Leaving hospital

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Hospital managers

• Who are the hospital managers?
• When can they discharge me?
• Can they discharge me in the same way as my responsible clinician
• Can they discharge me even if the responsible clinician has blocked my nearest relative from discharging me?
• What will they consider when discharging me?
• How can I ask the managers to discharge me?
• What if I get my tribunal hearing before my managers’ meeting?
• What will happen at the managers’ meeting?
• When will the managers tell me their decision?
• Will there be any aftercare planning?
• Can the managers transfer me to another hospital?
• Can I appeal against a managers’ decision?
• When will the managers refer my case to the tribunal?

Who are the hospital managers?

Hospital managers are a panel appointed specially to look at whether people should be discharged. They are independent of the hospital, Clinical Commissioning Group, Local Health Board or any organisation that runs your hospital, because they cannot be officers or employees.

You should have been given information on how to contact them when you were sectioned or put on your CTO, or you could ask an IMHA to find this out for you. This information should be available to you on your ward or at your clinic.

When can they discharge me?

Hospital managers can hold a review of whether or not you should be discharged at any time. They must either consider discharging you themselves, or arrange for their power of discharge to be used by a 'managers' panel'.

They must hold a review if:

• your responsible clinician sends them a report renewing your detention section or CTO, even if you have not challenged the renewal. They must consider whether you should be discharged anyway.

They should consider holding a review if:

• you request one. If you are under a detention section, guardianship, or a CTO, you can ask the managers to discharge you.
• your responsible clinician has made a report to them. This is called a 'barring report', and it blocks your nearest relative’s right to discharge you. For more information on this see our pages on the nearest relative.
• your section or CTO is coming to an end, and your responsible clinician has not held a review.

The hospital managers can't discharge you if you:

• have been sent to hospital by a court under sections 35, 36, or 38
• are being held in hospital under a section 5
• are in a hospital or place of safety under sections 135 or 136

See our information on sectioning to find out more about what these different sections mean.

Guardianship

Hospital managers can also give permission for you to be transferred into guardianship, if your local authority agrees. This will usually mean you will move to a different care setting that is not a hospital. Your responsible clinician may be given the job of discharging you into guardianship.

Restricted patients or conditional discharge

If you are a restricted patient or on conditional discharge, the managers can discharge you only if the Secretary of State for Justice agrees. But you still have the right to ask for the managers to hold a review of your detention. For more information see our pages on mental health and the courts.

Can they discharge me in the same way as my responsible clinician?

Yes, they can discharge you in the same way as your responsible clinician.

They also have a duty to consider certain matters independently of the responsible clinician and ward staff, such as problems that may have arisen during your time under section.

But they don't have the power to:

• discharge you into the community onto a CTO or onto conditional discharge
• give you hospital leave, or permission to leave the ward and hospital for a short time, while you are still under section

Only your responsible clinician would be able to do these things.

Can they discharge me even if the responsible clinician has blocked my nearest relative from discharging me?

Yes, they would look at the responsible clinician's barring report and reach a conclusion for themselves whether you are likely to be a danger to yourself or others if you were discharged.

What will they consider when discharging me?

This is different depending on whether you are under a:

• section
• CTO

If you are on a section

They can discharge you if the reasons for your sectioning no longer apply, and should consider whether:

• you still have a mental health problem
• you still need assessment and treatment or treatment in hospital
• your health would be at risk, or your safety or someone else’s would be at risk if you were discharged from your section and/or left hospital
• you have other options, such as whether you can be treated for your mental health problem in the community, and appropriate treatment will still be available to you

They are likely to look at reports from your:

• responsible clinician
• care coordinator
• named nurse
• other healthcare professionals involved in your care

This is because the managers will need to look at your past history of care and treatment and details of any future plans. This will include your care plan under the Care Plan Approach or Care and Treatment Plan, if you have one.

They will focus especially on any recent risk assessment or risk management plan, and any information that you have self-harmed in the past or used violence against anyone else.

You should be able to see the reports, unless the managers think that this is likely to cause serious harm to your physical or mental health or to someone else’s. If that is their decision, they will need to give reasons.

Other people who may get a copy of the reports are your:

• legal or other representative – such as your attorney or deputy
• IMHA
• nearest relative (if you agree)
• carer (if you agree)

The managers have to consider these factors when coming to a decision about whether to discharge you, but have a discretion to discharge you anyway if they feel your individual circumstances would justify it. They should consider the least restrictive option for you getting treatment and how best to maximise your independence.

