Summary: Mr X complains about the way London Borough of Wandsworth and South West and St George’s Mental Health NHS Trust detained him in hospital for mental health treatment. We will not investigate Mr X’s complaint. We are unlikely to find fault in the way Mr X was assessed before being detained. There is another organisation who is more suitable to consider the rest of his complaint.

The complaint

1. Mr X complains about the way London Borough of Wandsworth (the Council) and South West and St George’s Mental Health NHS Trust (the Trust) detained him in hospital for mental health treatment.
2. Mr X says he was held for six days with no legal basis under the Mental Health Act 1983 (the Mental Health Act) and without any appeal rights.
3. Mr X would like staff held to account, systemic changes and £10,000 in recognition of the distress caused to him by these events.

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The Ombudsmen’s role and powers

4. The Ombudsmen consider complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsmen consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A (1), as amended).
5. The Ombudsmen provide a free service but must use public money carefully. They may decide not to start or continue with an investigation if they believe:
• it is unlikely they would find fault, or
• there is another organisation better placed to consider this complaint

(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

6. I considered evidence provided by Mr X, the Council and the Trust as well as relevant law, policy and guidance.
7. Mr X had an opportunity to comment on my draft decision. I considered his comments before making a final decision.

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What I found

What happened

8. Mr X has a history of mental health problems.
9. In May 2024, Mr X called the police to say he was experiencing suicidal thoughts and had taken an overdose. The police took Mr X to St George’s Hospital, using section 136 of the Mental Health Act.
10. Section 136 is an emergency power which allows for the removal of a person from a public place to a place of safety, if the person appears to a police officer to be suffering from a mental disorder and to be in immediate need of care or control for the safety of themselves or others. The person should then receive a mental health assessment, and any necessary arrangements should be made for their ongoing care. A person can be detained for up to 24 hours under section 136, with a possible 12-hour extension.
11. In hospital, Mr X was assessed under the Mental Health Act. This usually involves three professionals needing to agree that the person needs to be detained in hospital. Mr X was assessed by an Approved Mental Health Professional (AMHP) from the Council and two doctors from the Trust who have been specially approved to carry out Mental Health Act assessments. 
12. Both doctors and the AMHP agreed that an application should be made to detain Mr X under section 2 of the Mental Health Act for his own safety. The purpose of detention under section 2 of the Mental Health Act is for assessment of a patient’s mental health and to provide any treatment they might need.
13. However, Mr X was not formally detained under section 2 as an AMHP cannot make an application for detention unless an appropriate mental health bed is available.
14. Due to concerns over his safety, Mr X was moved in the short term, under section 136, to a Health Based Place of Safety (the Place of Safety) while the Trust sourced a mental health placement.
15. Mr X’s section 136 expired at 2am the next day as 24 hours had passed. Mr X continued to be held in the Place of Safety awaiting a mental health bed.
16. Four days later, there was still no bed available. Mr X was discharged home.

Analysis

17. For reasons I will explain, this decision only addresses events occurring in the first 24 hours of Mr X’s detention, while he was detained under section 136.

Mental Health Act assessment

18. Mr X complains he was detained in hospital for six days with no legal framework under the Mental Health Act and he was not allowed to appeal his detention.
19. First, I have considered how Mr X was assessed under the Mental Health Act.
20. The Ombudsmen cannot make or remake professional judgements about whether detention under the Mental Health Act is appropriate. Our role is to consider if the professionals followed the steps set out in the Mental Health Act and the associated Code of Practice. Where the process has been followed, we would not question the judgements made at the end of it.
21. Both doctors and the AMHP agreed that Mr X required detention under section 2 to ensure his own personal safety. During the assessment, all three professionals considered Mr X’s mental capacity at the time, risk factors and whether any less restrictive options were available. I have not found any indication of fault in the way Mr X’s assessment was carried out.

Right of appeal

22. Mr X complains that he was not informed of his right to appeal.
23. Detention under section 2 does not formally start until a person arrives at an appropriate mental health placement, has their paperwork checked by a hospital manager and is formally admitted. Mr X was not formally detained under section 2 as there were no mental health beds available. As such, Mr X could not have appealed the detention under section 2 via the mental health tribunal.
24. There is no right of appeal to section 136, which is usually only in force for 24 hours.
25. The AMHP is responsible for deciding whether to go ahead with the application to detain the person and for telling the person. The AMHP would usually inform a person of their appeal rights. I have not been able to confirm whether the AMHP told Mr X about his appeal rights, as this is not recorded in the documents.
26. However, as explained above, it does not appear there were any appeal rights available to Mr X in relation to section 2 or section 136.

Health Based Place of Safety

27. Mr X remained in the Place of Safety for several days after the section 136 expired. Mr X complains he was held in hospital with no legal grounds to do so under the Mental Health Act and without any formal appeal rights.
28. When the section 136 expired after 24 hours, Mr X was in a Place of Safety managed by the Trust. The Trust was also responsible for sourcing a mental health bed. Without a suitable placement, the application for section 2 could not be made and the AMHP had no further involvement. The Trust managed Mr X’s care after he arrived at the Place of Safety, including any decisions about how to detain him further. This is a health only matter.
29. The Parliamentary and Health Service Ombudsman (PHSO) is already considering Mr X's concerns about his inpatient health care during his admission to the Place of Safety. PHSO are the most appropriate organisation to consider Mr X’s complaint about his continued detention after the section 136 had expired.

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Decision

30. We will not investigate Mr X’s complaint about the way he was initially detained in hospital for mental health treatment. This is because an investigation is unlikely to find fault in relation to how the Mental Health Act assessment was conducted. PHSO is the most appropriate organisation to consider his concerns about the grounds for his continued detention in hospital.

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Investigator's decision on behalf of the Ombudsman