Aftercare under Section 117 of the Mental Health Act 1983
Scope of this chapter
This chapter explains Section 117 Aftercare when a child or young person is discharge from hospital after having been detained under the Mental Health Act 1983.
When planning for discharge, practitioners should also have regard to the Statutory Guidance: Discharge from Mental Health Settings.
The statutory guidance clarifies how health and care systems should work together to support discharge in relation to children and young people from mental health, learning disability and/or autism inpatient settings.
It sets out best practice on:
- How NHS bodies and local authorities should work closely together to support the discharge process and ensure the right support in the community, and provides clarity in relation to responsibilities;
- Children, young people and parents/carers should be involved in discharge planning.
Guidance on how budgets should be shared to pay for Section 117 Aftercare is also provided.
Related guidance
- Mental Health Act 1983: Code of Practice Chapter 33 After-care
- Self-harm: Assessment, Management and Preventing Recurrence NICE Guidance
- Statutory Guidance: Discharge from Mental Health Inpatient Settings
- The Community Mental Health Framework (CMHF) has replaced the Care Programme Approach (CPA) as the framework for delivering effective community mental health services in England
Amendment
In November 2024, this chapter was refreshed.
Section 117 of the Mental Health Act 1983 requires Integrated Care Boards ('ICBs') and local social services authorities to provide aftercare services to patients who were detained in hospital for treatment under section 3, 37, 45A, 47 or 48 of the Mental Health Act 1983 ('the Act') and who are no longer detained.
The sections of the Act to which this duty relates are all concerned with compulsory detention in a hospital:
- Section 3 is a Treatment Order authorising a person to be compulsorily detained in hospital and for treatment to be administered to them without their consent. It can only be used following a Mental Health Act assessment (Section 2 Order under the Mental Health Act ). A person can be detained under Section 3 for up to 6 months, with the option for further renewals if required;
- Section 37 gives the magistrates' court or crown court a power to direct that a person will be detained in hospital either following conviction for an offence or on being satisfied that the person carried out the action that would have constituted the offence;
- Section 45A gives the higher courts a power to direct that a person convicted of an offence shall be detained in hospital instead of being detained on prison;
- Section 47 authorises the Secretary of State to direct that a person serving a prison sentence shall be detained in hospital;
- Section 48 authorises the Secretary of State to direct that a person who has been remanded to custody or detained under immigration legislation shall be detained in hospital.
This includes situations where eligible patients have remained in hospital informally after ceasing to be detained under the Mental Health Act.
The duty to provide aftercare services continues as long as the patient is in need of such services.
'Aftercare services' means services which meet a need arising from/related to the young person's mental disorder which reduce the risk of a deterioration in their mental condition and thus reduce the risk of them requiring admission to hospital again. The ultimate aim is to maintain patients in the community, with as few restrictions as necessary, wherever possible.
ICBs and local authorities should interpret the definition broadly. It can include healthcare, social care and employment services, supported accommodation and services to meet the young person's wider social, cultural and spiritual needs, if these services meet a need that arises directly from, or is related to, the young person's mental disorder and helps to reduce the risk of a deterioration in their mental condition. Aftercare should aim to support them in regaining or enhancing their skills, or learning new skills, in order to cope with life outside hospital.
Section 117(3) provides that the responsible bodies will be those:
'if, immediately before being detained, the person concerned was ordinarily resident in England, for the area in England in which [they were] ordinarily resident'.
The interpretation of this provision has been the subject of case-law. In R (Worcestershire County Council) v SSHSC [2023] UKSC 31, the Supreme Court held that:
- A duty under section 117(2) to provide aftercare services automatically ceases when the patient is detained again (‘the second detention’) for treatment under section 3 (or another provision specified in section 117(1) – a hospital order or direction under section 45A or a transfer direction under section 47 or 48) (but not a voluntary admission or an admission for assessment under section 2 Mental Health Act 1983);
- Upon the second discharge (i.e. discharge from the second detention), a new duty is placed on the local authority of the area in which the patient was ordinarily resident immediately before the second detention;
- The words 'is ordinarily resident' must be given their usual meaning, with the adaption where there is lack of capacity that the mental aspects of the Shah test (voluntary adoption and settled purpose) must be supplied by considering the state of mind of whoever has the power to make relevant decisions on behalf of the person concerned.
Although the duty to provide aftercare services begins when the young person leaves hospital, planning should start as soon as possible after they are admitted. ICBs and local authorities should take reasonable steps to identify appropriate aftercare services for young people in good time for their eventual discharge from hospital.
Aftercare planning requires a thorough assessment of the young person's needs and wishes. It is likely to involve consideration of:
- Continuing mental healthcare;
- The psychological needs of the young person and of their family;
- Physical healthcare;
- Daytime activities or employment;
- Appropriate accommodation - if the aftercare plan includes the provision of accommodation, and the young person has committed one or more criminal offences, the circumstances of any victims of the offence(s) and of their families should be taken into account when deciding where the young person should live;
- Identified risks and safety issues;
- Any specific needs arising from, for example, co-existing physical disability, sensory impairment, learning disability or autistic spectrum disorder;
- Any specific needs arising from drug, alcohol or substance misuse;
- Any parenting or caring needs;
- Social, cultural or spiritual needs;
- Counselling and personal support;
- Assistance in welfare rights and managing finances;
- The involvement of authorities and agencies in a different area, if the young person is not going to live locally;
- The involvement of other agencies, for example the National Probation Service or voluntary organisations;
- Any conditions likely to be imposed by the Secretary of State for Justice or the Tribunal;
- Contingency plans (should the young person's mental health deteriorate); and
- Crisis contact details.
