Saturday 29 June 2013

Sec.117 Aftercare: A Brief Guide for Patients and Relatives


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.

104 comments:

  1. Hello

    Great resource, thank you!

    My child is entitled to Sect 117 aftercare. However, though there are many meetings they are not delivering on what they say she needs. Don't know what we can do or who to go to for help. Any help you can give would be great. Thanks!

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  2. Does S117 aftercare cover prescriptions and if so how can this be applied for/ claimed?

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    1. I believe that 117 aftercare entities you to free prescription medication relating to your mental health condition. The care co-ordinator is the person to contact to arrange this.

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  3. Help a person has s117 what is the relationship to CPA? My friend has been sectioned under s3 MHA I am confused because a social worker said there is a difference between the after care given!?!

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    1. The Care Programme approach is designed to ensure that anyone with mental health problems receives the help they need. S.117 is a legal entitlement to aftercare for anyone detained under Sec.3. There should not really be any difference between the care and support offered to an individual regardless of whether or not they have been detained under Sec.3. The only difference would be that services, eg. day care or residential care designed to meet someone's mental health needs, would not be chargeable for someone subject to S.117.

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  4. Are 24 hour supported accommodation service charges covered by S117? The rent is covered by Housing Benefit. The placement was recommend by the Mental Health Accommodation Panel and there is no time limit on the placement. Surely the answer would be yes? Unfortunately there are many conflicting opinions on this matter. Your expertise on this subject would be much appreciated. Thanks.

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  5. Forgot to mention the service charge (re: 24hr supported accommodation) is for the individual's contribution to the maintenance and upkeep of the shared areas, such as, hall community room, garden etc.

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    1. I would say that if the patient is in this accommodation because it meets his needs for mental health aftercare then any charges not covered by housing benefit should come under sec.117.

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  6. AAAgh help - they want to discharge our 14 yr old daughter from her section 3 with a weeks notice and although the home treatment psych team will be in place her section 117 aftercare won't be in place in time and will come later. Can they discharge her without this in place ( a referral has been made for it) and if we want them to keep her in till it's in place do they have to? we will need support for her and us as I will be her only carer 24\7 as dad is at work and she's still not well.

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    1. While the hospital should listen to your concerns as the main carer, it will be ultimately up to the hospital to decide when to discharge. It does sound as if they are offering intensive follow up from the home treatment team. It depends really on what level of aftercare the S.117 plan includes.

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  7. My son held has been in hospital for the last 7 months initially under MHA section 2 and then section 3 with a non recoverable illness (Early dementia).
    He is due shortly to move to a life time care home. The NHS have suddenly moved him from MHA Section 3 to MCA DoLS.
    Is there likely to be anything devious or underhand in their decision? I, as 'closest relative' was not consulted.

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    1. Probably not. If he is no longer receiving active treatment for mental disorder and is considered ready for discharge, the hospital can decide to discharge from Sec.3 and then use DoLS to keep him in hospital (and subsequently in a care home). It will make no difference to his entitlement to Sec.117 aftercare, and he would still be entitled not to pay for his care home costs.

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  8. My grandfather had been detained under section 3 due to mental health problems. Whilst in hospital under the section 3 he has been diagnosed with Lewy body dementia and is much worse that when he was admitted. He's due to be released from hospital soon but into a care home as he's unable to return home due to the illness taking hold. Will his care home costs be covered by the 117? And will this be a permanent fund - in view of the fact that the dementia will only get worse - never better?

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    1. As he's been detained under Sec.3 MHA he will be entitled to Sec.117 aftercare to meet his mental health needs, which in this case would be for the dementia care home. He will continue to be entitled to aftercare as long as he continues to have mental health needs. If his needs become greater over time, then these changed needs would be covered.

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    2. Hello,

      I've just been reading this and wanted to clarify something. If a person was detained years ago and has not since been detained, but they are still subject to 117 aftercare and their needs have changed from what they were during initial admission under S3, are the additional needs eligible for 117 funding?

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    3. If their mental health needs have changed, then any additional costs should still be met through sec.117. If they have acquired physical disabilities, these would not be covered.

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    4. Can I query this as I understood that the after-care needs relate to those which related to the detention under s3. If the needs change, for example the needs relate to a different mental disorder (most commonly change to a dementia-type illness), these are not covered under s117. I would value your view please

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    5. I think it's difficult to separate out two forms of mental disorder, and just because a patient with schizophrenia then develops dementia doesn't mean they no longer have schizophrenia. How do you decide which delusions might relate to dementia and which to schizophrenia?

