Summary: We will not investigate Miss X’s complaint. This is because, in relation to some parts of the complaint, an investigation would be unlikely to achieve the outcomes Miss X is seeking. The other parts of the complaint are not ready for our consideration as work is ongoing locally to review Miss X’s care and support needs.

The complaint

1. The complainant, Miss X, is complaining about the care and support provided to her by Dudley Metropolitan Borough Council (the Council) and Black Country Healthcare NHS Foundation Trust (the Trust).
2. Miss X complains that the Council and Trust failed to provide her with the trauma therapy she requires to treat the symptoms of her diagnosed Post Traumatic Stress Disorder (PTSD). Miss X also complains that she has not received the autism support she needs
3. Miss X says this has left her as a vulnerable adult without support in the community and this has been very distressing for her.
4. Miss X would like to receive appropriate trauma therapy and have an allocated care coordinator. She would like her care records to accurately reflect the care and support she receives.

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The Ombudsmen’s role and powers

5. We investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, we consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A(1), as amended).
6. We provide a free service but must use public money carefully. We may decide not to start an investigation if we cannot achieve the outcome someone wants.

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How I considered this complaint

7. I considered evidence provided by Miss X and discussed the complaint with her. I also considered relevant law, policy and guidance.
8. I invited Miss X to comment on my draft decision statement and considered her response before making my final decision.

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What I found

Relevant legislation and guidance

Mental Health Act 1983

9. 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. This is sometimes known as ‘being sectioned’.
10. A person can be detained under section 3 of the MHA for treatment.
11. Section 117 of the MHA imposes a duty on health and social services to meet the health and social care needs arising from, or related to, the person’s mental disorder for patients who have been detained under specific sections of the MHA. This includes patients who have been detained under section 3.
12. Section 117 aftercare services are provided free of charge. They are intended to prevent a deterioration in a person’s mental health that could lead to a further admission to hospital.

Background

13. Miss X has complex mental health needs, including a diagnosis of PTSD. In addition, Miss X has a diagnosis of Autism Spectrum Disorder (ASD).
14. Miss X is entitled to free aftercare services under section 117 of the Mental Health Act 1983 as a result of having been detained under section 3 of the same Act. These services are intended to prevent a person’s mental health from deteriorating and to reduce the risk of them needing to be readmitted to hospital.
15. Miss X’s section 117 aftercare includes her specialist accommodation. As part of this provision, Miss X receives 1:1 support during the day and night.
16. Miss X is under the care of the Trust’s mental health services. Miss X also has an allocated social worker and community psychiatric nurse (CPN) and receives some support in the community from voluntary organisations.
17. In August 2024, Miss X submitted a complaint to the Trust. She complained that she was not receiving the trauma therapy she needed. Miss X said her care needs were too complex and that she was being passed between services.
18. The Trust responded to Miss X’s complaint in September. The Trust said Miss X had been reviewed regularly by clinicians and that a further review would take place in October. The Trust noted Miss X’s request for trauma therapy. It explained that the clinicians supporting Miss X would discuss this at a professionals meeting. The Trust added that engagement and attendance would be important and noted that Miss X had previously failed to attend several psychological assessment appointments.
19. Miss X complained to the Ombudsmen in November.
20. In the meantime, Miss X‘s care was discussed at multidisciplinary team meetings in October 2024 and January 2025. The psychology team concluded that Miss X would not be suitable for trauma therapy at the present time and would first need to complete emotional stabilisation work. The multidisciplinary team allocated two CPNs as complex emotional needs workers to support Miss X.
21. The care records show the Trust is in the process of considering the best way to support Miss X with this. The Trust identified Dialectical Behavioural Therapy (DBT – a therapy designed to help people manage very intense emotions) as one possibility. At the time of writing this decision statement, the clinical team were still considering whether this would be the most beneficial approach for Miss X.
22. In February 2025, the Council responded to a complaint from Miss X about various aspects of her care, including her medication and accommodation. The Council said it would discuss Miss X’s concerns with her allocated social worker and arrange a reassessment of her care and support needs, with input from her accommodation provider.

My analysis

23. There are two main parts to Miss X’s complaint. The first of these relates to her desire for trauma therapy.
24. The National Institute for Health and Care Excellence (NICE) provides guidance for clinicians on the management of people with PTSD and complex needs. The NICE guidance emphasises the need to help a person to manage any issues that may be a barrier to them engaging with trauma therapy. These include emotional dysregulation. Emotional dysregulation is a mental health condition that can make it very difficult for a person to control their emotions and reactions.
25. The evidence I have seen shows clinicians consider Miss X must first undergo work to help her regulate her emotions before she will be able to engage with trauma therapy. This is ultimately a matter of clinical judgement for the professionals involved in her care. The Trust is currently considering the best approach to take to support Miss X.
26. It is important to be clear that we cannot substitute our judgement for that of the clinicians. Nor can we direct that Miss X should receive a certain treatment. For this reason, I consider we would be unable to achieve the outcomes Miss X is seeking through an investigation. For that reason, we will not investigate this part of Miss X’s complaint.
27. The other part of Miss X’s complaint relates to her wider care and treatment and the suitability of her accommodation. The evidence I have seen shows the Council is currently in the process of reviewing Miss X’s social care needs and the support she currently has in place. This includes the suitability of her accommodation. The Council has explained that Miss X can contact her social worker of she has any questions about this process.
28. We will not investigate this part of Miss X’s complaint as the Council’s work to review Miss X’s care and support needs is ongoing. However, if Miss X is dissatisfied with the outcome of that review, she can complain to the Council in the first instance. It will then be open to her to return to the Ombudsmen to ask us to look at this part of her complaint.

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Decision

29. We will not investigate Miss X’s complaint about the Trust. This is because we would be unable to achieve the outcome Miss X is seeking through an investigation.
30. We will not investigate Miss X’s complaint about the care provided to her by the Council. This is because the Council’s work to review her care and support needs remains ongoing and this part of the complaint is not yet ready for us.

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Investigator's decision on behalf of the Ombudsman