S117, Probation Licence, MAPPA, ICB Responsibility

Law and practice Other
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1

Person entitled to S117 pre custody following detention under section 3 following a serious incident of self-harm in the community and remains entitled to S117 as not discharged from S117 prior to, or during custody.

Currently in custody for an offence of assault which took place whilst they were on a Mental Health Ward.

Long history of violence, including carrying weapons. Long history of substance misuse. Significant forensic history including admission to a high secure unit.

Due for imminent release.

MAPPA L3 Case

Probation Approved Premises and Community Accommodation Service Tier 3 applications declined as the risk posed to staff is deemed too high.

Emergency single occupancy accommodation currently being sort but proving difficult due to risks posed to others.

Mental Health presenting as stable in custody, not prescribed any treatment for mental health. No indication that specialist accommodation is required due to their mental health. Care package under S117 not required. Aftercare needs can be met through access to existing services.

ICB and LA have been involved.

Needs and risks to be managed with probation licence/MAPPA Frameworks.

However, as joint commissioners there is still a responsibility to meet needs under S117.

An updated S117 aftercare plan is to be completed by the LA and shared with the ICB for any required input, and the LA have completed a Care Act Assessment, which has not identified any mental health care and support needs.

Chief Operating Officer and Director of Nursing and Quality have been informed of the case due to the significant risk of actual harm to others, and potentially self should their mental health relapse.

Is there anything more the ICB can do at this point?

2

Looks like the ICB and the LA need to get together and decide (very carefully and thoroughly) whether they can discharge s117. Remembering that Care Act eligibility is not the same as s117 eligibility.

3

Laura82:

Chief Operating Officer and Director of Nursing and Quality have been informed of the case due to the significant risk of actual harm to others, and potentially self should their mental health relapse.

I read all of your OP. I took the natural construction of words as they appeared on the page. I do not infer what you mean or may have ‘meant’. The situation was valuable for my CPD. Hence I created a structure for my learning.

Key risk-related issues:

  1. Long history of violence.

  2. Long history of carrying weapons.

  3. Long history of substance misuse.

  4. Significant forensic history.

  5. Previous admission to a high secure unit.

  6. Currently in custody for an alleged offence of assault.

  7. Assault took place whilst on a Mental Health Ward.

  8. Risk posed to staff is deemed too high (by Probation/Tier 3).

  9. MAPPA L3 Case.

  10. Potential for self-harm should there be a relapse.

Areas of doubt or unknowns:

  1. Current legal basis of custody (e.g., remand, sentencing, or specific type of detention).

  2. Exact nature and severity of the assault offence.

  3. Current legal status of the Section 3 (S3) detention (Has the Responsible Clinician formally discharged the patient?).

  4. Identity and expertise of the person/team who assessed the patient as “stable in custody.”

  5. Specific diagnosis and severity of the mental disorder that led to S3 detention.

  6. Specific clinical features (if any) driving the history of violence and weapon carrying (e.g., psychosis, mood disorder, or severe personality disorder).

  7. Specific nature of the “high secure unit” admission (e.g. a High Secure Hospital or another type of secure unit/detention).

  8. Full rationale from the LA’s Care Act Assessment for concluding no mental health care and support needs.

  9. Specific content of the updated Section 117 aftercare plan being completed by the LA.

Areas of consideration

A reasonably competent psychiatrist will focus of the following (not a full list and this is not advice). :

  1. Is the patient still technically detained under Section 3 (MHA 1983) or solely under the Criminal Justice System? (and/or)

  2. Understanding if a clinical decision has been made to discharge S3 (if relevant).

  3. Undertake a search for and HCR-20 or any other relevant risk assessment.

  4. Determining the source and validity of the “stable in custody” assessment. Who conducted it, what diagnostic procedures were carried out, and did those adequately assess the risk of violent recidivism upon release?

  5. Quantify and qualitatively assess the dynamic and static risk factors, focusing on the risk of harm to others.

  6. Clarify the link between the patient’s mental disorder and violent behaviour. Is the violence a symptom of the disorder, related to substance misuse, linked to a co-morbid personality/lifestyle issues, or any combination of the latter?

  7. Define the therapeutic component of the required Section 117 (S117) after-care. Need to specifying the level of security, staffing expertise, and structure needed to manage the forensic risk.

  8. Integrate the S117 after-care plan with the MAPPA L3 Framework and Probation Licence, to ensure clinical and legal issues are seamlessly coordinated to maximise public protection.

Overall the situation bears resemblance to situations that will have provided ‘lessons’ e.g. Clunis 1992 and nearly every similar case over the next 30-odd years. In essence throwing a bunch of ‘agencies’ (nothing to do with locums) and a dozen professionals in the mix, is likely to result in a high degree of confusion and loss of focus from the core issues.

I will be proud if this post is not to be allowed if it appears to be AI generated.