Being discharged from the section may mean you leave the hospital at that time, but this will depend on:

• whether the managers think you are well enough and ready to leave hospital
• whether suitable care and treatment will be available to you in the community

Although the final decision will be theirs, the managers will also look at:

• what your responsible clinician’s views are
• your care and treatment plan
• the views of people who know you well

If you are on a CTO

The managers can discharge you in the same way as from a section, but the factors they consider will be slightly different.

How can I ask the managers to discharge me?

There are no special forms or procedures, and you can ask them as many times as you like. However the managers may choose to hold a 'paper review' in your absence rather than a full hearing if:

• you have made frequent requests for discharge but your circumstances have not changed within that time
• you have recently had a tribunal hearing where the tribunal decided not to discharge you, and your circumstances have not changed since then
• your responsible clinician has decided to renew your section or CTO but you do not want to challenge or have not yet challenged this

Getting support

If you wanted support when asking the managers to discharge you, you could speak to someone like your:

• IMHA
• IMCA
• carer
• attorney
• deputy

If you do not have the mental capacity to ask the managers for yourself, you could also get support from:

• your attorney (if you have appointed one under a healthcare lasting power of attorney), or
• a court-appointed deputy, who could can ask the managers on your behalf

See our pages on the Mental Capacity Act for general information about mental capacity.

What if I get my tribunal hearing before my managers’ meeting?

• If you are under a section 2, and have applied to the tribunal, your tribunal hearing will happen first. Your managers’ hearing will only happen if you are not discharged, but kept under section and then put under a section 3.
• If you are under a section 3 or another long-term section, your tribunal hearing will happen first. If the tribunal does not discharge you from your section, and you are still asking to be discharged, your managers’ meeting will be arranged for a later date. If the managers at that hearing find that your circumstances have changed, they may then hold a full hearing, or ask the Ministry of Justice to refer you again to the tribunal.

What will happen at the managers’ meeting?

There is no set formal procedure, for example, asking questions in any particular order. But the process that the panel chooses must be fair and reasonable.

Before the meeting, the panel will look at all the relevant information, including any recent reports from your responsible clinician and other healthcare professionals involved in your care.

You should be provided with this information in good time before the meeting so that you, and your representative if you have one, have the opportunity to consider it and prepare for the meeting.

Where will the meeting be held?

There is no set place for the meeting, but the managers will decide its location based on your best interests. If you are on a CTO or on leave from hospital, the hospital may not be the best place for you. The managers should consider other places that are more suitable, that would be practical to use.

What is the process?

Here is what should happen at the meeting:

• You should get the chance to explain fully, with any help you need from an IMHA, why you should no longer be under your section or CTO.
• If you do not have the capacity to put your views across, your deputy or attorney would be allowed to speak for you, if you have one, and you need them to speak for you.
• Your responsible clinician and other professionals should be asked to give their views on whether keeping you under section or a CTO is justified and to give reasons.
• You and the other people giving their views should be able to hear each other’s statements to the panel, if you wish, and ask each other questions, unless the panel believes that would be likely to cause serious harm to the physical or mental health of you or any other person. The English and Welsh Codes of Practice say that unless there is an issue of safety, you should always be given the opportunity to speak to the panel alone, with or without anyone who has represented or accompanied you.
• You can discuss other matters with the managers if you want to – for example, if you think that your care plan doesn't meet your needs, or your treatment in hospital has not been satisfactory. If you have any other concerns about your stay on the ward, or other things that are happening while you are sectioned and in hospital, you can raise it with them, as they may be able to make recommendations about how the hospital services are run.
• The panel will make their own decision based on the views of the professionals and other evidence they have. But if the professionals do not agree in their views, they will have to form an independent judgement, based on what is the least restrictive option that maximises your independence. They may need to consider adjourning the hearing so that they can ask for more medical or other professional advice.

Getting support

The managers should support you to take part in the process as far as possible, and you should be given enough information so that you can understand the process and use it as fully as you can.

You can have extra support if you want. Managers should arrange hearings and give enough notice so that you can have someone there to support you.

This means you can have:

• a representative of your own choice to help you put your views to the panel – this could be a legal adviser or solicitor
• a relative, friend, carer or advocate to support you
• the chance to speak to the panel alone if you want to, with or without your representative or anyone else you have asked to support you at the hearing. The only exception is if this is considered too unsafe.

When will the managers tell me their decision?

They must let you know the reasons for their decision as soon as they can. They should also:

• record the decisions and reasons at the end of the review
• give their decisions and reasons to your representative or legal representative, nearest relative, carer, and professionals involved as soon as practicable
• give you the chance to discuss the hearing soon afterwards

If they decide to discharge you, they should give or send you an order in writing.

