of Health. Department of Health, (2011). Ordinary Residence: Guidance on the identification of the ordinary residence of people in need of community care services, England. London: Department of Health. Jones, R., (2009). Section 117 After-Care: Mental Health Act 1983 (Revised 2007). Mental Health Act Manual 17 th Edition due London: Sweet and Maxwell. Department of Health, (2015). Mental Health Act 1983 Code of Practice. London: Department of Health. Who Pays? Determining responsibility for payments to providers August 2013 NHS England CNWL Section 117 Policy and Procedure 2013 (Draft) Hampshire NHS/Partnerships/County Council Guidance Notes and Matrix Formula 2013 for CHC assessments. 15

16 17.0 Definitions Care programme approach (CPA): Framework of assessment, care planning and review for people who receive mental health services. Care management: Framework of assessment, care planning, provision of care packages and review for people who receive services via Local Social Services Authorities Within adult mental health services, CPA and care management are fully integrated. This is true to a lesser and varied extent where CPA applies for other care groups. Therefore both CPA and care management will be referred to where applicable throughout the policy. Local Government Act 2000 Section 2: Entitles local authorities to do anything which they consider is likely to achieve the promotion or improvement of the social well being of their area provided that they are not forbidden from so doing by any prohibition, restriction or limitation on their powers in any enactment. Mental Health Act 1983: Section 3: Order detaining an individual in hospital for treatment Section 17 leave: Period of agreed community leave for a service user currently liable to detention in hospital. Section 17A (Supervised Community Treatment): Order providing a legal framework around the care plan of an individual who has been detained under section 3 (or section 37 hospital order), when they are discharged from hospital, although they remain liable for recall or revocation from the Community Treatment Order. Section 37: Hospital Order detaining an individual who has been transferred by the Courts to hospital for treatment. Note: Guardianship under section 37 does not confer section 117 status. Section 37/41: Order detaining an individual who has been transferred by the Courts to hospital for treatment, with restrictions Section 42 directions for Section 37/41 conditionally discharged service users: allows the Secretary of State to direct that someone under a restriction order should be discharged from hospital but subject to conditions e.g. place of residence, supervision by psychiatrist and social supervisor. Section 45A: When imposing a prison sentence for an offence other than when the sentence is fixed by law, the Crown Court can give a direction for immediate admission to and detention in a specified hospital, with a limitation direction under Section 41. The directions form part of the sentence and have the same effect as a hospital order. The Home Secretary can approve transfer back to prison at any time. Section 47 or 48: Orders detaining an individual transferred from prison to hospital for treatment. 16

17 Section 47/49: Orders detaining an individual transferred from prison to hospital for treatment, with restrictions. Social services: Various terms are used to describe the provision of social services throughout the policy: 1 Social services for general references 2 Local social services authorities where appropriate London Borough of Hillingdon 17

18 Appendix 1 ASSESSMENT OF HEALTH AND SOCIAL CARE NEEDS to be completed within 28 days of allocation and updated prior to every CPA review or when there are significant change in need. ASSESSMENT/REVIEW DISCUSSED IN SUPERVISION AND SIGNED OFF BY SUPERVISOR TO CONFIRM THE ASSESSMENT HAS CLEARLY IDENTIFIED NEEDS, STRENGTHS AND GOALS DISCUSSION AND AGREEMENT AT MDT REVIEW MEETING (CPA) ON CARE PLAN TO MEET IDENTIFIED NEEDS CONFIRMATION OF WHICH SUPPORT NEEDS ARE S117 AND WHICH ARE NOT ONGOING SUPPORT REQUIRED? YES: CLEARLY IDENTIFY WHICH NEEDS ARE PROVIDED UNDER S117 ON CARE PLAN AND APPROVED BY CPA CO- ORDINATOR &TEAM MANAGER SOME CHANGES: VARIATION TO FUNDED CARE PLAN (S117 ELEMENTS) PAPERWORK CHECKED BY CPA CO-ORDINATOR/TEAM MANAGER NO: RECOMMEND DISCHARGE FROM S117. PAPERWORK CHECKED BY CPA COORDINATOR /TEAM MANAGER SUBMISSION TO FUNDING PANEL FOR APPROVAL PAPERWORK REQUIRED: UPDATED CORE ASSESSMENT AND CPA CARE PLAN (Care Co-ordinator may be required to attend) WHERE DISCHARGE IS CONFIRMED CHANGE S117 STATUS ON JADE AND PROTOCOL. ENSURE SERVICE USER IS REMOVED FROM TEAM S S117 SERVICE USER AND ANY CARER(S) NOTIFIED IN WRITING OF DISCHARGE FROM 18 S117 OR OF ANY VARIATION TO THEIR AFTERCARE

