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Home > Publications > Selected Cases > Selected Investigations Completed December 2002March 2003 > Case no. E.1996/00-011
Complaint against Lincolnshire Healthcare NHS Trust
Summary of Case
Mr C, who was a drug user, was admitted to an acute psychiatric unit in December 1997, and February and March 1998. On the last two occasions he was subject to an order under Section 5(2) of the Mental Health Act (the MHA). He had been previously admitted in February 1994, under Section 2, and detained thereafter under Section 3. Mr C complained that there was a lack of suitable discharge arrangements for him when he was discharged from the unit in December 1997, February and March 1998, respectively, despite his being mentally unwell and in need of help. In particular, no aftercare was provided under Section 117 of the MHA. Mr C complained to the Trust but was dissatisfied with the responses he received under local resolution. The convener twice refused his request for an independent review.
Findings
The Ombudsman’s assessor noted the central difficulty in mental health of balancing the individual patient’s rights to freedom and choice, against the right to receive treatment and support which the patient might not want and may actively avoid. Whilst conceding the practical difficulties involved, the Ombudsman found that there was no evidence that an ordersuch as was available under the MHAhad been considered to facilitate Mr C’s safe survival outside the unit. He was entitled to Section 117 aftercare by virtue of having been placed under a Section 3 order and, since such aftercare arrangements had not been discontinued, they still applied on discharge on all three occasions. The consequences of discharging Mr C in February when he was reluctant to leave, and in March when he was still mentally unwell, did not appear to have been considered. The Ombudsman upheld the complaint that there had been a lack of appropriate discharge arrangements for Mr C.
The assessor considered that interpretation of Mr C’s dual diagnosis of schizophrenia and drug-induced psychosis had emphasised the latter and paid insufficient attention to the former. This had the effect of shifting the responsibility for his mental health problems onto Mr C and might have influenced the treatment offered to him at the time. A revolving pattern was repeated of short-term admissions and medication, followed by discharge when settled. Sustained in-patient care, incorporating rehabilitation with the sanction of a Section 3 order, would have been more beneficial. Of serious concern was the lack of evidence from the clinical records that, when Mr C was resistant to injections, they were subsequently given without consent under common law. The Ombudsman found failings and shortcomings in Mr C’s care and upheld the complaint. The Trust’s responses to Mr C’s complaint quoted inaccurate information that he was not entitled to Section 117 aftercare, and were found to be misleading and unhelpful. The Ombudsman upheld the complaint.
Remedy
The Ombudsman recommended that a training session be implemented on treatment without consent and that an audit programme be introduced to ensure that cases such as Mr C’s did not occur again. In view of the parlous state of the clinical notes, the Ombudsman recommended that the Trust take steps to ensure a policy in relation to the management of its health care records, which provided for proper control, ready accessibility and availability for use.
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