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

Terms you need to know

Term

Meaning

Advocate

An advocate is a person who can both listen to you and speak for you in times of need. Having an advocate can be helpful in situations where you are finding it difficult to make your views known, or to make people listen to them and take them into account.

Find out more on our advocacy information page.

Appropriate treatment or appropriate medical treatment

This means medical treatment for your mental health problem that is:

  • suitable for you
  • available
  • takes into account the nature and degree of your mental health problem and your individual circumstances

Approved clinician

A mental health professional who has certain responsibilities related to your healthcare. They are approved to do this by the Department of Health (England) or by the Welsh Ministers (Wales).

Approved clinicians may be:

  • doctors
  • psychologists
  • nurses
  • occupational therapists
  • social workers

Some decisions under the Mental Health Act, such as deciding on your medication or giving you permission to leave the ward or hospital, can only be taken by approved clinicians.

Approved mental health professional (AMHP)

AMHPs are mental health professionals who have been approved by a local social services authority to carry out duties under the Mental Health Act. They are responsible for coordinating your assessment and admission to hospital if you are sectioned.

They may be:

  • social workers
  • nurses
  • occupational therapists
  • psychologists

Attorney

An attorney is a person over the age of 18 whom you have appointed to make decisions on your behalf about your welfare and/or your property and financial affairs. You need an attorney if you are unable to make such decisions yourself. If you do not have the capacity to appoint an attorney, the Court of Protection will appoint a deputy to perform this role.

  • A health and welfare attorney makes decisions about things like your daily routine, your medical care, where you live and, if you specially request this, whether you should have life-sustaining treatment.
  • A property and financial affairs attorney makes decisions about things like paying bills, collecting benefits and selling your home.

See our pages on the Mental Capacity Act for more information.

Barring report

This is the report written by the responsible clinician stopping the discharge of someone under section when an application has been made by the nearest relative.

Capacity

‘Capacity' means the ability to understand information and make decisions about your life. Sometimes it can also mean the ability to communicate decisions about your life.

If you do not understand the information and are unable to make a decision about your care, for example, you are said to lack capacity.

See our pages on the Mental Capacity Act for more information.

Care coordinator

A care coordinator is the main point of contact and support if you need ongoing mental health care.

They keep in close contact with you while you receive mental health care and monitor how that care is delivered – particularly when you’re outside of hospital.

They are also responsible for carrying out an assessment to work out your health and social care needs under the care programme approach (CPA).

A care coordinator could be any mental health professional, for example:

  • nurse
  • social worker
  • other mental health worker

This is decided according to what is most appropriate for your situation.

A care coordinator usually works as part of the community mental health team.

Care Programme Approach (CPA)
and Care and Treatment Planning (CTP)

The Care Programme Approach (CPA) is a way that secondary mental health services are assessed, planned, coordinated and reviewed for someone that lives in England.

Secondary mental health services include the Community Mental Health Team, Assertive Outreach Team and Early Intervention Team.

The Care and Treatment Planning (CTP) is a similar process for people living in Wales. But it comes from a law called the Mental Health (Wales) Measure 2010.

In both England and Wales you should get:

  • a full assessment of your health and social care needs
  • a care plan
  • regular reviews
  • a care coordinator who will be responsible for overseeing your care and support

Clinical Commissioning Group (CCG)

CCGs are groups of GP practices and other healthcare professionals and bodies that are responsible for commissioning most health and care services for patients. They have replaced Primary Care Trusts (PCTs) in England.

Community treatment order (CTO)

If you have been sectioned and treated in hospital under certain sections, your responsible clinician can discharge you onto a CTO. This means that you can be discharged from the section and leave hospital, but you might have to meet certain conditions such as:

  • living in a certain place
  • going somewhere for medical treatment

See our pages on CTOs for more information.

Conditional discharge

This is where you are discharged from hospital into the community by a tribunal or the Secretary of State for Justice, but you have to meet certain conditions. If you break these conditions, you can be recalled to hospital by the Secretary of State for Justice.

You will only be put under a conditional discharge if you have been:

  • sectioned by a court under certain sections of the Mental Health Act and have been charged with a crime and you are a restricted patient under a restriction order, or
  • transferred to hospital from prison under the Mental Health Act and you are a restricted patient under a restriction direction

Court of Protection

The Court of Protection makes decisions and appoints deputies to act on your behalf if you are unable to make decisions about your personal health, finance or welfare.

See our pages on the Mental Capacity Act for more information.

Deprivation of Liberty Safeguards (DoLS)

If you are in a hospital or care home, your liberty can normally only be taken away if health professionals use the procedures called the Deprivation of Liberty Safeguards. This protects you from having your liberty taken away without good reason.

See our pages on the Mental Capacity Act for more information.

Deputy

A deputy is a person the Court of Protection appoints to make decisions for you once you have lost capacity to make them yourself. A deputy usually makes decisions about finances and property. The court can appoint a deputy to take healthcare and personal care decisions, though this is relatively rare.

Detained

A person is detained if they are being kept in hospital under section and are not free to leave.

Guardianship

This is where someone called a ‘guardian’ is appointed to help you live as independently as possible in the community, instead of being sectioned and kept in hospital.

You would be placed under guardianship if your mental health problem meant that it would be difficult for you to avoid danger or people taking advantage of you. Your guardian has the power to make certain decisions about you and to make conditions that you will be asked to keep to.

Hospital Managers (also known as Mental Health Act Managers)

An independent team of people in a hospital who make sure that the requirements of the Mental Health Act are properly applied. They have certain important responsibilities and can make decisions related to your detention – for example, they can hear your application to be discharged from your section and decide whether or not to discharge you

Independent mental capacity advocate (IMCA)

A specially trained advocate who can help you if you do not have the capacity to make particular decisions. NHS bodies or local authorities must take an IMCA's views into account when making decisions that affect you if you have lost capacity.  