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  9. My other half's sister has been detained under 2 sections 2 in the past 6 months and then the past couple of months under section 3. Just been told she is now released yet mother in law has not been notified of any section 117 care plan. Is this normal (Mil is nearest relative)

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    1. The NR should not only have been notified of the discharge but should also have been involved in any discharge care planning. Disgraceful.

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    2. Thank you for reply. Is there a protocol for complaints? Been a very stressful 6 months and sister in law is extremely capable at times but just so unpredictable at others. Assaulted my wife (when visiting her in mental health hospital) and very threatening so have concerns that she will stop taking her medicine and return to previous behaviour. Drugs and alcohol often part and parcel😞

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    3. You can make a formal complaint to the MH Trust, or go to the Trust's Patient Advice Liaison Service (PALS). They would be able to advocate on your behalf and advise what could be done.

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  10. 117 Aftercare . Can you advise individual who has been detained under section 3 and requires ongoing medication for the mental health would be able to free description under 117 Aftercare . Have found some information by rethink which does indicate individuals would be entitled to free medication under this section. Is and why I am posting this blog as I had attended GP surgery asking for free prescription for individual and which point they declined to give me some information to them by the Department of health of those who would be eligible in receipt of certain benefits and I'm going to

    Can you kindly advise .
    ��

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    1. Normally, medication directly administered by a mental health professional, eg in hospital or a depot injection, would not be paid for. But a prescription from a GP does not normally come under Sec.117 aftercare (although arguably it should). However, many people subject to Sec.117 are entitled to exemption from prescription charges because of income, or if they are in receipt of means tested benefits.

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  11. The duty is jointly upon the CCG and the LA. In practice, does the CCG carry out any assessments or have any other involvement in arranging the after care, or does this fall to the LA jointly with any NHS Trust that provides the care?

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    1. The CCG duty is delegated to the local NHS mental health trust, from whom they purchase services. However, having said that, the new CCG's do not necessarily understand their legal duties to provide Sec.117 aftercare -- or hospital beds for detained and informal mental health patients.

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  12. I have a friend who is under s.41 conditional discharge. He's in supp. accommodation funded by housing benefit. He's about to start a full time uni course but will lose housing benefit when he does. His accommodation has said that they won't have him without housing benefit. Can he argue that LSSA should pay the rent instead?

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    1. Your friend may be able to claim HB if he is in supported accommodation. He may also be entitled if he gets a disability or severe disability premium, which he might get if he has a severe and enduring mental illness -- which I imagine he has if he is subject to conditional discharge under Sec.37/41 MHA. If the LA is paying towards his supported accommodation as part of a Sec.117 aftercare package, he should continue to get this. But accommodation in itself would not be regarded as being subject to Sec.117. He should ask his care coordinator for help, and/or go to the local Citizen's Advice Bureau.

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    2. Also have a look at this website: http://england.shelter.org.uk/get_advice/housing_benefit_and_local_housing_allowance/what_is_housing_benefit/housing_benefit_for_students

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  13. A relative is in a care home funded via S117 but up to the local authority rate and the particular care home's fees are higher than that of the local authority. Should the local authority meet the full cost of the care home fees under S117, or doe an individual have to pay the top up fee themselves? Thank you.

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    1. Anonymous Yes that is what I would like to know too. Same thing Mum under s117. Gven a CHC checklist, she passed but I was told she was not eligible for a DST they made the decision that she didn't qualify for Healthcare, she has Complex Dementia, Diabetes, Kidney Disease Stage 3, Asmhma etc. Under a LA Home which is not meeting her needs at all I want to change her but it costs more than the one she is currently in. Like you I need to know whether or not she has to pay. Thanks

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  14. My relative was detained under Sec.3 in 2004.She received home care prior her detension and it continued after but Section 117 has never been mentioned.
    I became aware of S.117 last year.
    Her CPA care plan and review document shows Section 117:No.
    I assume a mistake was made.Due to S.3 detention I beleive she qualifies and am now trying to have the MHA change the status but they seem reluctant to do so saying "she has a CPA so she is receiving aftercare" or "It's not necessary to have a letter where it is stated" or veiled threats that if this is pursued she will no longer receive care.
    Would you kindly let me know what you think?
    Many thanks

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    1. Apologies,MHT(Mental Health Trust)not MHA

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    2. Since she was receiving services following her detention under Sec.3 she should not be charged for these services. If she is being charged, then the local authority, who arrange for home care, should be reminded that they can't charge, and she should ask for a full refund of any charges, going back to when she was detained. If the LA refuse you can appeal to the local government ombudsman, who has adjudicated on such cases in favour of the service user.

