I work with MH residents in a care home setting. My understanding is that S117 only applies to patients admitted to hospital under section 3, but I am wondering whether voluntary admission is now becoming a term used to a wide range of situations and not necessarily applied only to actual cases, where the patient said ‘I want to go to hospital, I am unwell’.
I have seen more and more cases where patients are admitted ‘voluntarily’, although it is the professionals that start the process and flag up the issues, the person has little or no insight into their mental health condition, and the only indication of consent or voluntary nature of the admission is the fact that the person gets in the car and doesn’t present challenging behaviours.
I believe there is a need for a review of what exactly constitutes ‘voluntary admission’ for the purposes of establishing eligibility for section 117.
In virtual absence of free aftercare provision for mental health long term needs other than section 117, we need to ensure that long term MH patients are entitled to free aftercare even if their behaviour doesn’t challenge.
CHC focuses on physical health, so doesn’t provide a great alternative and there seems to be no provision who suffer long term MH, perhaps attend clozapine clinics, perhaps have regular psychiatric reviews, and are unable to get a job. They too deserve a quality of life and their needs met. Instead they tend to get regular benefits, like the jobseekers. But job seekers can get a job and improve their situation. Our residents do not have that opportunity due to their mental health limitations.
I will be very curious to see what everyone thinks and what your suggestions are.
I think this could have been an interesting question before the new AGNI judgment. Previously if someone was consenting to an admission but lacked capacity to understand what a voluntary admission was, that would contravene Article 5 and they should be detained under the MHA rather than being admitted voluntarily. If they were there “voluntarily” in those circumstances, that could be challenged.
Post-AGNI, someone can be in hospital voluntarily so long as they are “validly consenting” to it, which doesn’t require the high bar of capacity to understand what a voluntary admission entails.
It would be lovely if everyone could receive free health and social care, but it’s prohibitively expensive and Parliament has drawn a line at S.117. For good or bad, it only applies to people who have been detained under an eligible section of the MHA, meaning they have a mental health condition so severe that they’ve required compulsory treatment for a non-negligible period of time.
For all the reasons given above, I tend to avoid using the term ‘voluntary’ admission, and prefer the more legalistic ‘informal’ admission. This may seem somewhat pedantic, but it clarifies that legal compulsion under the MHA wasn’t used, although the ‘voluntary’ nature of many informal psychiatric admissions can be somewhat flexible! This has become even more relevant following the AGNI judgement regarding the threshold for Article 5 engagement.
Like it or not, section 117 aftercare is restricted to those people who have been detained for longer term treatment, and there is absolutely no chance of this being extended in the foreseeable future.
A patient/service user is eligible for s117 aftercare if they have ever been detained under a relevant section of the MH Act. Any later admissions to hospital, even if voluntary, don’t override this and there’s no requirement to be under or in contact with secondary care services at all. Aftercare (should) only end when the patient is discharged from s117 itself.
Without CHC funding obviously the legal duty is on the Local Authority under the Care Act (2014) to meet peoples’ needs based upon the eligibility criteria. This does attract financial assessment but remember there is a Minimum Income Guarantee and people can also offset some Disability Related Expenditure.
If needs change a DST can review and determine funding splits at any time.
Sometimes there are advantages to split funding and sometimes there can be problems with it in practical terms. Certainly if someone lacks capacity around finances or needs a social worker other than for an annual review it can be advantageous to fall under the Care Act rather than fully funded health.
With the recent changes to DoLS some people may fall under the MHA when they would otherwise have come under a standard authorisation. If this happens and they are detained beyond S2 (28 days) and go on to meet the threshold for S3 they will immediately be eligible for S117 Aftercare. It’s difficult to see how things will pan out at the moment with the changes to DoLS.
Thank you all for your input. I appreciate the new DoLs provision giving more room for assessment depending on circumstances and individual situation. I do worry though that what was already a flexible definition of consent and voluntary basis, will now become a gateway to not awarding S117 to any of the more compliant (but also requiring life long MH support) patients, and in turn this will mean they will have to pay for their care. In my setting this might mean people will not be able to lead a rich, meaningful life, as they will be left with the customary £30/week spending money from their benefits. This might be appropriate for a temporary support for a job seeker, but it certainly is not enough for a person who cannot and will not have a job to improve their income due to health issues. They won’t be able to go on trips and outings, afford clothes, use hairdresser/chiropodist and other services. This in a long run is bound to affect their mental health and cause even deeper problems. I am not sure what the answer to this might be, but we certainly need a solution.