Leaving hospital

Explains the rights you have to get your section lifted if you are being detained in hospital under the Mental Health Act, and your rights to care and support after leaving hospital. Applies to England and Wales.

Your stories

Leaving hospital

Philippa felt abandoned when she was discharged from hospital without warning. Now she's helping our campaign.

Posted on 01/03/2017

How to help someone who's been sectioned

Harriet from our information team shares ways to help someone who's been detained under the Mental Health Act.

Mind Info team
Posted on 07/03/2017

Responsible clinician

When can my responsible clinician discharge me?

The rules are different depending on whether you are under a:

If you are under a section

Your responsible clinician should discharge you as soon as he or she considers that you no longer need to be sectioned because the medical reasons for keeping you sectioned no longer apply.

If your section is coming to an end because it is reaching its maximum time limit, which will depend on which section you are under, your responsible clinician must decide whether your section should be renewed. Renewal is normally possible only with some sections, such as section 3 or 37.

They must examine you in the last two months of your section and decide whether the conditions for renewing your section are met and whether you should be discharged. They should also discuss their decision with you.

Then they must do the following:

  • Consult one or more professionals involved in your medical treatment.
  • Explain in full their reasons in a report to the hospital managers. If they are satisfied that the conditions for renewing your section are met, they must put this in their report.
  • Get agreement in writing from another professional. The professional must be involved in your care and treatment, have had recent contact with you and not be in the same profession as your responsible clinician.

If your section is not renewed, then when it reaches its maximum time limit, you should be:

  • discharged and free to go, or
  • placed under another section

If you think you are no longer sectioned, and are not discharged or free to go, you should

  • report this yourself, or ask someone else to report this to the hospital managers as soon as possible
  • report this to the Care Quality Commission as a serious incident

If you are not sectioned again, the hospital managers should make sure that a review is held within one month to:

  • find out why this has happened
  • find out what has been done to correct the situation
  • make sure that it will not happen again in the future

If you are under a CTO

Your responsible clinician should make a decision about your discharge, that considers the least restrictive option and the maximum independence available to you. They should think about whether you should be:

  • discharged from your CTO into guardianship, or
  • fully discharged from your CTO

If your CTO period is about to come to an end, your responsible clinician must examine you in the last two months before it reaches its maximum time limit and decide whether to discharge you or extend your CTO.

Only your responsible clinician can extend your CTO. In making this decision they should take the following steps:

  • Consult the wider multi-disciplinary team involved in providing your care and treatment. This would include your care coordinator and anyone else involved in your care in the community.
  • Consult you, your nearest relative, your IMHA or other representative, family and carers, the local authority and Clinical Commissioning Group responsible for your aftercare, and any other organisation providing key services for you. This consultation should take place during a Care Programme Approach assessment and before the responsible clinician decides whether or not to extend the CTO.
  • Consider whether extending the CTO is appropriate in your case – for example, the longer you have been on a CTO without the responsible clinician having to recall you to hospital, the more carefully they have to think about whether the conditions for extending are met or whether you should be fully discharged from your CTO.
  • Submit a report to the hospital managers if they decide that the conditions for extending the CTO are met, and not to discharge you from it. They should explain their reasons in full in their report, and they must get an AMHP to agree in writing that it should be extended. They should give the AMHP enough time to interview you before they agree to the extension, but it does not need to be an AMHP who knows you already.

How will my responsible clinician discharge me?

This is different depending on whether you are under a:

If you are under section

The responsible clinician will do this by making an order in writing. This lets the hospital authorities know that you are no longer under section, and that you should be allowed to leave hospital, and supported to do this.

The law says that there are slightly different reasons for keeping you sectioned under a section 2 or section 3. But generally speaking, your responsible clinician must reach a decision about your mental health, taking into consideration whether:

  • your mental health has improved enough for you to leave hospital
  • 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
  • there are other options available to you, such as whether it is possible for you to be treated for your mental health problem in the community, and whether appropriate treatment will still be available to you

Or, if your section has reached the maximum time allowed by the law, then the law says you should:

  • be discharged
  • have your section renewed, or
  • be sectioned under another section. The length of time you are kept under the section may depend on which section you are under

Your responsible clinician can also discharge you for other reasons, and at any time. If the conditions for keeping you under your section or your CTO are no longer being met, they must discharge you, and they should not wait until your section or CTO has ended before discharging you.

Also, if the second professional consulted by the responsible clinician decides not to agree to your section being renewed or the AMHP decides not to agree to your CTO being extended, this does not mean your section or CTO are automatically ended. However your responsible clinician would have stronger reasons to think about discharging you.

If you are under a CTO

The factors the responsible clinician will look at will be similar to when you are being discharged from section. But instead of looking at whether you are well enough to leave hospital or will be able to receive the right treatment in the community, they will look at whether they still need the power to recall you to hospital, and possibly have you brought there for treatment.

To find out more, see our information on CTOs.

What if my section has ended but my responsible clinician hasn’t discharged me?

If your section has reached its time limit, and it has not been renewed or replaced by another section, you should be free to go. If you think you should have been discharged but this has not happened, you should let the hospital managers know. If you need help to do this, an IMHA should be able to help you.

What if I only want to leave hospital for a short time?

You will need to get permission from your responsible clinician. This is covered under section 17 of the Mental Health Act.

 


This information was published in January 2017. We will revise it in 2019.


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