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    3. Many thanks for your reply.

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  15. Please help me. Please. My mother is a paranoid schizophrenic. She was finally diagnosed after many many years battling with doctors, hospitals and local mental health team. I cannot even begin to tell you the hardship my family have suffered trying to get help for my mother (my brother is also schizophrenic) My mother has medication administered by injection and has been sectioned numerous times. We have only recently had access to my mothers medical report. It clearly states she is under section 117 (something we where never informed of). The support she and the family receive is non existent. My mother has received a letter from the DWP stating she is under investigation for benefit fraud (regarding housing benefit) they have set a date to interview my mother under caution. She is being threatened with prosecution. They have stated she had more monies than allowed in savings to claim housing benefit. The local authority do not pay the entire rent for my mothers accommodation and will not provide any other type of accommodation e.g sheltered housing. My mother is in no fit state to be interviewed. She does not have a regular nurse and has been refused a social worker(she has never had a social worker even after/during discharge from hospital). The local mental health team have reduced her medication which has resulted in my mothers mental health deteriorating. They are however adamant she must attend the interview with DWP. No support has been offered. Is housing benefit for people under section 117 means tested? Should the local authority also pay the full amount of rent? Full rent has never been paid for my mother, alternative accommodation has also never been offered. I was in direct threat from my mother as a child. The mental health team advised my father that my mother was never to be left alone with me. We where informed social services had been informed of our situation to safe guard me at the time (I was around 9 years old at the time) social services never contacted or helped our family. My mother was released under section 117 after being detained under the mental health act back into the home. They where aware we where in direct harm from my mother and yet no safe guarding was ever put in place. No alternative accommodation was provided for my mother. I'm certain it's only by the absolute strength of my father that I'm alive today. The mental health system has consistently failed my family. I strongly believe there is a genuine case of medical negligence. Any help/advice you can provide will enormously appreciated. Please please help. I apologise for the long statement

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    1. Housing costs in local authority, housing association or private accommodation are not covered by Sec.117. However, your mother is entitled to an assessment of her care needs under the Care Act. Either you or she can request the local authority to conduct an assessment.
      I would also advise that your mother should go to the Citizens' Advice Bureau for help with her benefits problems.

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  16. Dear Zorro ( Masked hero),

    I am a social worker and have been trying to convince our health colleagues to invite family to section 117 meetings but been clearly told this was not appropriate but if I insist it would be the job of a sw to invite them. What are your thoughts and is there any official guidance I could use to be persuasive with my friends from the NHS?

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    1. The Code of Practice, para34.12 states: "34.12 In order to ensure that the after-care plan reflects the needs of each patient, it is important to consider who needs to be involved, in addition to patients themselves."
      There then follows a long list, which includes:
      "• any carer who will be involved in looking after them outside hospital (including, in the case of children and young people, those with parental responsibility)
      • the patient’s nearest relative (if there is one) or other carers"

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    2. With the patients consent surely?

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  17. Hello this a very interesting forum. My wife has bipolar and was sectioned unset S3 a few years back and subsequently had a voluntary admission. I am her long suffering husband and we get no support under s117, non CPA or no free prescription even though she hasn't worked for years. She is no being accused of theft through spending on a friend's credit card (even though she had permission). Friend now deceased so not bble to vouch for her. My question is can we use s117 (or the lack of it) to assist in her defence of the accussation?

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    1. If the offence can be said to have arisen as a result of mental illness, and it can she shown that she has not had, or been assessed for after care under Sec.117, and has not received support from mental health services despite duties to regularly review after care needs, then this could be used as mitigating circumstance. Her solicitor needs to press for psychiatric reports.

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  18. I am a carer for my mum and my mum got sectioned under S3 about 8 years ago and has now had to start having carers coming into her home 4 times a day. This all got put in place in June 2016 by the council and she has to pay a contribution towards the weekly care costs. Should my mum be having to pay a contribution or not with her being sectioned 8 years ago? She also got diagnosed with Alzheimer's in September 2016 and will probably have to go into a care home eventually but might have to sell her house to pay the costs. Should my mum be covered under section 117 even though it was 8 years ago and should she have to pay a contribution to her home care and care in the future in a care home? Any advice would be much appreciated as I've only just read about this section 117 and am very confused as to what my mum's rights should be.

