What is the legal duty of a Trust to provide a bed once an AMHP has decided that they will make an application for admission under section? What if the patient agrees to be admitted informally while waiting for the bed?
It appears that in many mental health Trusts AMHPs are carrying out Mental Health Act assessments and even when they have decided that the person should be detained the Trust does not prioritise the provision of a bed. Medical Recommendations expire before the AMHP can make m application. What would be the legal position if the patient agrees to come into hospital informally and bed is found?
If Judges cannot get hospital beds for the mentally disordered offenders, what chance as an AMHP got regardless of s. 140 MHA (1983). This is a meaning less piece of legislation in regards this particular section.
In 1983 Lawton LJ in R. V. Harding (15.06.1983) outlined that failure of a hospital to make a bed available would be contempt of court? Not been tried and tested as yet far as I am aware of. The evidence does seem to suggest in some cases if no beds for offenders them the HMP service is utilised.
How many psychiatric beds in the UK. In the 1950s before Enoch Powell cull of 0.5m beds, there remains some where between 22-27K beds. CQC have no figures. NHS digital have no figures.
A Trust or for a collaborative Tier 4 bed (250 beds) it is a discretionary measure to provide a bed. Some Trusts will reserve beds only for their ordinary resident patient (not that they should) others depending on resources, or who is the duty bed manager or CRHTT gateway worker may give you a bed. More chance of winning on the lottery!
Can you admit a patient under s. 131 if they are willing to do so? It would appear in s. 131 (3) if the patient is consenting to come to hospital and is aware that s/he may become liable to be detained, noting that s/he is capacitious in their decision. Then the least restrictive route should be utilised.
In regards to the the 14 days, the AMHP monitors the situation daily if no bed found with the CRHTT acting on the behalf of the Clinical Managers acting on the behalf of doctors acting no the behalf of the ICBs. If the patient is admitted informally, then the AMHP can decide if they wish to make an application or not. Just because a patient is in informally does not mean the AMHP has to sign the application (R v East London and the City MHT Ex.p Bradenburg [2003).
Iām not sure about the legal position but many authorities donāt have any beds to provide, a friend was recently sent 80 miles from home when their CTO was recalled.
Itās only meaningless because commissioners in ICBs / LHBs either havenāt heard of it or they ignore it and because nobody polices it - either at the ICB end or the provider trust end. When raised, ICBs say they comply with this legislation and fund the trusts accordingly; trusts say they are not resourced sufficiently - unless somebody cares about exposing that contradiction, then yes, itās meaningless.
But itās only meaningless because weāve allowed it to be and if I go back several years, most AMHPs I encountered hadnāt heard of it and almost all I meet now admit they never raise the absence of effective arrangemnets pursuant to the provision, whenever they have a āno bedā situation which pushes them in to breach of human rights territory, as it all too often does.
Of course weāve now got the Surrey Police v PC and Ors judgment from last year to remind us the High Court wants AMHPs and LAs much more across the legal failures which put these rights and peopleās safety at risk, so I look forward to hearing of my more High Court applications.
There are loads of things which could be said about this but itās a long and boring list of things which are widely ignored or not known, so Iāll just focus in on this -
Itās unlawful (by virtue of s6 Human Rights Act 1998) for a public authority to act in a way which fails to ensure ECHR rights of vulnerable people such as those assessed by AMHPs for admission. So many of the āno bedā situations give rise to potential breaches of some or all of articles 2/3/5/8, so AMHPs are quite within the rights to escalate to trust, IBC or LA managers are demand support and intervention to prevent such breaches, including by going to the High Court, as was suggested in the Surrey Police v PC and Ors (2024) case last year.
It would then be down to individual bodies to justify whether theyāve complied with the various specific duties which exist upon them and for the court to untangle any failures.
The reality to me seems to be, ICB commissioners and executives just do not seem interested in ensuring provision adequate enough to prevent those ECHR breaches and that absolutely nobody in the CQC / NHS England or NHS Improvement is policing that in any kind of meaningful way. Iām reminded that in December 2018 a meeting took place in Manchester involving those bodies and CQC guidance was put out about s140 MHA duties to ensure urgent admissions mechanisms. Having been published in autumn 2019 it was withdrawn from the internet within a few hours and sources tell me itās because NHS were unhappy at the obligations to sort matters being highlighted so prominently. I heard that third hand so it may not be correct, but what I do know is that the promise to āreviseā that guidance and republish it ASAP never happened.
I was at the Manchester meeting so I know this happened and I have a copy of the withdrawn guidance because I saved it before it was withdrawn, thankfully.
If anyone wants a copy - email me and Iāll send it across.
My practical experience in the field as a psychiatrist is as follows: No AMHP can make an application until they find a bed. This means the āWill of Parliamentā is stalled by NHS Trustsā. Iām not into debating this against those who do not believe because Iāve seen it too many times. Iāve never seen an AMHP make an application without a bed being available.
