Aftercare under Section 117 of the Mental Health Act 1983
SCOPE OF THIS CHAPTER
This policy applies when a child or care leaver is discharged from hospital after having been detained under the Mental Health Act 1983.
1. S117 Explanation
Section 117 (s117) places a joint statutory duty on both Health (Clinical Commissioning Group (CCG)) and Local Authority (LA) services to provide aftercare support and assistance for persons who have been detained under certain sections of the Mental Health Act (MHA) following discharge from hospital.
Access to s117 joint aftercare services is for individuals who have been admitted to hospital for the purpose of treatment for a diagnosed mental disorder or mental disorders. 'Aftercare services' means services which meet a need arising from/related to the individual's mental disorder which reduce the risk of a deterioration in their mental condition and thus reduce the risk of them requiring admission to hospital again.
Services of support are put in place to reduce the incidence of future admissions, and ensure the individual has access to relevant support to empower those eligible to manage their mental health in the community and promote long-term stability. The ultimate aim is to maintain patients in the community, with as few restrictions as necessary, wherever possible.
The joint after-care planning and support of all individuals must be planned and delivered within a multi-agency context to support and meet the needs of those eligible. Services of support is free and should not bear a fee.
2. The Duty to Provide Aftercare Services
Section 117 of the Mental Health Act 1983 requires Clinical Commissioning Groups ('CCGs') and Local Authorities to provide aftercare services to patients who were detained for treatment under sections 3, 37, 45A, 47 or 48 of the Mental Health Act 1983 (MHA), and then subsequently discharged.
The sections of the Act to which this duty relates to are all concerned with compulsory detention in a hospital:
- Section 3 deals with patients who are detained in hospital for treatment;
- Section 37 gives the magistrates' court or crown court a power to direct that a person will be detained in hospital either following conviction for an offence or on being satisfied that the person carried out the action that would have constituted the offence. Individuals transferred from the Courts under s37 MHA (admission for treatment) then maybe given restrictions such as, place of residence, supervision by psychiatrist and social supervisor under s41 MHA;
- Section 45A gives the higher courts a power to direct that a person convicted of an offence (including those who are detained under civil law or immigration legislation) shall be detained in hospital instead of being detained in prison. The courts can also direct removal to hospital prior to deciding to impose a sentence of imprisonment for the offence;
- Section 47 authorises the Secretary of State to direct that a person serving a prison sentence shall be detained in hospital; this also includes individuals who are detained under the civil law or immigration legislation;
- Section 48 authorises the Secretary of State to direct that a person who has been remanded to custody or detained under civil law or immigration legislation shall be detained in hospital who do not fall under s47 MHA.
This includes situations where eligible patients have remained in hospital informally after ceasing to be detained under the Mental Health Act.
CCGs and local authorities should interpret the definition broadly. It can include healthcare, social care and employment services, supported accommodation and services to meet the young person's wider social, cultural, and spiritual needs, if these services meet a need that arises directly from, or is related to, the young person's mental disorder and helps to reduce the risk of a deterioration in their mental condition. After-care should aim to support them in regaining or enhancing their skills, or learning new skills, to cope with life outside hospital.
After-care services must be jointly provided or commissioned by local authorities and CCGs, who should maintain a record of people for whom they provide or commission after-care and what after-care services are provided.
All services of support provided under s117 MHA must be clearly recorded in all the individual's care plans; where appropriate this must be included within the individual's care and support plan, or if they are a child/young person Care Treatment Review (CTR), or Care Education and treatment Review (CETR) plan. It is the responsibility of Health and the Local Authority to review any plans of support regularly and jointly alongside multi-agency partners.
The duty to provide aftercare services continues as long as the patient is in need of such services.
3. Ordinary Residence
Section 117(3) provides that the responsible bodies will be those:
'if, immediately before being detained, the person concerned was ordinarily resident in England, for the area in England in which [they were] ordinarily resident'.
The statutory guidance explains that the bodies responsible for s. 117 after-care provision retain responsibility even if they place a person out of area. If a person is living in specialist accommodation which they require as a result of their s117 needs, and is re-detained under the Act, a fresh s. 117 duty arises, and that new duty falls on the authorities where the person was ordinarily resident before their second detention. A person placed out of area, pursuant to s. 117, can thus acquire ordinary residence in the place of their s. 117 accommodation.