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    1. As she has been detained in the past under Sec.3 she would be entitled to Sec.117 after care. Only if there had been a formal meeting involving NHS and the local authority concluding that after care was no longer required would this have ended. So the council need to look into this and, as long as her needs relate to mental disorder, rather than, say, physical frailty, then she should not have to pay, and should get a refund. If the LA are reluctant to do this, you can complain to the Ombudsman.

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    2. Thanks for your reply. Would she have to sell her house to go into a care home? I also live in the same house so if she had to sell it then that would then make me homeless !

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    3. If she is entitled to Sec.117 after care then care home costs relating to her mental disorder would not be chargeable.

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  19. I have a relative who was admitted to a private hospital under s2 later under a s3 she has now been discharged for approx 6 weeks but a s117 plan was not written. I spoke to the hospital who said it wasn't their job? Who's job should it have been to arrange it? The social worker funded the service. Also is it too late to agree a plan now?

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    1. Hospitals have a duty to have a Sec.117A meeting, which is a meeting designed to devise an aftercare plan prior to discharge. Even private hospitals should do this. Now your relative is in the community, there should still be regular S.117B review meetings. Speak to the social worker or care coordinator and ask them what arrangements they are making for these reviews.

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  20. I have a close family member who at the age of 40 has a rare genetic form of Alzheimer's. She voluntarily went into a mental health assessment hospital and today was sectioned (S3) and we heard for the first time about s117. Up until now the SW was organising a 'best interests meeting' to decide what the next step would be. I think we're all in agreement that full time residential care is the only option. As she has specific needs because of her age and the rapid decline that occurs in the rare form of Alzheimer's we have already put forward a case for SS paying more than their usual upper limit for residential home fees. With s117 aftercare funding can we still put forward a case for paying more than the standard upper limit that the council will normally pay?

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    1. I should add that the higher care home fees relate to a care home that has a specialism in young onset dementia and therefore more experience of the different needs of younger people with Alzheimer's and also an environment where my family member wouldn't be the only young person there.

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  21. I was placed on a s117 on leaving hospital 3yrs ago. I still have a cpn, psychiatrist and a support worker how often does my care plan have to be reviewed and should I be present. It has only been reviewed once since coming out of hospital 3years ago

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    1. There are two parts to this.
      Sec.117 aftercare should be formally reviewed at least every 6 months. You should be involved with that meeting, and should be asked to sign a form agreeing to your aftercare plan.
      Regardless of Sec.117, you should also be subject to the Care Programme Approach (CPA). You should have a care plan and regular reviews, which should take place at least every six months. Again, you should be involved in this review, and should be in agreement with your care plan.
      If you haven't had any reviews since leaving hospital, you need to have a word with your care coordinator. It is the care coordinator's job to ensure that you have regular reviews of your care needs, which should involve you.
      Tell them the Masked AMHP said so!

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  22. Can the Section 117 help an individual's housing application to live closer to their family or carer or both?

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    1. Sec.117 aftercare is designed to assist a patient to recover and/or manage their mental disorder. Moving nearer to people who can support them can certainly be a factor in designing an aftercare package.

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  23. My mother was sectioned under Section 3 in 2011 and has been receiving care in her own home for the last year. I am my mother's carer and I also live with my mother but I required extra help at home as I was struggling to cope with all my mother's needs so now carers come in 4 times a day to my mother's home as well as the support and care that I still provide as a carer. The problem is is that I've only just found out about section 117 aftercare and she has been paying a contribution towards her care at home for the last year and I am not sure if my mother was removed from section 117 aftercare when she was discharged from hospital after being sectioned under Section 3 in 2011 as I was looking after her at that point when she came back home and she had no other support apart from myself. My mother also got diagnosed with Alzheimer's in Sept 2016. I think my mother may have to go into a care home eventually but I am confused now as to what happens if she was removed from section 117 aftercare back in 2011. I hope she wasn't removed from section 117 aftercare back then but I'm not sure if she was or not and now I don't know what is going to happen if she was removed from it in regards to costs and if my mum now has to pay for everything herself if she was removed from section 117 aftercare back in 2011 when she was sectioned under Section 3.
    Any advice would be greatly appreciated.