If they decide not to discharge you:

• They should give you their reasons, and you can ask for these in writing if you do not get them.
• At least one member of the panel should offer to see you or your representative to explain the reasons for their decision in person. They should discuss with you the record of the decision and reasons, and copies of the review papers should be placed in your medical notes.
• You should also be informed as quickly as possible after the hearing of your right to apply for discharge to the tribunal.

Will there be any aftercare planning?

The managers will hold a meeting to consider what discharging you from section and allowing you to leave hospital will mean for your future care.

Before the meeting, your responsible clinician and your multi-disciplinary care team will think about what care you might need if you were discharged, and whether these would be enough to make it no longer necessary for your section or CTO to continue. These may include:

• community care arrangements
• a Deprivation of Liberty Safeguards Authorisation (DoLS), or
• a Court of Protection order

Managers can adjourn the meeting if:

• they don't have enough information about your future care arrangements, and they want to ask for more information
• they believe you should be discharged but there are practical steps that need to be taken for your aftercare before this can happen. They can adjourn for a short time so these steps can be taken before discharging you, but they should try and make this time as short as possible.

Can the managers transfer me to another hospital?

Yes, they can give permission for you to be transferred, but cannot force another hospital to give you a place, or for another Clinical Commissioning Group to give funding for your care.

They might decide to transfer you because:

• your hospital can no longer offer you the care you need
• they want to move you to a more specialised service
• they want to move you somewhere closer to home

The factors they will consider include:

• whether a transfer would give you better access to your carers
• what effect a transfer is likely to have on your mental health problem or your recovery
• whether there is a suitable place available for you at the hospital you might be transferred to
• whether a transfer would allow you to be in a more suitable place culturally or an environment that meets your needs better, or would it have the opposite effect

When making their decision, they must think about what's best for you when deciding whether or not you should be transferred. This means that:

• Your human rights should be respected. They should make sure that their decisions do not interfere with your right to respect for private and family life under human rights law.
• You should be involved in the decision-making. The managers should make sure the reasons for considering a transfer are explained to you, and if you wish, to your nearest relative and carers, and the reasons should be recorded.
• You should not be transferred to another hospital without warning. This should only happen in exceptional circumstances. If you feel this has happened to you without a good reason, you can complain about the decision, or take legal advice if you have a legal adviser or solicitor.
• If you are asking for a transfer, they should try to meet your wishes. You might ask for a transfer because, for example, you want to be treated by a different clinical team or be nearer to your family or friends. If the decision is you cannot be transferred, they should give you their decision in writing and the reasons for it.

Can I appeal against a managers’ decision?

If you want to appeal against a decision not to discharge you, see our information in Getting my section lifted.

If you believe the managers have reached a decision without considering all the relevant information, or following the right procedure, you should speak to a legal adviser or mental health solicitor (see Useful contacts). They can tell you whether it's worth trying to get their decision reviewed by a court, as it is hard to bring this type of legal claim and to get legal aid for it.

When will the managers refer my case to the tribunal?

The managers may refer your case if you have not applied to the tribunal yourself. This may happen if you can't apply yourself because of your illness or other health reasons. This could happen if, for example, you were detained under section 2 or 3.

They must apply on your behalf if:

• six months have passed since you were first sectioned, even if you are now now on a CTO, but not if you have had a tribunal hearing since you were sectioned under section 3
• three years have passed since your case was considered by the tribunal (or one year if you are under 18)
• you have been transferred from guardianship to a hospital, and six months have passed, unless you have already applied to the tribunal after being transferred from guardianship to a hospital
• you were under a CTO, but it has been revoked by your responsible clinician and you are back in hospital under a section. Your case should be referred to the tribunal as soon as possible after your responsible clinician has revoked your CTO.

Secretary of State/Welsh Ministers

The hospital managers should consider asking the Secretary of State (if you are a patient in England), or the Welsh Ministers (if you are a patient in Wales), to refer your case to the tribunal if you are unable to have your case considered by the tribunal quickly after you were first sectioned and kept in hospital, or at reasonable time intervals after that. This is because this violates your rights under the European Convention on Human Rights.

The hospital managers should normally ask for this if:

• your nearest relative is being displaced and your section 2 has been extended so that you stay in hospital while this is happening
• you don’t have the mental capacity to ask for a reference yourself, or
• your case has never been considered by the tribunal, or a considerable length of time has passed since it was considered

Read more about when the tribunal can discharge you.

This information was published in August 2018. We will revise it in 2020.

References are available on request. If you would like to reproduce any of this information, see our page on permissions and licensing.

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