They are normally appointed by the local authority in England, and by local Health Boards or other NHS bodies in Wales. They must be independent people of integrity and good character with appropriate experience and training.

See our page on IMCAs for more information.

Independent Mental Health Act Advocate (IMHA)

An IMHA is an advocate specially trained to help you find out your rights under the Mental Health Act 1983 and help you while you are detained. They can listen to what you want and speak for you.

You have a right to an IMHA if you are:

  • detained in hospital under a section of the Mental Health Act, but not if you are under sections 4, 5, 135 and 136
  • under Mental Health Act guardianship, conditional discharge and CTOs
  • discussing having certain treatments, such as electroconvulsive therapy (ECT)

In Wales, voluntary patients can also have an IMHA.

See our pages on IMHAs (England) and IMHAs (Wales) for more information.

Informal patient or voluntary patient

These are people who are staying in a psychiatric hospital but are not detained under the Mental Health Act. They should be able to come and go from the hospital within reason and are able to discharge themselves if they decide to go home.

See our pages on voluntary patients for more information.

Judicial review

This is a type of court procedure where a judge reviews a public authority’s decision, policy, practice, act or failure to act, and decides whether it is lawful or not.

If it is not lawful, the court may cancel the decision or action (‘quash’ it), and require the public authority to reconsider it, lawfully. The court can order the authority to do or not do something.

Lasting power of attorney

A lasting power of attorney is a legal document that lets you appoint someone, called an attorney, to make decisions for you.

Local Health Boards (LHBs)

These are organisations in the health service in Wales that have been set up to develop and provide health services based on the needs of the local community.

Medical treatment

In the Mental Health Act this means medical treatment that is used to relieve the signs and symptoms of your mental health condition, or to stop it from getting worse. It includes:

  • nursing
  • psychological intervention and specialist mental health habilitation (learning skills)
  • rehabilitation (relearning skills)
  • care

Mental Health Act 1983 (MHA)

This is a law that applies to England and Wales which allows people to be detained in hospital (sectioned) if they have a mental illness and need treatment. You can only be kept in hospital if certain conditions are met.

See our pages on the Mental Health Act for more information.

Mental Health Act Administrator

The Mental Health Act Administrator works in the hospital and deals with collecting and keeping the section or CTO papers safe. They make sure that procedures are followed – like making sure you are given the right information and arranging hearings.

Mental Health Act Code of Practice

This tells health professionals how they should follow the Mental Health Act 1983.

It is not law, so it cannot be enforced by going to court, but health professionals should follow it unless there is a good reason not to.

The Code covers some areas not specifically mentioned in the Mental Health Act 1983, such as visiting rights and the use of seclusion.

If a health professional doesn’t follow the Code, you can make a complaint.

There is both an English and Welsh Code of Practice. They are mostly identical, but have certain differences based on the fact that there are some laws which are different in England and Wales.

Mental Health Tribunal (MHT)

This is a special court that deals with cases relating to the Mental Health Act 1983. The Tribunal decides whether you can be discharged from your section and can decide about suitable aftercare and make recommendations about matters such as hospital leave, transfer to another hospital, guardianship and CTOs.

The court is made of a panel, which normally includes:

  • a legally qualified chairperson
  • a ‘lay person’ who has appropriate experience and qualifications in the area of mental health
  • an independent psychiatrist, who will speak to you and examine you before the tribunal hearing in certain circumstances, and when you request to see them

Where you see a reference to the Mental Health Tribunal in this guide, it means:

  • First Tier Tribunal (Mental Health), if you live in England, or
  • Mental Health Review Tribunal for Wales, if you live in Wales

Nearest relative

This is a family member who has certain responsibilities and powers if you are detained in hospital under the Mental Health Act. These include the right to information and to discharge in some situations.

The law sets out a list to decide who will be the 'nearest relative'. This can sometimes be changed.

See our information on the nearest relative.

Registered medical practitioner

A qualified doctor, for example a GP or psychiatrist.

Remand

This means that you will go to prison until you go to court to have your case considered. Sometimes you can be remanded to hospital instead of prison.

Responsible clinician (RC)

This is the approved clinician in charge of your care and treatment while you are sectioned under the Mental Health Act.

Certain decisions, such as applying for someone who is sectioned to go onto a CTO, can only be taken by the responsible clinician (see our information on CTOs).

All responsible clinicians must be approved clinicians. They do not have to be a doctor, but in practice many of them are.

Restriction order or restriction direction

This is an order made by the court when it has made a hospital order under section 37 to put restrictions on your discharge, transfer or leave from hospital. The Secretary of State's consent must be obtained in order to do these. This means it will be harder to get discharged by the tribunal or you might have to comply with certain conditions.

It can only be made if it is necessary to protect the public from serious harm.

Section

In this guide, being 'sectioned' means that you are kept in hospital under the Mental Health Act. There are different types of sections, each with different rules to keep you in hospital. The length of time that you can be kept in hospital depends on which section you are detained under.

See our information on sectioning.

Section 117 aftercare

Health authorities and local social services have a legal duty to provide free aftercare for people who have been detained under Mental Health Act sections 3, 37, 47 or 48, but who have left hospital. The duty to provide aftercare also applies if you are under a CTO. Aftercare services in the aftercare plan should be provided free of charge.

Upper tribunal

This is a tribunal which handles appeals received from lower tribunals. It is not a specialist mental health tribunal.

You can appeal to it if the Mental Health Tribunal got a point of law wrong. In practice, it is rarely used in mental health.

 


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


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