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    1. If your mother has required aftercare since 2011, there cannot be any charges for that care. If she has deteriorated over time, that should not make any difference to her aftercare entitlement. If she has been paying for care since 2011, she should be entitled to a refund. If the local authority refuse to do this, you can appeal to the local government ombudsman. There have been a number of ombudsman judgments that have been very critical of local authority attempts to avoid their duties under Sec.117.

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  24. Hi! Child being discharged to residential school (with psychological therapies onsite) from section 3 . can 117 aftercare (social care) pay for this along with education and health or does child need to be accomodated under section 20 of children's act? Thanks for any advice you have.

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    1. It seems most likely that your child is being funded by the local education authority. There would not be any need for them to be accommodated under Sec.20.

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    2. Thanks. I would be very very happy if education will fund alone. They MAY but SW still needs to assess as part of the process I've been told. In our area we keep being told 52 week residential school needs to be funded by health plus education plus social care. We are refusing section 20 as residential is purely a back up to prevent her going back into hospital if she goes downhill again. I think if education refuse to fund alone we might push 117 aftercare too. She has autism and along term mental health condition. Any thoughts would be welcome.

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    3. Sec.117 is for needs arising out of the patient's mental disorder. I guess if it is thought that residential school is likely to meet these needs, then it should be covered by Sec.117 aftercare. I gnereally get involved in adults on Sec.117, so not so sure how it pans out with education. There are some things established in case law that are not covered by Sec.117 aftercare, including rent for a flat, food, and other things which are universal needs, and not just relating to the patient's mental disorder. I'm not sure how educational needs might be interpreted.

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    4. Hello please excuse me inputting Masked AMPH.

      I work for LA in Special Educational Needs and an a trained Social Worker (who is just applying to become an AMPH)
      The SEN (LA Educational Dept) will pay for the educational element of the residential school and Social Care should pay for the Social aspect of the care. You should not be signing a S20 as you are not voluntary putting your child into care. However LA's are reluctant to pay the high costs associated with this care but will if all other avenues have been tried. I would state as S117 would seem to aply this would help you with justification as to why this service could be needed. (Not having seen any paperwork or assessments difficult to say for sure).

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  25. Hi There

    I'm writing on behalf of my 18 year old daughter who was detained under the section 3 mental health act in 2014. She has now been discharged from hospital and lives with me at home. She currently gets free medication as a student, but it's possible that from September she will not longer be at college. I am led to believe that under 117 aftercare, according to your factsheet, she will be entitled to free prescriptions for her mental health medications, of which there are several, even when not a student. I have queried this with her care co-ordinator, who disputes this and says she has never heard of this arrangement before.
    Do you know whether it's true, and if so, how the care co-ordinator goes about arranging this ?

    TIA

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  26. You can tell your daughter's care co that anything that is part of a patient's care plan under section.117, including prescribed medication for mental disorder, is not chargeable. Generally does not matter if patient is on a low income, but if on a taxable income then has to be free.

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  27. If a patient is awaiting outcome of a housing assessment is then discharged from a ward due to using illegal drugs in hospital how does this affect 117? Does a patient HAVE to remain in hospital whilst housing is found?

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    1. If they were detained under Sec.3 then Sec.117 would not be affected. It is up to the ward to take a hard line on drugs on the ward, although I'd say that it was inappropriate to discharge someone who by definition has a severe mental disorder without them having anywhere to live. As a vulnerable person they should be entitled to emergency accommodation provided by the local housing authority.

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  28. Hi how soon before a tribunal should a 117 meeting take place?my partner has recently been recalled back to secure hospital as his mental health deteriorated and is now back on his original 37/41 section.can he be discharged straight home from a forensic hospital?im worried everyday.thankyou

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    1. He could only be discharged with the consent of the Home Secretary, and would have to have a social supervisor, as well as conditions of his release. They should not discharge to a relative/carer who was reticent about them returning. There's no particular rule about S.117 meetings prior to a tribunal. It's much more difficult for a S.37/41 patient to be discharged, than for someone on S.3.

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    2. I want him to come back home here with us,and I know it's difficult but he only relapsed he did nothing else wrong the mojo just recalled him because of his mental health

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    3. Make sure your relative's care team know your wishes. But they also have to assess risk to others.

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  29. Hi,
    We are having problems with the dwp as they have stopped my cousins dla/pip benefit. my cousin was sectioned under s3 a few years ago. Reading your info the s117 should this be allowed or does the s117 entitle him to the benefit please ??

