Summary
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The complaint
Mrs M had suffered from depressive illness since the 1950s. Over the years, this had meant that she had sometimes needed to be admitted to a mental hospital during acute periods of her illness. In 1989, due to a severe recurrence of her illness, Mrs M was compulsorily detained in hospital under section 3 of the Mental Health Act 1983. She was discharged home again that year and continued to live at home, cared for by her husband, and supported locally by mental health services under the supervision of a consultant psychiatrist. Following her husband’s death in 1998 Mrs M lived alone; in the period from 1997 to 2003 she went into hospital on five occasions as a voluntary patient for periods of between several weeks and several months. Since 1999, it had been noted that there had been a deterioration in her physical health: she began to experience falls, her gait had changed, and she became incontinent and needed considerable help with daily activities. No definite cause for this deterioration was ever found but, by 2004, she was not coping well at home and she went into a residential care home (the Care Home) where she remained for the rest of her life. She died in October 2009. Throughout her time as a resident of the Care Home, Mrs M had funded her own care.
Our investigation
We investigated complaints by Miss M (Mrs M’s daughter) that it was wrong that Mrs M had been expected to fund her own care in the Care Home – that this should have been provided under section 117 of the Mental Health Act 1983 (which makes provision for patients who have been compulsorily detained under the Act to receive free aftercare). Miss M complained that the explanation she had been given about her mother’s ineligibility for section 117 funding, by the Trust, was unreasonable; and that the Trust’s assertion that the admission had been for physical needs, rather than for mental health needs, was an attempt to avoid responsibility for funding the placement. Miss M also complained that her mother’s subsequent discharge from the Community Mental Health Team (CMHT) in 2005 was inappropriate, and that the provision of care and treatment by the Trust from the admission to the Care Home to her mother’s death was inadequate. She complained too that the transfer of responsibility for her mother’s care to the Council’s Adult Social Care team (ASC team) in 2008 had been inappropriate; and finally that the assessment of her mother’s needs following that transfer did not adequately take into account her mother’s needs or her own views, her mother’s medical history, nor the opinions of medically qualified professionals. To sum up, Miss M said that her mother’s complex needs were not met, that she was placed in the Care Home and then forgotten, and that she then failed to receive the treatment she needed.
Our findings
We found that the delivery of aftercare services for Mrs M under section 117 of the Mental Health Act, and her discharge from that provision, were not properly considered in accordance with relevant legislation and guidance; and the later explanations given about this by the Trust and by the Council were inadequate and contradictory. We found too that the procedure followed in discharging Mrs M from the CMHT in 2005 was not in accordance with relevant guidance. However, we did not consider that these failures were the cause of significant injustice to Mrs M or Miss M. We did not find that Mrs M failed to receive the medical or social care services that she needed from the Trust or the Council. There was no fault in the arrangements for the admission to the Care Home, in the care provided by the Trust and the Council after the admission, nor in relation to the transfer of care to the Council’s ASC team and the later assessment of her needs. Most significantly, we did not find that the period of residential care in the Care Home should definitely have been funded by the Council under the provisions of section 117.
We concluded that there was no doubt that Mrs M had severe and enduring mental health problems following her discharge from compulsory detention in hospital in 1989, and we noted that the severity of these acute episodes had resulted in informal admissions to hospital between 1987 and 2003. However, we also noted that there was considerable evidence, from professional and clinical staff involved with Mrs M, that her physical deterioration and inability to cope at home alone, dating from the end of that period, could not definitely be attributed to the underlying depressive illness that had been so severe in previous years. It was acknowledged by staff that Mrs M’s physical and mental health problems were interrelated, but there was evidence that her later symptoms could be attributed to a more general deterioration that was possibly linked to symptoms of dementia.
Conclusion
We found evidence of some failures on the part of the Trust and the Council; but in the absence of any consequent injustice that we could identify, we did not uphold any of Miss M’s complaints.
