Summary: Ms X complains about a decision not to detain her son under the Mental Health Act and that professionals completing the assessment did not take information she provided into account. We will not investigate the complaint. There are no indications of fault relating to the assessment. We are also unlikely to achieve more by investigating the information Ms X says she disclosed.

The complaint

1. Ms X complains about the care and treatment her son, Mr Y, received from Midlands Partnership University NHS Foundation Trust (the Trust), NHS Staffordshire and Stoke-On-Trent ICB (the ICB) and Staffordshire County Council (the Council) in March 2023. She says they failed to:
• consider Mr Y’s mental capacity and suicidal thoughts during a mental health assessment in March 2023; and
• record and consider information about Mr Y having a knife, which would have changed the outcome of the assessment.
2. Ms X says if the mental health assessment team had given Mr Y support or treatment for depression, he may have engaged in treatment for his physical health, which would have prevented his death.

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The Ombudsmen’s role and powers

3. The Local Government and Social Care Ombudsman and Health Service Ombudsman have the power to jointly consider complaints about health and social care. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA).
4. We provide a free service, but must use public money carefully. We may decide not to start or continue with an investigation if we believe:

• it is unlikely we would find fault, or
• it is unlikely we could add to any previous investigation by the bodies, or

(Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

5. I have considered information provided by Ms X, the Council, the Trust and the ICB. This includes relevant health and social care records. Ms X had an opportunity to comment of a draft of my decision.
6. Ms X has made a separate complaint about other health care issues. In this case I have only considered the MHA assessment.

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What I found

Relevant regulations and guidance

Mental Capacity Act

7. The Mental Capacity Act 2005 (the MCA) applies to people who may lack the ability to make certain decisions. Section 42 of the MCA provides for a Code of Practice (the Code) which sets out steps organisations should take when considering whether someone lacks mental capacity.
8. Both the MCA and the Code start by presuming individuals have capacity unless there is proof to the contrary. The Code says all practicable steps should be taken to support individuals to make their own decisions before concluding someone lacks capacity. The Code says people who make unwise decisions should not automatically be treated as not being able to make decisions. Someone can have capacity and still make unwise decisions.
9. The Code says, at paragraph 2.11, there may be cause for concern if somebody repeatedly makes unwise decisions exposing them to significant risk of harm or exploitation. The Code says this may not necessarily mean the person lacks capacity but further investigation may be required.

Mental Health Act

10. Under the Mental Health Act 1983 (MHA), when someone has a mental disorder and is putting their safety or someone else’s at risk they can be detained in hospital against their wishes. Usually, three professionals need to agree the person needs admitting to hospital. These include an Approved Mental Health Professional (AMHP) and usually two doctors approved to carry out Mental Health Act assessments. 
11. The Code says professionals cannot use the MHA if the need for physical health treatment is the only reason a person needs admitting to hospital.

Brief background

12. Mr Y suffered with a long-term physical health problem that needed regular treatment. Mr Y often declined treatment.
13. In March 2023 Mr Y has failed to attend his hospital appointment for treatment relating to his physical health. Ms X spoke with Mr Y’s GP and they asked for a MHA assessment.
14. The assessing doctors and AMHP spoke with Mr Y and decided he had capacity to make decisions about his health care. They did not consider he needed hospital admission for assessment or treatment for his mental health.
15. After the MHA assessment, Mr Y’s physical health deteriorated further and he sadly died in April 2023.

My assessment

16. Under the MCA, someone’s ability to understand the decisions they are making is assumed unless there is reason to believe they do not have mental capacity. The MHA assessment papers show the doctors and AMHP specifically considered Mr Y’s capacity. They agreed he could make decisions about his life and physical health needs, and that he understood the consequences of the decisions he made.
17. The assessing professionals recorded Mr Y had long-term physical health problems that needed treatment and he had low mood, but he stated he had no plan to end his life suddenly. The assessing doctors advised Mr Y that he could get help for his low mood in the community, but he would have to agree to this. They recorded that Mr Y accepted this.
18. The records show the assessing team considered and discussed capacity and suicidal thoughts with Mr Y. We are therefore unlikely therefore to find fault about this.
19. The assessing team also noted the MHA could not be used to force treatment for physical health if someone has capacity. They discussed accepting care for his physical health needs and Mr Y agreed to attend an appointment the following day for treatment. The Trust confirmed Mr Y attended this appointment. The assessing team appear to have made their decision in line with the Code. I therefore consider we are unlikely to find fault with how they reached the decision not to admit Mr Y to hospital under the MHA.
20. Ms X says she provided information to the assessing team about Mr Y having a knife. She says this shows Mr Y was at risk of harming himself and the assessing team did not take her concerns seriously.
21. There is no mention of this in the records and when questioned during the complaints process, none of the professionals present at the assessment recalled the events as described by Ms X.
22. The Trust response explained that had there been any suggestion Mr Y had a knife, the assessment could not have been completed without considering involving the police to ensure everyone’s safety. The records of the assessment show Mr Y was calm throughout and showed no signs of distress.
23. Given the different recollections and lack of evidence to show a conversation about a knife took place, investigation is unlikely to achieve more. As noted above, the assessment records show the professionals considered Mr Y’s presentation in line with the Code and reached a decision based on the information they obtained from Mr Y.

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Final decision

24. I do not consider we should investigate this complaint. There is not enough evidence of fault in the assessment process and we are unlikely to achieve more by investigating the alleged incident with the knife.

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Investigator's decision on behalf of the Ombudsman