Does anyone have a view on this scenario? Person suffers a brain injury due to Hyperosmolar Hyperglycaemic State and possible fall. Person is objecting to care and treatment on a neuro ward and subsequently moved to a neuropsych ward. Person is then detained under S3 of the mental health act so would be eligible for S117 after care for needs arising from/related to the person’s mental disorder. Person exit seeks, has emotional dysregulation, moderate cognitive impairment and behavioural issues. At the discharge planning stage the psychiatrist is saying the person doesn’t have a mental disorder. ICB also stating there are no S117 needs and would screen for CHC. Will need 24 hr care and lifelong care and support. I’m confused as to why the psychiatrist would say the person doesn’t have a mental disorder. Any thoughts re whether they have a mental disorder as defined under the MHA and S117? Thanks in advance.
The s3 paperwork will have the information about the mental disorder, as determined by the assessing doctors. They will have been required to confirm the person needs treatment (in hospital) for the mental disorder, and that the treatment is available.
I’m no psychiatrist, but emotional deregulation and cognitive impairment, presumably as a result of the brain injury would appear to suggest a mental disorder.
MHA Code of Practice (p26) lists clinically recognised conditions which could fall within the Act’s definition of mental disorder: including “Personality and behavioural changes caused by brain injury or damage (however acquired)”
Whether it is sufficiently severe to require either treatment in hospital or now aftercare is another matter.
Thank you Steve, that was my understanding which was why I was confused. Hopefully the psychiatrist will be able to attend a meeting and clarify their reasoning.
If no disorder then s3 becomes invalid. When I was on the Tribunal I sat on a panel where the RC announced there was no disorder at the beginning of the hearing. We got some sense of the reality of the situation only from the OT and discharged the p.
Are they attempting to avoid s117 responsibilities I wonder?
Get a 2nd opinion if necessary
Thanks Tony. I don’t think they are trying to avoid S117 responsibility, the ICB seems to be repeating what the psychiatrist has said. If it wasn’t 117 then it would likely be fully CHC funded so they would probably be paying the full amount. The hospital won’t be bothered how care will be funded, so have no reason to try to avoid S117 responsibility. I work for the LA and it’s me querying why he no longer has a mental disorder, so the LA isn’t trying to avoid responsibility either. Thanks again.
Hi, I’ve been having a look through some older messages - this caught my eye! Are you happy to share what happened?
I’m curious to know under what framework the psychiatrist was treating the person in hospital if they did not have a mental disorder? Acquired brain injury seems to be especially complicated!
Thanks,
Hi Clare, the psychiatrist had used the Mental Health Act S3 and had also completed a report for tribunal. The issue was determining S117 after care needs prior to discharge. The psychiatrist stated the person didn’t have a mental disorder so had no S117 needs. The rationale for the use of the MHA was “no other option” (DoLS MH assessor said not a DoLS). ICB fully funded on discharge but at review wanted to pay only FNC. LA said no, it should be 50:50 and LA is funding our 50% as S117 after care (cognitive/behavioural/low mood). Final split still to be agreed between the parties.