Section 117 and multiple diagnoses

Do aftercare services under section 117 extend to meeting needs arising from mental disorders other than the one for which the patient was originally detained?

This question arose at the annual conference of the Mental Health Lawyers Association in November to much head-scratching. I hope that this note can clear up this important issue. The question was something like this:

Mr P is detained under the Mental Health Act under a diagnosis of schizophrenia. He is later discharged and receives a package of aftercare under section 117 which meets needs arising out of that condition. Mr P later develops dementia and has additional needs. Must his aftercare package meet all needs or only those arising from the original condition?

The answer, in brief, is yes, and is found in the passage through the House of Lords of the definition of aftercare services now set out in section 117(6).

The original definition was this (emphasis added):

In this section, “after-care services” means services which have both of the following purposes:

(a) meeting a need arising from or related to the mental disorder of the person concerned; and

(b) reducing the risk of a deterioration of the person’s mental condition (and, accordingly, to reduce the risk of the person requiring admission to a hospital again for treatment for the disorder).

It was raised in the committee stage that the underlined "the" suggested that aftercare services were only those that met needs arising from the mental disorder for which the patient was detained. As such the relevant part was changed to:

(b) reducing the risk of a deterioration of the person's mental condition (and, accordingly, reducing the risk of the person requiring admission to a hospital again for treatment for mental disorder)

The reasons for the change were made explicit in the report stage:

"… [we have] changed the clause to remove the definitive article when referring to “mental disorder”…This is intended to remove any doubt about our intention that the scope of aftercare covers more than just one form of mental disorder, and is not necessarily limited to the specific disorder or disorders for which the person was previously detained under the Act and which gave rise to the right to aftercare." (16.10.2013 Column 600)

So, if Mr P’s needs increased due to his developing dementia his aftercare package must be reassessed and support provided that meets the statutory definition in relation to either condition. 

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