To clarify this, a patient can āagreeā to be admitted and still an application can be made subject to bed availability. Itās uncommon but the legal complexity surrounding that is too much to explain in 100 words and would take about 2000 words (Iāve explained it elsewhere).
Bed availability is the big blocker. So the patient disagreeing is not always the situation that holds up application or detention in a hospital.
Of course. This is standard. Iām inclined to think (but do not conclude) that you may be a member of the general public who didnāt know whatās what and discovering reality.
Thatāll be no problem at all! [TIC]
Nobody knows how many or what percentage of med recs expire [Not TIC] I know of situations where my med rec āwas tossed in a binā and emails seeking explanation returned no responses though I had read receipt. Now thatās power - when you donāt have to respond - and no consultant psychiatrist will spend 4 hours putting in a complaint and pursuing you.
And it gets ābetterā - last year I was being compelled to rescind a med rec that I did not complete! I refused point blank but that didnāt stop certain so-called consultants from telling me 'thatās what we do hereā (or very similar words). I had mentioned this before some time ago, but nobody cared then and nobody will care now.
The legal position is usually that the patient is admitted informally. But mental health law is not as straightforward as most people believe. Words like āagreeā or āconsentā run very deep into truckloads of case law.
Few know of beyond Cheshire West and the triangular framework. AI may or may not assist you. Iām on a tight leash being a āloose cannonā and all, so I cannot post links, photographs or make more than 3 responses in any thread.
I have to LOL that! No beds means no beds and it doesnāt matter who you are. Itās mathematical. Zero means zilch. Judges canāt command creation of a bed from āzeroā.
But wait - are there really zero beds? Ahhahhh.. when there are zero beds in the NHS there are mechanisms to purchase beds outside of the NHS. Ooops that costs money and nobody has āendless moneyā, unless you own a Central Bank of course. But for ordinary folk/organisations zero money means zero beds.
OMG! Yikes.. that means the chance is worse than 1 in 76,000,000 (for Euromillions) You know what, Iām taking a few chances in the Jackpot for this Tuesday coming. Wish me luck cuz if I win the big one Iāll set up a National Foundation to go into War Mode, on the whole lot!
Nobody really cares about Human Rights at organisational levels. How? Fines are cheap and minor blemishes of reputation mean nothing.
Too right! And why would they police their own incompetence? [Rhetorical] CQC woefully unfit for purpose, not just me saying so. NHS England apparently killed on one day, then morphed and resurrected a few days later! You could make it up, if youāre a politician.
Thank you for all of the replies. I am an experienced AMHP but have not worked as an AMHP now for 6 years
I have had over 40 years experience in mental health and I have to say these replies and the sense of hopelessness of anything changing is thoroughly depressing.
I have been supporting colleagues on the unit where I work to understand the legal implications of a MHAA having taken place and the patient not being prioritised for a bed for a lot of complicated reasons that I cannot share here. We were able to support the patient to make a decision to come to our unit (we do not fall under the usual bed management system) informally but the Trust MHA office refused to allow us to admit the patient informally saying that because there were two medical recommendations and AMHP had decided to make application that even though the patient arrived of their own accord we had to accept the application that had been made 9 days before (but surely an application cannot be made when there was no bed available).
The AMHP had agreed that the patient could be admitted informally tonis but this did not happen due to insistence of Trust. This seems to be all totally illegal and bureaucracy instead of law being followed. The patient had not been told that they were liable to be detained at any time during the preceding 9 days and arrives on a ward voluntarily to find themselves detained. I am appalled by a system that seems to have collapsed in on itself.
6 years ago when I assessed someone I stayed with them until a bed was found (over 24 hrs once). I appreciate that that is not possible now and it is partly why I am no longer an AMHP as I see that there is complete disregard for human rights, but this latest experience has left me confused thinking perhaps I am horribly out of touch with recent case law etc.
Back on the Magic Mountain in 1996 I giggled on noticing 'Bed Occupancy 116 %ā highlighted amid many stats on the noticeboard. Mea culpa. It was not funny.
It was likely a couple of days after a memorable lunchtime during which several patients had been obliged to eat sitting or kneeling on the floor because a number of chairs had been āborrowedā by an adjacent ward.
Annecdotal and necessarily untethered, yet itās humbling, and maybe salutary to reflect on the lives lived within and around these legal and medical institutions.
No beds means no beds and it doesnāt matter who you are. Itās mathematical. Zero means zilch. Judges canāt command creation of a bed from āzeroā.
You know what, Iām taking a few chances in the Jackpot for this Tuesday coming. Wish me luck 
cuz if I win the big one Iāll set up a National Foundation to go into War Mode, on the whole lot!