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    1. While being diagnosed with a severe and enduring mental disorder, and having been detained under the MHA, may provide supporting evidence of a person's need for disability benefits, being subject to S.117 aftercare in itself would not entitle someone to benefits. However, if the aftercare they were receiving indicated a high level of personal care, eg being in a care home, having several hours per week of a personal assistant, ought to be taken into account by anyone assessing for these benefits.

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  30. Hi,

    Can I just ask the following question in relation to Sect 117.
    My mother is currently a Section 3 Patient, having been sectioned following admission to hospital having been found out on her own at 5am.
    Her Dementia diagnosis has been confirmed while she has been in hospital, but the scan and test etc had been done prior to this point.
    She was sectioned due to Paranoid behaviour partly to protect my father from assualts etc.
    I've searched as best I can but can you confirm that you would expect Sect 117 to apply no to her and any care required would be paid for ?
    While I've seen things which say that some people consider that Dementia is not a Mental Illness, I think it can be described as a "Mental disorder".

    Would you view it reasonable to expect that Sect 117 would apply here and pretty much anything related to Dementia care to be covered as a result ?

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    Replies
    1. Definitely. All mental disorder is covered by the MHA and dementia is a mental disorder, so if your mother has been detained under s.3,she will be entitled to s.117 aftercare and cannot be charged for this.

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    2. Sorry to come back with more questions.
      My mum is now in a dementia specialist nursing home.
      We've just got a letter from the council that talks about Personal Budget - Chargeable. This figure is £750 a week. It then talks about financial assessment.
      Can you confirm if you think this is something that we'd need to worry about being billed for eventually or is this just the fee that it's costing the council ? (It's half the home fee)
      My understanding was that if you ended in a care home due to dementia following a section then litterally everything was covered as part of the after care.
      My mum was happily living at home prior to this so it's as a result of the mental disorder.

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    3. Yes, anyone detained under S.3 will be entitled to S.117 aftercare and any care relating to mental disorder is not chargeable. There would be no need for a financial assessment. You might need to remind the council that she is subject to S.117.

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    4. Thanks very much.
      It might just be that this was a generic form which does not apply to this case.

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  31. Hi there, and thank you for your time. I am a care co-ordinator and rnmh, I have recently been trying to convince my trust that the supposed 117 meetings that take place on inpatient wards minutes before discharge are invalid due to the lack of local authority representatives (none and sometimes not even a consultant psychiatrist is present) but have been told that I am this representative although do not work for local authorities as my contract is as a nurse with a health trust. I have quoted the code of practice but am still told that these meetings are sufficient. Surely as we have la employed social workers within the CMHT that I work in, this would be their role. Please help as I am currently viewed as someone who is trouble making, when all I want is what is right for my patients.

    Thanks

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    Replies
    1. If you have SWs who are integrated into the MH Trust through some sort of secondment or TUPE agreement with the LA, then it is often the case that nurse or OT care coordinators can take on the LA role. However, there should always be the responsible clinician involved in the meeting, as the S117 agreement has to be signed by the RC as well as the SW/Care Co. It also sounds as if your Trust is not adhering to CPA regulations, as, regardless of S.117 requirements, under the Care Programme Approach proper arrangements should be in place for the after care of a patient prior to discharge. I am afraid this is often not happening across the country, with the result that patients are discharged too early, and with no adequate plans for their care in the community, resulting in needless relapse and readmission.

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  32. patient is on s3,and has been in hospital for 52 weeks which will mean housing benefits and ESA will now stop. The patient is waiting for the availability of a bed in a rehab unit, which will mean that her rent will not be paid and she will get into huge arrears by the time that she is discharged home to the community. could it be argued that the LA can pay the rent as part of s117 aftercare to avoid the rent and debt problem? many thanks in advance

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    Replies
    1. No, only costs relating to mental disorder are covered by S.117. Basic needs, such as housing, food, heat, etc are universal needs therefore not considered to be unique to mental disorder.

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  33. My grandma has been in a nursing home for 12 months funded by s117 aftercare. A s117 review meeting is being held and I am told she may lose the funding. The reason for this being that her health has deteriorated so much that she could not be physically violent anymore. She can't walk anymore so is not an escape risk. However she still does not want to be in the home and a dol is in place and she does try to get out but this results in her falling due to her forgetting she can no longer walk.Do you think on these grounds they could remove the s117 funding?

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  34. She still has needs that arise from her mental disorder. Even if the precise needs have changed, she is still entitled to S.117 aftercare, so there would be no grounds to discharge her from S.117.