4. After-care Planning and Assessment
4.1 After-care Planning
Although the duty to provide aftercare services begins when the young person leaves hospital, planning should start as soon as possible after they are admitted. CCGs and local authorities should take reasonable steps to identify appropriate after-care services for young people in good time for their eventual discharge from hospital.After-care can also be planned within the framework of the Care Programme Approach.
4.2 After-care Planning Assessment
After-care planning requires a thorough assessment of the young person's needs and wishes. It is likely to involve consideration of:
- Continuing mental healthcare;
- The psychological needs of the young person and of their family;
- Daytime activities or employment;
- Appropriate accommodation - if the aftercare plan includes the provision of accommodation, and the young person has committed one or more criminal offences, the circumstances of any victims of the offence(s) and of their families should be taken into account when deciding where the young person should live;
- Identified risks and safety issues;
- Any specific needs arising from, for example, co-existing physical disability, sensory impairment, learning disability or autistic spectrum disorder;
- Any specific needs arising from drug, alcohol or substance misuse;
- Any parenting or caring needs;
- Social, cultural or spiritual needs;
- Counselling and personal support;
- Assistance in welfare rights and managing finances;
- The involvement of authorities and agencies in a different area, if the young person is not going to live locally;
- The involvement of other agencies, for example the probation provider or voluntary organisations;
- Any conditions likely to be imposed by the Secretary of State for Justice or the Tribunal;
- Contingency plans (should the young person's mental health deteriorate); and
- Crisis contact details.
Professionals with specialist expertise should also be involved in After-care planning for young people with autistic spectrum disorders or learning disabilities.
After-care planning should take account of the young person's age and should involve their parent/carer (as appropriate) to ensure that they will be ready and able to provide the assistance which the young person may need.
To ensure that the After-care Plan reflects the full range of needs of the young person, it is important to consider who needs to be involved. Subject to the views of the young person, this may include:
- The young person's responsible clinician;
- Nurses and other professionals involved in caring for the young person in hospital;
- A practitioner psychologist, community mental health nurse and other members of the community mental health team;
- GP and primary care team;
- Any carers who will be involved in looking after the young person outside hospital including, where relevant, those with parental responsibility;
- The patients' nearest relative or other carers;
- A representative of any relevant voluntary organisations;
- MAPPA co-ordinator if applicable;
- Probation service if applicable;
- A representative of housing authorities if accommodation is an issue;
- The CCG's appointed clinical representative if appropriate;
- An Independent Mental Health Advocate, if the young person has one;
- An Independent Mental Capacity Advocate, if the young person has one;
- Attorney/Deputy if applicable;
- A person to whom the local authority is considering making Direct Payments for the young person;
- Any other representative nominated by the patient; and
- Anyone with authority under the Mental Capacity Act 2005 to act on the young person's behalf.
The practitioners concerned, in discussion with the young person, should agree an outline of the young person's needs and a timescale for implementing the various aspects of the Aftercare Plan. All key people with specific responsibilities should be identified.
There are several assessment and planning systems in place for children and young people across health, and social care services such as the Framework for Assessment for Adults, Children in Need - Child and Family Assessment (C&F), Care Programme Approach (CPA), SEN Code of Practice, and the Youth Offending Team (YOT) ASSET assessment; all of which should take into consideration where appropriate s117 community aftercare assessment, planning and support recommendations.
It is important that those who are involved in discussions about Aftercare Plans can make commitments about their own continuing involvement and the services to be provided or commissioned. If the worker will need to seek approval for this, extra time must be set aside for planning so that this causes no delay to the implementation of the after-care plan.
4.3 The After-care Plan
The After-care Plan (under the Care Programme Approach) aims to ensure a transparent, accountable and co-ordinated approach to meeting wide ranging physical, psychological, emotional and social needs associated with the young person's mental disorder. It should set out the practicalities of how the young person will receive treatment, care and support day-to-day and should not place undue reliance on the young person's carers.
Included within the After-care Plan are:
- A Treatment Plan which details medical, nursing, psychological and other therapeutic support for the purpose of meeting the young person's individual needs promoting recovery and/or preventing deterioration;
- Details regarding any prescribed medications;
- Details of any actions to address physical health problems or reduce the likelihood of health inequalities;
- Details of how the young person will be supported to achieve their personal goals;
- Support provided in relation to social needs such as housing, occupation, finances etc.