Professionals with specialist expertise should also be involved in aftercare planning for young people with autistic spectrum disorders or learning disabilities.
Aftercare planning should take account of the young person's age, and should involve their parent/carer (as appropriate) to ensure that they will be ready and able to provide the assistance which the young person may need.
In order to ensure that the Aftercare Plan reflects the full range of needs of the young person, it is important to consider who needs to be involved. Subject to the views of the young person, this may include:
- The young person's responsible clinician;
- Nurses and other professionals involved in caring for the young person in hospital;
- A practitioner psychologist, community mental health nurse and other members of the community mental health team;
- GP and primary care team;
- Any carers who will be involved in looking after the young person outside hospital including, where relevant, those with parental responsibility;
- The patients' nearest relative (as defined in Section 26 Mental Health Act 1983) or other carers;
- A representative of any relevant voluntary organisations;
- MAPPA co-ordinator if applicable;
- National Probation Service if applicable;
- A representative of housing authorities if ordinary accommodation is an issue;
- The ICB's appointed clinical representative if appropriate;
- An Independent Mental Health Advocate, if the young person has one;
- An Independent Mental Capacity Advocate, if the young person has one;
- Attorney/Deputy if applicable;
- A person to whom the local authority is considering making Direct Payments;
- Any other representative nominated by the patient; and
- Anyone with authority under the Mental Capacity Act 2005 to act on the young person's behalf.
The practitioners concerned, in discussion with the young person, should agree an outline of the young person's needs and a timescale for implementing the various aspects of the Aftercare Plan. All key people with specific responsibilities should be identified.
Where it is established that the person requires assistance to access their welfare rights (benefits), it should be clear in the Aftercare Plan who is going to be responsible for providing this assistance both prior to discharge and on any ongoing basis. This will avoid any confusion for the young person and their family to ensure that they receive the benefits they are entitled to in a timely way.
It may be important that those who are involved in discussions about Aftercare Plans are able to make commitments about their own continuing involvement and the services to be provided or commissioned. If so and the worker will need to seek approval for this, extra time must be set aside for planning so that this causes no delay to the implementation of the aftercare plan.
Aftercare planning should take account of the young person's age and should involve their parent/carer unless there is a good reason not to. This will ensure that they will be ready and able to provide appropriate assistance to the young person.
It should be clearly recorded on the final Aftercare Plan:
- That the child or young person is eligible for Section 117 aftercare and the basis for this determination;
- Which services are to be provided as part of Section 117 aftercare;
- Who the named practitioner is (who has overall responsibility for co-ordinating the preparation, implementation and evaluation of the Plan).
Included within the Aftercare Plan are:
- A Treatment Plan which details medical, nursing, psychological and other therapeutic support for the purpose of meeting the young person's individual needs promoting recovery and/or preventing deterioration;
- Details regarding any prescribed medications;
- Details of any actions to address physical health problems or reduce the likelihood of health inequalities;
- Details of how the young person will be supported to achieve their personal goals;
- Support provided in relation to social needs such as housing, occupation, finances etc.
- Support provided by carers (both formal and informal);
- Actions to be taken in the event of a deterioration of the young person's presentation; and
- Guidance on actions to be taken in the event of a crisis.
Aftercare Plans should include details of any areas of need which are critical to preventing behavioural disturbance, and should provide guidance on how staff/carers should respond if behavioural disturbance does arise.
The Aftercare Plan should be recorded in writing and a copy given to the young person. It is essential that any changes are discussed with the young person as well as others involved, before they are implemented. The Aftercare Plan should be regularly reviewed. It will be the responsibility of the named practitioner/agency to arrange reviews of the Plan until it is agreed between all parties, including the young person, that it is no longer necessary.
The Aftercare Plan will need to be reviewed if the young person moves to another area. The named practitioner in the original area will be responsible for making transfer arrangements if commissioning responsibility consequently passes to authorities in the new area.
A local authority may make Direct Payments to a representative of the child/young person to pay for aftercare services, having regard to whether it is appropriate for the person's condition, the impact of that condition on their life and whether a Direct Payment represents value for money.
The duty to provide aftercare services exists until both the local authority and the Integrated Care Board are satisfied that the aftercare services are no longer needed. The usual reason for this is that the young person’s mental health has improved.
Services should not be withdrawn solely because the young person has been discharged from the care of specialist mental health services, or because an arbitrary time limit has passed.
The young person and their carer/advocate if applicable, should be fully involved in the process of ending their aftercare.
Aftercare services may be reinstated if it becomes obvious that they have been withdrawn prematurely, e.g. where a young person's mental condition begins to deteriorate immediately after services are withdrawn.
Last Updated: November 8, 2024
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