Cumbria Council at fault in its Mental Health Act assessment process

Decision Date 22/11/19

What Happened

Mr X had autism, and had had several admissions under Section 2 of the MHA to psychiatric units over the previous few years. An entry on his file in 2013 stated he had “Cyclothymia”, a condition similar to Bipolar Disorder. There were many subsequent statements that Mr X did not believe he had Cyclothymia, but had a speech condition relating to his autism especially Asperger’s Syndrome and speech patterns associated with Asperger’s.

During 2018 Mr X had lots of contact with the mental health team. He was admitted to hospital in September after he took an overdose (although he said it was not suicide, but ‘protest against the NHS’ with whom he had disputes with). On 5th October he called the mental health team and threatened to chop off his finger.

Assuming from the report that he did not actually chop his finger off, the next day the team requested Mr X should have an MHA assessment. The same day the Council’s Approved Mental Health Professional (AMHP) applied under section 135 of the MHA for a warrant to allow a police officer to enter Mr X’s property by force if required, in order to carry out the assessment.

The Court granted the warrant. On 6 October, the Police, AMHP and two psychiatrists visited Mr X’s property. He was admitted to hospital under Section 2 of the MHA for further assessment.

The AMHP’s assessment recorded Mr X had no communication needs. The AMHP left blank the section for recording any concerns as to whether communication impacted on wellbeing.

He was discharged in circumstances unexplained in the report, on the 11th October.

Mr X complained to the Council that the AMHP failed to take proper account of his communication needs and that the diagnosis of Bipolar, which he disputed having, was the major factor in determining the outcome of the assessment.

The Council appointed an investigator who partially upheld Mr X’s complaint that the AMHP’s assessment only took a ‘limited account’ of Mr X’s communication needs, but could not say that this was the reason which led to Mr X being admitted to hospital.

Mr X remained unhappy with the AMHP’s assessment, as he said it contained inaccuracies and incorrect diagnosis.

What was found

The law says the Ombudsman cannot look at matters that have been considered by the courts. Therefore, the LGO could not look at the AMHP’s application to court for a section 135 warrant, or the contents of that application.

The Council itself partially upheld Mr X’s complaints with regard to the communication section of the assessment; however it was unable to say the outcome would have been different if that section had been filled out properly. The LGO stated that the Council’s own findings were ‘robust and evidence based’.

The LGO then went on to say ‘the Council made recommendations to help prevent a reoccurrence of these faults. These actions are a suitable way to resolve Mr X’s complaints. It is unlikely any further investigation by the Ombudsman would add to the Council’s investigation or would lead to a different outcome.’ Those ‘recommendations’ aren’t to be found or explained in the report, however.

So, the Council was found at fault for its MHA assessment process, but the LGO did not find any unremedied injustice caused to Mr X, nor the changes the Council will make to prevent these failures in the future.

Comment

We think that the LGO did not go far enough here: if the assessment has been made on an inadequate footing, without being person centred, it would not be valid, and it would at least arguably have led to inappropriate detention, which sounds in damages.

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The full Local Government Ombudsman report of Cumbria County Council’s actions can be found here

https://www.lgo.org.uk/decisions/adult-care-services/assessment-and-care-plan/18-013-457