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    Replies
    1. Thanks for your reply. Hopefully they will not discharge her from aftercare at the meeting and if they do I will appeal the decision.

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    2. I have the exact same scenario with my Aunt. They are saying her physical need now outweighs her mental needs as she is no longer able to move as well and threaten staff and leave on her own accord. She still clearly requires aftercare for her mental needs. Did you manage to appeal?

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  35. I am wondering if you can help.
    My mother has resided in a care home since the age of 40 following a diagnosis of Paranoid Schizophrenia, she spent many years in and out of metal health hospitals.

    I recent obtained all of her medical records as I was always under the impression she had been sectioned. Most seference informal or section 2.

    In approx 10 documents dating between 1989 and 2016, it clearly states that the review relate to S117 aftercare or that my mother is entitled to S127 aftercare, including CPA’s. I also have notes from the NHS trust database stating my mother needed to be placed in a new home home suitable for S117 needs.

    I have provided these to the LA as evidence of a possible S117 arrangement and the LA are stating these are errors and unless I find the original section 3 then they will not backdate or cease her care contributions.

    My mother’s first incident was in 1979 and all I have is 1400 pages of health records so it appears many records are missing including those which prove she is a S117 aftercare patient.

    I am perplexed how an LA and their legal team can state all these firms (completed by health care professionals) are wrong as they must have assumed my mother was an S117 patient.

    Any help or advice is gratefully received

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    Replies
    1. The LA ought to have a record of having assessed your mother under the MHA, as there would have been a formal referral requesting a MHA assessment and an AMHP or ASW (prior to 2008) would have been assigned the task and should have written a report. However, records as far back as 1979 may be sketchy.
      The Mental Health Act Administrator for the area MH Trust must keep a record of all patients detained under the MHA, and should keep a register of those entitled to s.117 aftercare.
      If the information is not in the medical records you have, the MHA administrator may have a separate register with that information. It does seem unlikely that there are records of her being under s.117 without her ever having been detained under s.3. If the LA have been paying for her care at any time, it is odd if they now decide she isn't entitled.

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  36. Hello AMHP,

    My partner, living in a different area, was sectioned to a 37/41in 1997, he spent time as a detained in-patient until 2002 in a unit away from the primary area when he was granted permission from the Home Secretary to live at a supported housing project, from 2002-2011 he had a social supervisor and regular out patient reviews and regular meetings with a psychiatrist. In 2011 my partners sections were rescinded by a MHRT and later that same year he was discharged from MH services in the secondary area. My partner has had no history of re-admission to MH services, no contact with the police in the entire period of 2002 to the present day. Recently my partner had a sudden sec 117 review without much explanation after 8 years without any contact from/with MH/CMHT during which a psychiatrist and social worker were present and felt more like an interrogation as I was present with him as was a support worker from my partners supported housing project for my partners 117 review. Now 4 months on from the December 2019 117 another one has been called without much explanation. My partner has had no contact with police or MH readmissions since before the 2019 117 or since, he always takes his medications religiously. One doesn’t wish to sound conspiratorial but why this sudden interest in my partner after so long without any contact by the CMHT and why the sudden frequency of sec 117.

    ReplyDelete
    Replies
    1. You might have though that your partner's psychiatrist and a social worker would have formally discharged him from s.117 aftercare back in 2011, since he no longer required any MH aftercare services.
      It may be that someone was looking through paperwork years later and could not find any discharge paperwork, so started them up again.
      Since he is no longer a conditionally discharged patient under s.37/41, there is no requirement for him to attend any s.117 meetings if he doesn't want to, and there is no power to force him. Alternatively he could ask at the next meeting for them to discharge him from s.117 aftercare. It does seem like a waste of time.