19 Appendix 2 S117 DISCHARGE PROCEDURE and VARIATION OF SECTION 117 AFTERCARE This procedure should be followed by mental health and learning disabilities services when seeking to discharge a service user from section 117 aftercare, or vary their aftercare. These steps are outlined in a Flowchart at Appendix 1. Step 1 - Assessment of service user needs carried out in accordance with the main S117 Aftercare Procedure. Guidance on assessment quality and discharge or variation options is available from team managers, senior practitioners and, where necessary, Hillingdon Council Legal Services and the CCG s legal advisors. Step 2 - Discussions and formal review meeting arranged with the service user, carer, nearest relative, relevant professionals involved in their care and service providers to discuss needs and potential discharge from S117 or variation to aftercare. The CPA Co-ordinator/ Team Manager should oversee this process. Step 3 - If there is a recommendation to discharge or vary services which involve a funded package of care it must be submitted to the Funding Panel for decision with the S117 aftercare plan from the CPA. The Funding Panel will review each case presented to it, but will be expected to follow the recommendation unless there are cogent reasons for not doing so. The Funding Panel will require the service user s Core Assessment and CPA Care Plan in order to make a decision on section 117 discharge or variation. The care coordinator or other team member will need to attend the Funding Panel to present their cases if required by the Panel. The outcome of the Panel decision may require the sourcing of a placement via the brokerage service. If there is professional disagreement the case will be escalated to senior managers for resolution under the Alternative Dispute Resolution set out below. Pending resolution of the dispute the service user remains supported by way of section 117 of the Mental Health Act. Step 4 - Where discharge is confirmed this information is updated on Jade and the service user s Protocol file, with details of who was involved in the decision making and the reasons behind those decisions recorded. Care coordinators also need to update the CPA Co-ordinator/ Team Manager s section 117 register once discharge or variation is confirmed. Step 5 - The service user and any carer/s involved should be notified in writing of discharge from S117 or of any variation to their aftercare. It should be made explicit that the services that the client receives will change as a result of discharge or variation of aftercare. This may result in the service user being charged for services. Step 6 - The service user should also be subject to a financial assessment to check that they are eligible for free services, and referred to the Council s Financial Assessment Team. This needs to be undertaken at the point of assessment to vary or discharge the Section

20 Appendix 3 CNWL CARE PROGRAMME APPROACH CPA POLICY TO BE ADDED Appendix 4 Service User Leaflet SERVICE USER LEAFLET S117 Aftercare - Your rights under the Mental Health Act What is section 117 Aftercare? Section 117 of the Mental Health Act 1983 (MHA) says that Local Social Service Authorities and Primary Care Trusts must provide certain after-care services free of charge, to people who have been detained under certain sections of the Mental Health Act These after-care services must be for specific health and social needs, assessed as necessary by your care coordinator and care team in consultation with you. The purpose of this after-care is to prevent someone needing to go back into hospital. This means that services should meet someone s immediate needs and also support them to gain skills and help them to cope with life outside of hospital. This may involve a direct service, for example a carer to support you, or it may be through self directed support (SDS), which allocates a sum of money which you can use more flexibly for your assessed needs. (For further information on SDS please ask your care coordinator) These services are re-assessed at every review and when the care team have assessed someone s needs as having been met, a formal care review meeting will be set up to discuss discharging them from S117. When does section 117 start? Section 117 begins when you leave hospital, although planning for after-care should begin as soon as you are admitted to hospital. Who is entitled to section 117 Aftercare? People who have been detained under the treatment sections of the Mental Health Act. These are sections 3, 37, 45A, 47 or 48. People who are discharged from the above sections, but who remain in hospital voluntarily after their discharge People who are released from prison, who have also spent some of their sentence in hospital, detained under sections 37, 45A, 47 or 48. People granted leave from hospital under section 17 are entitled to services during their period of leave People going onto Supervised Community Treatment (SCT) or Guardianship. Who is responsible for providing the Aftercare? 20

