Summary: Mr X complains about the way Devon County Council and Devon Partnership NHS Trust acted in relation to a hospital detention. We will not investigate this complaint. This is because an investigation is unlikely to find fault in the organisations’ actions.

The complaint

1. Mr X complains about the actions of Devon County Council (the Council) and Devon Partnership NHS Trust (the Trust). He complains the Trust and Council:
• did not tell him or his closest relatives that they intended to detain him in hospital;
• did not discuss other options with him or his family;
• recorded inaccurate information regarding his mental state; and
• made the wrong decision to apply for him to be detained in hospital. The decision was based on inaccurate and exaggerated information about his condition.
2. Mr X also complains about the way the Trust handled his complaint. He considers the Trust did not address his concerns or care about the issues he raised.
3. Mr X says the organisations’ faults caused him the following injustice:
• an avoidable six days detained in hospital, during which he was frightened all the time;
• a loss of trust in the organisations, affecting his willingness to use mental health services in the future; and
• financial losses.
4. Mr X would like the organisations to acknowledge the errors they made, improve their services, and pay him a financial remedy.

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The Ombudsmen’s role and powers

5. The Local Government and Social Care Ombudsman and Health Service Ombudsman have the power to jointly consider complaints about health and social care. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA).
6. We provide a free service, but must use public money carefully. We may decide not to start or continue with an investigation if we believe it is unlikely we would find fault. (Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

7. I have considered:
• information Mr X has provided to the Ombudsmen in writing and by telephone.
• written information from the Council and the Trust. This includes copies of the organisations’ records relating to the events Mr X complains of; and
• Government guidance titled ‘Mental Health Act 1983: Code of Practice’ (the Code).
8. Mr X had an opportunity to comment on a draft version of this decision.

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What I found

What happened

9. Mental health professionals from the Trust met with Mr X in February and March 2023. At the time, they considered he:
• was refusing to take medication or engage with community mental health services;
• presented as having psychosis. Psychosis is when a person loses some contact with reality. It may involve delusions (believing things that are not true) and/or hallucinations (seeing or hearing things that are not there);
• had in the past been arrested while carrying knives in relation to his delusions;
• was refusing to go into hospital voluntarily;
• posed unpredictable risks to himself and others; and
• may present a flight risk because of his fears around mental health services.
10. Professionals therefore decided to ask for a formal assessment under the Mental Health Act 1983 (the Act). This assessment was to consider whether it was appropriate to detain Mr X in hospital under the Act. Before they requested the formal assessment, professionals noted that:
• they had considered whether to discuss the assessment with Mr X in advance but decided not to; and
• this was because they considered doing so would increase his paranoia and flight risk.
11. Before Mr X was detained, clinicians spoke with his mother as she is his ‘nearest relative’. The Act sets out who can be a nearest relative. Nearest relatives have rights to information about the detention. Mr X’s mother was in a different town so the conversation was by telephone.
12. An Approved Mental Health Practitioner (AMHP) acting on behalf of the Council carried out the formal assessment. The assessment took into account two doctors’ recommendations that Mr X should be detained in hospital. The Trust’s complaint response to Mr X says the following about the doctors’ reasoning for recommending a detention.
• Clinicians considered admission to hospital was the least restrictive option available at the time, to assess Mr X and establish if he needed treatment for a mental health disorder.
• They considered Mr X did not have insight into his condition or capacity to accept an informal hospital admission. They therefore decided it would be appropriate to detain Mr X under the Act.
13. The formal assessment concluded Mr X met the criteria for detention under section 2 of the Act. The purpose of detention under section 2 is for assessment of a patient’s mental health and to provide any treatment they might need. Patients can be detained under section 2 for a maximum of 28 days.
14. Mr X was detained in hospital under section 2 of the Act on the day of the assessment. Six days into the detention, Mr X’s mother used her legal right under the Act to discharge him from hospital detention.

Analysis

15. The Code says professionals should engage with patients “in the process of reaching decisions which affect their care and treatment under the Act” wherever possible. This means the organisations had the discretion not to tell Mr X or his family that they were considering detention in hospital, if they had good reason for this. The available records indicate that the organisations:
• considered whether to discuss the option of detention before the assessment;
• had cogent reasons for not doing so; and
• made a written record of their reasons.
16. The records also indicate the organisations discussed medication and voluntary hospital admission with Mr X and that he would not agree to this.
17. I therefore consider it unlikely that an investigation by the Ombudsmen would find fault in:
• the way the organisations decided not to tell Mr X and his family earlier that they were considering hospital detention; or
• relation to the complaint about not discussing options other than hospital detention with Mr X.
18. The record of the AMHP’s assessment includes the opinions of two doctors who met with Mr X during or just before the assessment. The record details:
• the AMHP’s and doctors’ recollection of their conversations with and observations of Mr X;
• relevant clinical history from previous records; and
• their professional opinions on why Mr X met the criteria for hospital detention.
19. The assessment records are in accordance with the Code and provide cogent reasons for the professionals’ opinions. It is therefore unlikely that an investigation by the Ombudsmen would find fault with them, even though Mr X disagrees with the professionals’ opinions.
20. For all the reasons set out above, an investigation by the Ombudsmen is unlikely to uphold Mr X’s complaint that the organisations made the wrong decision to apply for him to be detained in hospital.
21. I also consider that an investigation by the Ombudsmen is unlikely to find fault with the Trust’s complaint response, even though Mr X disagrees with it. This is because the Trust’s letter:
• addresses the key points Mr X made in his complaint;
• explains its answers and supports them with reference to records; and
• apologises for issues such as not telling Mr X it had contacted the DVLA and identifies this as a learning point.

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Final decision

22. We will not investigate Mr X’s complaints about the Council and Trust. This is because an investigation is unlikely to find fault in the organisations’ actions.

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Investigator's decision on behalf of the Ombudsman