Summary: We found no fault by the Council and Trust with regards to the care they provided to Miss T when she became unwell.

The complaint

1. The complainant, who I will call Miss T, is complaining about the care provided to her by London Borough of Lambeth (the Council) and South London and Maudsley NHS Foundation Trust (the Trust).
2. Miss T complains that mental health services and the Approved Mental Health Practitioner service failed to provide her with appropriate care and detained her under Section 2 of the Mental Health Act 1983 without good reason.
3. Miss T says this caused her significant distress and trauma and resulted in a deterioration in her mental health.

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The Ombudsmen’s role and powers

4. The Ombudsmen investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsmen 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).
5. If it has, they may suggest a remedy. Our recommendations might include asking the organisation to apologise or to pay a financial remedy, for example, for inconvenience or worry caused.  We might also recommend the organisation takes action to stop the same mistakes happening again.
6. If the Ombudsmen are satisfied with the actions or proposed actions of the bodies that are the subject of the complaint, they can complete their investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

7. In reaching this draft view, I have considered information provided by Miss T. I have also considered information and documentation provided by the Council and Trust, including relevant care records. Furthermore, I have taken account of relevant legislation and guidance.
8. I invited comments from all parties on my draft decision statement and considered the responses I received.

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What I found

Mental Health Act 1983

9. Under the Mental Health Act 1983 (the 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. Ordinarily, three professionals need to agree that the person needs to be detained in hospital. These are either an Approved Mental Health Professional or the nearest relative, plus a doctor who has been specially approved in MHA detentions and another doctor. Admission should be in the best interests of the person, and they should not be detained if there is a less restrictive alternative.
11. 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.
12. The MHA is accompanied by the Mental Health Act Code of Practice (the Code of Practice). This provides guidance for health and social care staff on how to implement the MHA in practice.
13. The Ombudsmen cannot consider a complaint about the decision to section someone. This is because the doctors involved in the sectioning process are working under specific powers granted to them as individuals by the MHA. In this capacity, they are not acting as NHS clinicians. As a result, their actions do not fall under the jurisdiction of PHSO.
14. A person who has been detained under the Mental Health Act 1983 has a right to appeal that decision to a Mental Health Review Tribunal.

Approved Mental Health Practitioner

15. The Approved Mental Health Practitioner (AMHP) is responsible for deciding whether to go ahead with the application to detain a person and for telling the person and their nearest relative about this. The AMHP is acting on behalf of the local authority.
16. The AMHP process for Lambeth is set out in the Council’s Centralised Approved Mental Health Professional Service: Operational Policy (2015).
17. If it is thought likely that a person will not allow access to their property, an AMHP can apply for a warrant under Section 135 of the MHA. This section empowers police to enter a person’s home and remove them to a place of safety for assessment.
18. The AMHP is required to complete a full report as soon as possible after the completion of a Mental Health Act Assessment. This should document the assessment, the reasons for the decision and any discussions with the person’s nearest relative.

Background

19. Miss T lives at home with her mother.
20. Miss T’s mother referred her to the Trust’s Crisis Outreach Service (COS) in February 2020 as she was concerned about her mental health. Miss T’s mother reported that Miss T had not left the house for over two years. She told the COS that Miss T was becoming increasingly aggressive and was screaming, shouting and kicking her bedroom door.
21. The COS visited Miss T at home on 25 February. However, she would not open her door or engage with the service. She spoke through the door to say “I’m fine.”
22. The COS made a further visit on 2 March. Miss T’s mother reported that Miss T had become more agitated after the previous visit. She said Miss T had grabbed a kitchen knife and threatened to take her own life. Miss T would not speak to the COS officers. The officers noted a strong smell or urine coming from Miss T’s room. Miss T’s mother told them she thought Miss T may be incontinent.
23. The COS referred Miss T to the AMHP service later that day so a Mental Health Act Assessment could be arranged.
24. The AMHP service initially arranged for the assessment to take place on 23 March. However, on that day the COS advised that Miss T had a bad cough. Miss T’s mother called the NHS 111 service and was advised that Miss T should self-isolate as she was showing symptoms associated with COVID-19. The AMHP postponed the assessment.
25. The rescheduled assessment took place on 14 April. The police executed a Section 135 warrant. The police officers were accompanied by the AMHP and two clinicians. Miss T initially left the house to avoid the assessment. But was persuaded to return.
26. The assessment found Miss T was presenting with a mental disorder and was putting her safety and that of others at risk. The assessment concluded that Miss T required assessment and treatment and the decision was made to detain her under Section 2 of the MHA.
27. Miss T subsequently appealed her detention to the Mental Health Review Tribunal. The detention was upheld on 24 April.

My analysis

28. The professionals within the COS had a responsibility to act when Miss T’s mother reported concerns about her wellbeing. This is because the information she provided suggested Miss T might be at risk of harm.
29. The COS visited Miss T at home to assess her. However, Miss T would not engage with the COS officers or come out of her room. This made it difficult for the COS to determine whether she was experiencing an episode of mental illness.
30. The COS returned on 2 March. Miss T’s mother reported that she had threatened to harm herself with a knife following the previous visit. This gave the COS further cause for concern as it suggested Miss T might be at risk of harm. In addition, Miss T’s increasingly aggressive behaviour towards her mother gave the COS reason to believe that she may also pose a risk to others. Furthermore, the COS had concerns about Miss T’s physical wellbeing and her ability to look after herself.
31. In the circumstances, I consider it was appropriate for the COS to refer Miss T to the AMHP service for a Mental Health Act Assessment when she would not engage with the service. I found no fault by the Trust on this point.
32. The AMHP’s record of the assessment shows she found Miss T was suffering from a mental disorder that placed her safety and that of others at risk and that she lacked insight into her care needs. This view was shared by the COS consultant who attended the assessment. The record of the assessment shows that the AMHP appropriately considered whether it would be possible to find a less restrictive treatment option. However, Miss T’s refusal to engage with the COS meant other treatments could not be explored. This led the assessing professionals to conclude that Miss T would require a period of assessment in hospital.
33. I am satisfied the AMHP completed the Mental Health Act Assessment in accordance with the requirements of the Code of Practice and the Council’s operational policy. I found no fault by the Council on this point.

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Final decision

34. I found no fault by the Council or Trust with regards to the care they provided to Miss T. I have now completed my investigation on this basis.

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Investigator's decision on behalf of the Ombudsman