21 It is the Health Authority/NHS and the Local Social Services Authority (LSSA) in the area where the person normally lives at the time they were admitted to hospital. There are some exceptions to this but this responsibility will be dealt with by the care co-ordinator and care team. Who is involved, and what services count as S117 Aftercare? You will be directly involved in planning your after-care. Any carers should also be involved as long as you consent. Other people involved could include a psychiatrist, community psychiatric nurse, social worker, occupational therapist, psychologist, advocate, housing officer and people who represent you with your consent like an attorney or deputy. Factors considered in the assessment will vary from person to person. After-care services could include: o Provision of domiciliary services o Access to accommodation o Social work support o Day services e.g. support with employment, social inclusion and relationships o Medical supervision and psychological support o Access to welfare rights and housing benefits advisors Your after-care support plan, also called a Care Programme Approach (CPA) care plan must be in writing and include timescales. This will specify your S117 health and social care needs as well as any other needs not identified as S117 needs. This plan will be reviewed regularly. It is the care co-coordinator s responsibility to arrange reviews, at least 6 monthly. Discharge of section 117 Aftercare The duty to provide after-care lasts as long as the care team assess that you continue to have S117 health and/or social care needs. We recognise that even if someone is doing well outside hospital, they may still need after-care services to prevent them becoming unwell again, especially if they have a long history of mental health difficulties. Section 117 services only end when the section is formally discharged. This must involve a meeting, which includes you and the people you would like to be there, such as a carer or advocate. If you were not involved in a discharge meeting, then you are still on a section 117. However, please be aware, that if you are invited to the meeting, non-attendance will not prevent discharge from S117 if the care team believes it is appropriate. The decision to discharge from S117 lies with your care team and must include your care coordinator and consultant psychiatrist. If you disagree with a decision to discharge from S117, you are entitled to appeal against this decision (see below). Stopping of services and/or funding under S117 You should be given two week s notice before any service provided under S117 ceases. After-care should not be stopped on the following grounds alone: 21

22 You are discharged from specialist mental health services, such as a community mental health team A certain length of time has passed since you left hospital You return to hospital voluntarily or under section 2 You are deprived of your liberty under the Mental Capacity Act 2005 You are no longer on supervised community treatment or section 17 leave Appealing against the Decision If a decision is made to discharge you from S117 and you do not agree with the decision, you have a right to make a formal complaint. Your care co-ordinator can help with this. If you need further information about how to complain Frequently Asked Questions. 1. What can I do if I haven t received services under section 117 that I think I m entitled to? You could contact either your care co-ordinator, psychiatrist or local team manager who would be happy to discuss any issues with you. the response you can make a complaint in writing. Your care co-ordinator can assist you with this. If still unsatisfied, you can complain to the Local Government Ombudsman who has the power to investigate complaints against councils, including social services departments. You could ask a solicitor. 2. What can I do if I ve been charged for services whilst on section 117? You may be able to claim this money back. You should do this as soon as possible by writing to the Trust or Local Authority. The process of reimbursing will raise complicated issues about benefits. You may have received benefits that you wouldn t have been entitled to if you had received free after-care under section 117. You should seek specialist advice if you think you may be in this situation. 3. What happens if I do not want to receive a service or I change my mind? You do not have to accept services if you are offered them. If you change your mind later, you would still be entitled to receive these services if they are still assessed as required to meet your needs. 22