I quite often get emails from relatives of people with mental illness asking questions relating to Sec.117 of the Mental Health Act 1983. From the information they give, it often appears that the regulations and guidance relating to Sec.117 are not being adhered to, or patients and relatives are not being kept in the loop when arrangements for aftercare are being made. I thought therefore that it might be helpful to lay out the basics relating to Sec.117 for the benefit of the consumer, so to speak.
What is Sec.117?
Sec.117 lays down a duty for the local authority and the NHS to provide services for people who have been detained and then discharged from certain sections of the Act. The most common section is Sec.3, where a patient has been detained for treatment. There are some other sections of the Act relating to people who have committed criminal offences for whom Sec.117 also applies. These are Sections 37, 45A, 47 and 48. Detention under these sections is much less common.
A patient who has only ever been an informal patient, or who has only ever been detained under Sec.2 (for assessment) is not entitled to aftercare under Sec.117. However, this does not mean that someone with mental health needs, but who has never been detained for treatment, is not entitled to services.
What is Sec.117 Aftercare?
The Code of Practice to the Mental Health Act says:
“After-care is a vital component in patients’ overall treatment and care. As well as meeting their immediate needs for health and social care, after-care should aim to support them in regaining or enhancing their skills, or learning new skills, in order to cope with life outside hospital. (27.5)”
Before anyone detained under the relevant sections is discharged from hospital, there has to be a meeting involving any relevant professionals or others, including the patient, relatives, and carers. There’s an extensive list in the Code of Practice as to what should be considered (27.13). These include: the psychological needs of the patient, as well as their family and carers; their physical healthcare; daytime activities or employment; appropriate accommodation; identified risks and safety issues; social, cultural or spiritual needs; assistance in welfare rights and managing finances; contingency plans and crisis contact details. There are many other things to be considered as well.
Once the patient is discharged, there have to be regular reviews in the community.
Will I have to pay for aftercare?
The most significant aspect of Sec.117 is that any aftercare provided under this section cannot be charged for. The MHA Reference Guide observes: “Because the Act provides no power to charge anyone for after-care services provided under section 117, they must be provided free of charge.” (24.18) Therefore, the patient cannot be charged for the cost of day care services, or residential care, for example, as long as it is specifically to meet the mental health needs of the patient.
Are there any exceptions to this?
There are some things that are not covered by Sec.117 aftercare. These are things which are considered to be basic needs, and not needs arising from the person’s mental health problems. These things include food and clothing, and rent for a flat. It may also be considered that if someone had mental health problems and a physical disability, needs arising from the physical disability might not be covered, and might therefore be chargeable, subject to an individual’s personal resources, of course.
I am the nearest relative of someone who has been detained in hospital under Sec.3 MHA. What can I expect to happen?
There should be regular Sec.117 Aftercare planning meetings. These take place while the person is an inpatient and well before they are discharged, and also periodically, usually at 6 monthly intervals, once they have been discharged.
At the meeting there should be the patient, their nearest relative, a representative of the local authority (for instance, a social worker), the patient’s Psychiatrist, a nurse, and then anyone else who might be involved in providing their aftercare, for example, someone from a day centre or a care home.
This meeting should set out what the patient’s mental health needs are, and what services are required to support them with these needs once they are discharged. The aftercare plan could be very simple, for example, stating that the patient will see a mental health professional regularly, that they should have regular outpatient appointments and that they should take specified medication. However, an aftercare plan may also entail placement in a residential care home, attending a day centre, the involvement of other professionals or care providers, etc.
Is Sec.117 aftercare time limited?
Sec.117 aftercare has no time limit. As long as the patient continues to require aftercare, even at a basic level, such as periodic outpatient reviews with a psychiatrist, then Sec.117 aftercare rules will continue to apply. Sec.117 aftercare can only cease if both the mental health service and the local authority are in agreement that it is no longer necessary, and they have to make a formal decision about this.
If someone has been detained under Sec.3 once 10 years ago, but since then has had a number of informal admissions, or admissions under Sec.2 alone, the subsequent admissions do not invalidate or strike out Sec.117. There should still be Sec.117 aftercare planning meetings even for someone who is an informal patient, no matter how long ago it was that they were detained under Sec.3.