Summary: We will not investigate Mr X’s complaint about the decision to detain him under the Mental Health Act, or about how he was interviewed during the assessment. This is because it was reasonable for Mr X to appeal to the mental health tribunal about the decision, and because it is unlikely we would add to the response he has already received about the assessment.

The complaint

1. Mr X complains that Norfolk and Suffolk NHS Foundation Trust (the Trust), Suffolk County Council (the Council), and NHS Norfolk and Waveney Integrated Care Board (the ICB) wrongly decided to detain him, and continue the detention under the Mental Health Act (MHA). Mr X complains that in doing so, the organisations did not comply with the MHA and there was no justification for detaining him. Mr X also complains the Approved Mental Health Professional (AMHP), acting on behalf of the Council, did not interview him properly as part of the assessment.
2. Mr X said this caused him outrage and distress, and that his time in hospital was stressful. Mr X also said the record of Section 2 in his medical records could cause incorrect assumptions to be made in future.
3. In bringing his complaint to the Ombudsmen, Mr X wants the organisations to improve their practice in completing Mental Health Act assessments, as well as improving understanding of and compliance with the Mental Health Act. Mr X also wants the reference to Section 2 in his records to be deleted or qualified.

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The Ombudsmen’s role and powers

4. 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).
5. The Local Government and Social Care Ombudsman investigates complaints about adult social care providers (Local Government Act 1974, sections 34B, and 34C, as amended). The Health Service Ombudsman investigates complaints about ‘maladministration’ and ‘service failure’ in the delivery of health services (Health Service Commissioners Act 1993, section 3(1)).
6. 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 could add to any previous investigation by the bodies, or
• it would be reasonable for the person to ask for a review or appeal.

(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

7. I considered information provided by Mr X, the Council and the Trust.
8. I considered the Ombudsman’s Assessment Code.
9. I also considered the relevant legislation and guidance.
10. Mr X had an opportunity to comment on my draft decision. I considered his comments before making a final decision.

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My assessment

Mental Health Act assessment

11. 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’. Usually, three professionals need to agree that the person needs to be detained in hospital. These are either an Approved Mental Health Professional (AMHP) or the nearest relative, plus a doctor who has been specially approved in Mental Health Act detentions and another doctor (Section 12 doctors).
12. The AMHP is responsible for deciding whether to go ahead with the application to detain the person and for telling the person and their nearest relative about this. The AMHP acts on behalf of the council.
13. People who have been detained under the MHA can apply for a hearing to the First Tier Tribunal (Mental Health) if they disagree with the decision. The Tribunal must discharge the person from detention if, on the day of the hearing, the person does not meet the criteria for detention.
14. Mr X was assessed under the MHA, and admitted to hospital under Section 2. The purpose of detention under Section 2 of the MHA is for assessment of a patient’s mental health and to provide any treatment they might need. Patients can be detained under Section 2 for a maximum of 28 days.
15. Mr X explained that after several days in hospital, he was reviewed by a doctor who decided to continue his detention. Mr X said he initially stayed in isolation and was unable to take outdoor exercise. He explained he then spent a further 10 days in hospital. An appeal to the mental health tribunal was scheduled to take place. However, prior to this, Mr X was reviewed by a doctor and discharged.
16. The Council responded to Mr X’s complaint that the AMHP, acting on behalf of the Council, did not interview him properly. In its response, the Council said the AMHP had not referred to detention as a possible outcome of the assessment, because the MHA Code of Practice states “the threat of detention must not be used to coerce a patient to consent to admission”. The Council also explained why a second AMHP assessment was needed, and apologised if the reasons for this were not explained to Mr X at the time. I recognise a lack of explanation for the second AMHP assessment would have been frustrating for Mr X. However, the Council has explained the reasons for this and apologised. Therefore, my view is it is unlikely we could add to this explanation for Mr X by investigating this part of his complaint.
17. I recognise Mr X’s view that these events were distressing for him. Mr X lodged an appeal against the decision to detain him at the mental health tribunal, but as noted above, he was discharged before the tribunal took place. Mr X said the doctors involved in the assessment did not comply with the requirements of the MHA in making their decisions. He also said the registered clinician did not comply with the MHA in their decision to continue the detention. This part of Mr X’s complaint concerns the recommendation and decision to detain Mr X under the MHA. Mr X appealed to the tribunal, and I consider this was the most appropriate way for him to challenge this decision. Therefore, I do not consider we should investigate this part of Mr X’s complaint.

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Final decision

18. We will not investigate Mr X’s complaint. It was reasonable for Mr X to appeal to the tribunal about the decision to detain him under the MHA, and we would be unlikely to add to the response he has already received from the Council.

Investigator’s decision on behalf of the Ombudsmen

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Investigator's decision on behalf of the Ombudsman