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  37. I have worked for the local authority as a Social worker in an an integrated team for 11 years, for 9 of those years as a Care Co-Ordinator. However more recently our LA terminated a Sec 75 agreement with health and transferred all social care staff in the CMHT integrated team into a structured Social care model managed by a local authority manager. I believe this was to ensure Care Act Compliance and move Social workers and Social Care Support Officers away from CPA and the medical model. Our team now provide support and assess individuas that are non-CPA under Care Act statute, even though we remain somewhat integrated as a CMHT. This actually means that we review individuals that are Sec 117 but are not under CPA or Care Co-Ordinated as they have been discharged by our health colleagues. I have for sometime wondered why more people subject to Sec 117 with no apparent MH needs or services are not discharged from Sec 117. I have also experienced and made attempts to complete Sec 117 reviews but been informed by the individual that they do not wish to engage in a review and don't currently have any services working with them other than a social care worker that contacts them every 10 months in an attempt to complete a Sec 117 review. Some individuals completely refuse to allow or engage in an assessment, they appear to be making this decision with capacity, therefore surely it would be appropriate to discharge the Sec 117 so we do not have to track them down every year to offer a review that they are clearly not interested in. Some that are Sec 117 move home, register with different GPS or even leave the county or country making it almost impossible for us to fulfill the obligation of completing a Sec 117 review. Why do we not have a national database of all those that are Sec 117 which would reduce the investigative work involved in trying to establish this eligibility. Our systems differ up and down the country, therefore someone moving from one local authority to another could lose Sec 117 entitlement and be charged for aftercare services which I am aware has happened on many occasions. I personally come across individuals on our LA system that have not had a Sec 117 review completed for years or have not accepted the offer of a Sec 117 review even though all practicable steps have been made to complete.

    ReplyDelete
  38. I was detained under a s3 last year due to anorexia. I did well on discharge but subsequently relapsed. I'm at breaking point mentally but physically my health is stable. I've had multiple crisis assessments but don't meet the threshold for an acute or EDU admission. My treatment team agree that a short respite admission could turn things around, but that isn't an option on the nhs. The Priory had a private residential eating disorder unit, which isn't a hospital. It could potentially meet my current assessed needs. Have you know for 117 to be used to fund anything like that and if so how you go about making an application to fund, is it via the community MH team/ ccg or social care? I'm autistic so it could also be argued that planned support would be more effective than urgent treatment months down the line which would be longer and ultimately cause more trauma.

    ReplyDelete
    Replies
    1. S.117 aftercare is to provide care following discharge from hospital. The Priory unit, if it not counted as a hospital, could be eligible. Your Mental Health Team/Trust/CCG are responsible for assessing your needs and providing the appropriate aftercare. Social Services would also be involved in that planning. Any needs arising from your autism diagnosis should also be covered by s.117 aftercare, even if that was not the reason you were detained under s.3.
      I don't see any reason why a short respite hospital admission should not be considered - if your team think it would help, they should look at a private hospital bed if none are available with the NHS. From a purely financial point of view it could, after all, end up costing the NHS less in the longer term

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    2. Thank you. I was also looking at the shared lives scheme but I think today's announcement will mean my application won't be considered. I'm due to have a care and treatment review (my first) soon, is that a place to raise funding a bed or does there need to be a CPA or something else? No-one seems to know anything about s117 involved in my care :(

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    3. The review would be a good place to raise it. Your NHS Trust must have a record of you being detained, and every MH Trust is supposed to have a Mental Health Act Administrator who keeps records of detentions and s.117 eligibility. The Local Authority, who appointed an AMHP to assess and detain you, must also have a separate record of the section used to detain you.

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  39. Hi
    My daughter is under s117. She's in assisted living and has a self contained flat. The local council are charging her council tax reduced to around 18 pounds per month. Is she responsible for paying this

    ReplyDelete
    Replies
    1. Housing costs are never covered by s.117. It sounds as if her contribution to council tax is based on her income.

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  40. Hello, my adult son who lives with me and I care for unofficially is currently on a section 3. My question is , when he comes home and if on a 117 care plan..will he or the local authority be able to pay me as his carer ? I am struggling to think of a way I can continue to work and leave him alone all day ? I'm happy to be his full time carer but worried how I will manage financially

    ReplyDelete
    Replies
    1. The LA would not pay, but you would be entitled to Carer's Allowance, which is around £67 per week. Here is a link to further information about it:
      https://www.homecare.co.uk/advice/carers-allowance-in-202021-amounts-and-how-to-claim#:~:text=How%20much%20is%20Carer's%20Allowance,each%20week%20in%20Carer's%20Allowance.&text=The%20amount%20paid%20is%20a,for%20and%20claim%20Carer's%20Allowance.

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    2. Thankyou very much 2🙂

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  41. Hello my adult son has been put on a section 3 ..my question is , will the 117 care plan pay me as his carer? He lives with me already .I an struggling to think how I can possibly return to work on his discharge, leaving him alone all day. Obviously finances are a major worry .

    ReplyDelete
  42. Any idea where I might find section 117 aftercare leaflets in languages other than English? Local MHA office unable to assist.

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    Replies
    1. Mental Health Law Online has a lot of information leaflets in many languages, but I'm not sure they've got s.117 leaflets.

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