Unable to discharge from S2 due to RC

Law and practice Mental Health Act
1

Hi,

I’m hoping some light could be shed onto this topic!

I know an rc who not discharging a patient due to him posing a danger to others when he was admitted but since then has completely resided in symptoms and shows no sign of psychosis , he is well and has been home to visit with no issues on the ward. The rc is basing his reason to not discharge on his condition when he was admitted rather than his condition now. His S2 is complete on Wednesday and there is no evidence to suggest why he may need to go to a s3 even though this has not been mentioned yet!

2

There’s not enough information for me to offer any suggestions, they would be purely speculation. If I was in this position I would want more information from the RC. I would want to understand the RC’s concerns. What are the risks? Will these risks increase on discharge? Once you have an idea of the risks, you can then ask what safeguards are in place to minimise the risk?

It appears the patient has had a psychotic episode. If substance misuse is an accompanying factor, then I would want to make sure that any risk management took this into consideration.

Sorry I cannot be more helpful.

1 Like
3

What is the long term past history? There have been lots of inquiry reports where people have been discharged who have appeared well on the ward - but a significant danger to themselves and others when off it. Are you aware of the full history?

4

There is no history, otherwise a well behaved individual who has no reports of mental health or crime related incidents, has kids and worlds 2 jobs. He had an episode where he broke a window which was why he was admitted but since then has apologised, is on the right meds and has not posed a threat to anyone on the ward or his family

5

Hopefully we can put faith in the system that an AMHP will not sign off on the S3 if it’s as cut and dry of a case as you state. Does the patient have an objecting Nearest Relative?

6

I will not be commenting on another clinician’s specific decisions, in a specific case that is active (as per General Medical Council standards). Others not so bound may comment freely. I am totally unaware of the identities of parties, and do not need to know.

My opinions are not intent on taking any sides or offering advice. Opinion in this instance is not advice (we can debate it later). I have no duty of care to an individual patient in this forum.

Reported facts:

  1. P said to be posing a danger to others when admitted.
  2. P has completely ‘resided in symptoms’, showing ‘no signs of psychosis’.
  3. Has been on some leave to home (unclear how that leave went - as no specific report).
  4. No issues on the ward.
  5. RC reportedly basing ‘his reasoning not to discharge’ on condition at time of admission, rather than now.
  6. S2 completed on Wednesday (presumably less than 7 working days - time of this post is at Tuesday 04/02/2025).
  7. No evidence to suggest need for detention under S3.

I always consider that reported facts may lack rich and contextual details.

Unreported (but relevant facts)

  1. The diagnosis or diagnoses - including any comorbidity - with relevant ICD-10, or ICD-11 codes. Psychosis is not a diagnosis (debates on that later as well).
  2. Known biopsychosocial factors that may affect prognosis/stability beyond discharge.

I am not seeking the above information.

Opinions:

  1. I note that the absence of evidence is rarely evidence of absence in mental health circles.

  2. The word ‘condition’ is often used to refer to some aspect of mental health. I avoid vagueness - and get into trouble for that. Reasons not to discharge are not based on ‘condition’. The law requires consideration of the statutory criteria applicable both at the time of detention and thereafter. The legal criteria are very clear. It is for RCs making decisions about discharge, to evaluate (inter alia):

    a) history,

    b) patterns,

    c) severity,

    d) duration of episode(s),

    e) risks of relapse and other relevant risks.

    f) durability of any improvements,

    g) probability of adherence to any treatment in the future, and

    h) biopsychosocial factors that may affect mental health stability.

  3. ‘Now’ means at the present snapshot in time. Some believe it means within the last few days. Some believe it is longer than that.

  4. No signs of psychosis - usually means no observable signs. That normally means what nurses report but it could mean reports from others.

  5. Appropriately diligent assessment of people with diagnoses similar to schizophrenia should involve use of rating instruments such as the PANSS e.g. PANSS electronic version