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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.

  • This information applies to England and Wales.
  • This information applies to adults. It doesn't apply to children unless specifically stated.

What is section 117 aftercare?

Some people who have been kept in hospital under the Mental Health Act can get free help and support after they leave hospital. The law that gives this right is section 117 of the Mental Health Act, and it is often referred to as 'section 117 aftercare'.

Aftercare is the help you will get in the community after you leave hospital. This can cover all kinds of things like healthcare, social care and supported accommodation.

Section 117 of the Mental Health Act says that aftercare services are services which are intended to:

  • meet a need that arises from or relates to your mental health problem, and
  • reduce the risk of your mental condition getting worse, and you having to go back to hospital

Who can get section 117 aftercare?

You can get free aftercare under section 117 if you have been detained:

  • for treatment under section 3
  • under a hospital order under section 37
  • following transfer from prison under section 47 or 48
  • under a hospital direction under section 45A

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

You also have the right to section 117 aftercare if:

  • you have been discharged onto a CTO for the entire period of your CTO, or
  • you are a restricted patient on a conditional discharge.

You may have a right to aftercare when you are on leave from hospital. If your leave is open-ended, unescorted or for a long time, then you should able to get aftercare while on leave if you need it. You can speak to your responsible clinician about the support you need.

You have the right to section 117 aftercare after you leave hospital whether you:

Examples

  • Darren is being discharged from a section 2. This is not covered by section 117, so he is not entitled to section 117 aftercare.
  • Hannah is being discharged from hospital after spending a month as a voluntary patient. Voluntary patients are not covered under section 117, so she is not entitled to aftercare.
  • Clarence is on trial leave to a supported accommodation placement while he remains on section 3. As his leave is long-term and unescorted, section 117 should apply and the support he needs may be covered under section 117.
  • Miriam was discharged from her section 3 but did not feel ready to leave hospital and so spent over a month as a voluntary patient. Section 3 is covered by section 117 aftercare, so even though she stayed on as a voluntary patient, she is entitled to free aftercare services under section 117.
  • Steve has been transferred to hospital from prison under section 47. When the criteria for detention under the Mental Health Act no longer apply, he is returned to prison. He is entitled to aftercare services under section 117.

What kinds of services are covered?

The English and Welsh Codes of Practice have examples of what sort of things might make up aftercare services under section 117.

These include:

  • healthcare
  • social care and employment services
  • supported accommodation
  • services to meet your social, cultural and spiritual needs – as long as they meet a need that arises from or is related to your mental condition and help reduce the risk of your mental condition getting worse.

Housing

You will probably not be provided ordinary housing under section 117 aftercare services. So, for example, you will almost certainly not be provided with an ordinary flat by the council after you are discharged from hospital. However, you may be given free specialist accommodation under section 117.

In some circumstances, if the local authority are to provide you with accommodation, you can choose the accommodation you want to live in rather than accept what has been offered, though you will have to pay the difference if it is more expensive.

You can find out more in our information on your housing rights.

Medication

Medication can come under section 117, which means that it should be provided free. If you generally have to pay for your prescriptions, then speak to your care coordinator. They should be able to help you claim free prescriptions for any medication that is part of your section 117 aftercare.

Example

Jorge is being discharged from hospital after being detained under section 3. He has a diagnosis of bipolar disorder and has a history of difficulties with drugs and alcohol, which have had an impact on his mental health. He also has type 1 diabetes.

Jorge is entitled to drug and alcohol counselling services under section 117, as these meet needs which relate to his mental disorder and reduce the risk that he will have to be readmitted to hospital for treatment of his mental condition. He cannot be charged for these services.

But he doesn't have the right to any free social care services under section 117 for his diabetes, as this is a physical rather than a mental condition.

Who is responsible for providing section 117 aftercare?

It is the duty of the:

It is their responsibility to provide you with aftercare services, or to arrange for them to be provided. They often provide them together with voluntary agencies.

Sometimes there are disputes between different Clinical Commissioning Groups, Local Health Boards and local authorities about who has to provide or pay for your aftercare services. Even if this happens, your care planning and discharge should not be delayed.

Direct payments

Local authorities can make payments directly to you, or to someone else suitable, to pay for aftercare services under section 117. For this to happen, you must be an adult, and:

  • you must have the capacity to ask for direct payments
  • if you want someone to act on your behalf, they must agree to this
  • the local authority must be satisfied that you or anyone acting on your behalf are capable of managing the direct payments, if necessary with help from others, such as family members
  • the local authority is satisfied that making direct payments is an appropriate way of meeting your needs for care and support

How long will I get section 117 aftercare?

You will be provided aftercare services under section 117 until the Clinical Commissioning Group/Local Health Board and the local authority are satisfied that you no longer require these services.

The English and Welsh Codes of Practice say that you should be fully involved in any decision making process to end your aftercare services.

They also say that aftercare services under section 117 should not be taken away because:

If your aftercare services have been taken away and your mental condition has begun to deteriorate, then the services should be put back to stop your condition from getting worse.

What can I do if there are problems with my section 117 aftercare?

Clinical Commissioning Groups/Local Health Boards and local authorities have a legal duty to provide aftercare services under section 117, although they have a choice as to exactly what services are provided.

If you have problems with the aftercare services, you have a number of options:

  • Raise your problem with your care coordinator to begin with. They may be able to find a solution for you.
  • If your problem is with health-related services, you can follow the complaints procedure of that service. If you are not happy with the outcome of your complaint, or the way it was handled, you can ask the Health Service Ombudsman to investigate. They can make recommendations to put things right. (See our guide to complaining about health and social care).
  • If the complaint is about social care provided or paid for by the local authority, you should follow that local authority’s complaints procedure. If you are not happy with the outcome of your complaint, or the way it was handled, you can ask the Local Government Ombudsman to investigate. They can make recommendations to put things right. (See our guide to complaining about health and social care).
  • Ask for a judicial review. You can take the Clinical Commissioning Groups, Local Health Board or local authority to court and challenge them in a judicial review. This is where the court does not decide whether the decision they made was wrong, but whether it was made properly, taking into account all the relevant circumstances. Judicial review claims have a very strict time limit and must be brought within 3 months of the decision you are challenging. Sometimes, just by writing a letter saying that you want to make a judicial review claim can convince them to reconsider their decision. If you want to do this, you should get the help of a solicitor (see Useful contacts for information on how to find a solicitor). You might be able to get legal aid to pay for it too.

If I can't get section 117 aftercare services, do I have to have to pay for my after hospital care?

If you aren't eligible for free section 117 aftercare (for example, if you have been discharged from a section 2), you will not have to pay for your ongoing medical treatment. But you may have to make a contribution towards the cost of your social care treatment on a means-tested basis (see our info on financial assessments to find out more).

Ending section 117 aftercare

There are no clear rules in the Mental Health Act for deciding when a person no longer needs aftercare; but section 117 of the MHA says that it is up to the health and social services who are dealing with your case to make a joint decision that you no longer need it.

They must be able to give clear reasons for their decision and your needs must be reassessed before the aftercare is ended, to see how your mental health and ability to manage would be affected.

Guidance says that even if you are well settled in the community, aftercare may still continue to prevent you from becoming ill again or from getting worse.

< Care planning Useful contacts >

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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