- Support provided by carers;
- Actions to be taken in the event of a deterioration of the young person's presentation; and
- Guidance on actions to be taken in the event of a crisis.
After-care Plans should include details of any areas of need which are critical to preventing behavioural disturbance and should provide guidance on how staff/carers should respond if behavioural disturbance does arise.
The After-care Plan should identify a named individual as Care Co-ordinator who has responsibility for co-ordinating the preparation, implementation, and evaluation of the After-care Plan.
The After-care Plan should be recorded in writing and a copy given to the young person. It is essential that any changes are discussed with the young person as well as others involve, before they are implemented. The After-care Plan should be regularly reviewed. It will be the responsibility of the Care Co-ordinator to arrange reviews of the Plan until it is agreed between all parties, including the young person, that it is no longer necessary.
The After-care Plan will need to be reviewed if the individual moves to another area. If the individual has moved to a new area, the current Care Coordinator and LA (Kent County Council – KCC) cannot transfer S117 after-care support, and their involvement must continue until the s117 duty ends.
5. After-care Payments
A local authority may make Direct Payments to a representative of the child/young person to pay for after-care services, having regard to whether it is appropriate for the person's condition, the impact of that condition on their life and whether a Direct Payment represents value for money.
6. Ending After-care
The duty to provide After-care services exists until both the Local Authority and the CCG (health) are satisfied that the young person no longer meets the s117 legislative criteria for continued services of support.
The decision to formally end s117 after-care services must be a joint decision between health and the LA and may include (where appropriate) all relevant professionals involved in the community care plan.
A meeting to review and end s117 must include the young person/adult, those with Parental Responsibility, and or advocate. The young person/adult's carer (if applicable) should be fully involved in the process of ending their after-care.
After-care services may be reinstated if it becomes obvious that they have been withdrawn prematurely, e.g. where a young person's mental condition begins to deteriorate immediately after services are withdrawn.
- Mental Health Act, 1983; Mental Health Act 1983 (legislation.gov.uk) Accessed: 25/05/21;
- Sectioning Overview, 2021; Young Minds Overview | Mind, the mental health charity - help for mental health problems Accessed 25/05/21;
- Rethink s117 Aftercare Fact Sheet, 2021, Section 117 Aftercare (rethink.org) Accessed 25/05/21;
- Community Care Mental Health Aftercare FAQ 2021, Your questions answered on mental health aftercare | Community Care Accessed: 25/05/21;
- Community Care Aftercare services under section 117 of the Mental Health Act 1983, 2021 Free aftercare services under section 117 of the Mental Health Act 1983 | Community Care Accessed: 25/05/21;
- Kent and Medway NHS and Social Care Partnership Trust Multi-Agency Policy and Practice Guidance, After Care s117 Mental Health Act 1983, 2020, Accessed: 25/05/21;
- tri.x Online Briefing 231, The Independent Review of the Mental Health Act Interim Report, 2021;
- The Youth Custody Service Placement Team Overview of operational procedures;
- Young Minds Transitions Guide for Professionals, 2021, transitions-guide-for-professionals-email-version.pdf (youngminds.org.uk) Accessed: 25/05/21;
- Care Programme Approach Helpful NHS Guide, 2021, Care for people with mental health problems (Care Programme Approach) - NHS (www.nhs.uk) Accessed: 25/05/21;
- HM Prison & Probation The Youth Custody Service Placement Team Overview of operational procedures 2017, Accessed: 25/05/21;
- Sectioning Guide and Overview, 2021, Overview | Mind, the mental health charity - help for mental health problems, Accessed: 25/05/21;
- Section 47 National Health Service and Community Care Act, 1990, National Health Service and Community Care Act 1990 (legislation.gov.uk) Accessed: 25/05/21;
- The Children Act 1989 and 2004 Accessed: 25/05/21;
- S117 Mental Health Act, 1983 Accessed: 15/06/2021;
- Mental Health Act, 1983 Code of Practice Accessed: 15/06/2021;
- Mental Health Act, 1983 Reference Guide Accessed: 15/06/2021.