Summary: We have found fault in the Council’s actions. The Council failed to properly consider Mrs B’s request for an assessment of her husband under the Mental Health Act 1983 and its communications with Mrs B were poor. This fault has caused distress to Mrs B and her husband. The Council has agreed to apologise to Mrs B and her husband and to pay them a small financial remedy.

The complaint

1. Mrs B complains on behalf of her husband, Mr B. She says the Council failed to properly consider her request for an assessment of Mr B under the Mental Health Act 1983 and its communications with her were poor.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(1), as amended)

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What I have and have not investigated

4. I have investigated the actions of the Council and the Approved Mental Health Professionals (AHMP) who are employed by the Council. I have not investigated the actions of any professionals employed by the NHS such as mental health nurses or psychiatrists. The Parliamentary and Health Services Ombudsman investigates complaints against the NHS.

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How I considered this complaint

5. I have discussed the complaint with Mrs B and I considered evidence provided by Mrs B and the Council as well as relevant law, policy and guidance.
6. Mrs B and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Law, guidance and policies

Mental Health Act 1983

7. The Mental Health Act 1983 is the legislation which covers the assessment, treatment and rights of people with a mental health disorder. ‘The Code of Practice: Mental Health Act 1983’ provides guidance to professionals on their responsibilities under the Act.
8. Under the Mental Health Act 1983 (MHA), when someone has a mental disorder and is putting their safety or someone else’s at risk they can be detained in hospital against their wishes. Usually, three professionals need to agree that the person needs to be detained in hospital. These include an Approved Mental Health Professional (AMHP) and usually (but not always) two doctors who have been specially approved to carry out Mental Health Act assessments.
9. The nearest relative is a term under the Mental Health Act and the Act provides a list of people who are the nearest relative. Nearest relatives have certain rights under the Act.
10. Section 13(4) of the Act says:
• It shall be the duty of a local social services authority, if so required by the nearest relative of a patient residing in their area, to make arrangements … for an approved mental health professional to consider the patient’s case with a view to making an application for his admission to hospital; and if in any such case that professional decides not to make an application he shall inform the nearest relative of his reasons in writing.
11. The Code of Practice says the following about the AMHP’s duties if a request for an assessment is made by a nearest relative:
• Section 13 of the Act places a duty on councils to arrange for an AMHP to consider the care of any patient who is within their areas if they have reason to believe that an application for detention in hospital may need to be made in respect of the patient. Local authorities must make such arrangements if asked to do so by the nearest relative.
12. The Code of Practice also says:
• Unless different arrangements have been agreed locally between the relevant authorities, AMHPs who assess patients for possible detention under the Act have overall responsibility for coordinating the process of assessment.
• Before it is decided that admission to hospital is necessary, consideration must be given to whether there are alternative means of providing the care and treatment which the patient requires.
• Any admission to hospital under the Mental Health Act should be in the best interests of the person and they should not be detained if there is a less restrictive alternative.
• Because a proper assessment cannot be done without considering alternative means of providing care and treatment, AMHPs and doctors, should, as far as possible in the circumstances identify and liaise with services which may potentially be able to provide alternatives to admission to hospital, such as crisis and home treatment teams.
• Where the AMHP has considered a patient's case at the request of the nearest relative, the reasons for not applying for the patient's admission must be given to the nearest relative in writing. Such a letter should contain as far as possible sufficient details to enable the nearest relative to understand the decision while at the same time preserving the patient’s right to confidentiality.

What happened

13. Mr B is an older man who has a mental health diagnosis and dementia. He lives with Mrs B who is his full-time carer.
14. The Council had been previously involved with Mr B following a hospital admission, but there was no care package in place.
15. The Later Life And Memory Service (LLAMS) in the area comprises different services including the Community Mental Health team and an assessment team with mental health nurses. LLAMS had been previously involved with Mr B because of his dementia and his mental health diagnosis.
16. Mrs B contacted the Council’s Mental Health Team on 9 December 2024 and requested an urgent assessment of Mr B under the Mental Health Act as his nearest relative. She said Mr B had deteriorated in recent weeks. He was expressing delusional ideas and had been verbally abusive towards her.
17. The Council’s AMHP referred the matter to the LLAMS’ psychiatrist. The AMHP asked the psychiatrist to arrange a review of Mr B and to advise whether an assessment was necessary. The AMHP said they were happy to complete a joint assessment if the psychiatrist thought this was necessary.
18. The psychiatrist visited Mr B later that day and sent an e-mail to the AMHP to say that a Mental Health Act assessment was not needed. The LLAMS duty worker should arrange support. The AMHP said there was ‘no further action’ for the AMHP team.
19. Mrs B rang the Council on 10 December 2024 at 14:40. She said Mr B had left the house at 11:00 to go to the bank and had not returned. Mrs B was not satisfied with the input from the psychiatrist in the previous day. She said the psychiatrist had spent a minimal amount of time with Mr B.
20. The case note of the conversation says: ‘Discussion held on nearest relative rights and asking for assessment. We discussed LLAMS visited yesterday to review [Mr B's] mental health. If at that time it was deemed a hospital admission was needed he could have completed a medical recommendation however it was deemed this was not required by [the Doctor] following his review yesterday.’
21. The AMHP agreed to call LLAMS to find out what the next step was in terms of follow up and support for Mr B. Mrs B agreed to call the police. It was agreed that the AMHP would ring Mrs B back.
22. The AMHP spoke to a nurse at LLAMS. It had been agreed that LLAMS would hold a multi-disciplinary meeting on the next day and formulate a plan for Mr B. The doctor had advised Mrs B to call the police as it was out of character for Mr B not to return home.
23. The AMHP rang Mrs B and Mrs B said she had already called the police and they were currently at the home. Mr B returned home in the evening. There was no further involvement from the Council in the following weeks.

Complaint – January 2025

24. Mrs B complained to the Council in January 2025 and said:
• She rang the Council on 9 December 2024 as Mr B was experiencing a severe mental health crisis. She told the Council officer that she was making a request for an assessment of Mr B under the Mental Health Act as a nearest relative. The officer told her she was not entitled to request an assessment as a nearest relative.
• Mrs B ended the call and checked that she still had the same rights under the Mental Health Act. She rang the Council again and spoke to an AMHP. She said the AMHP told her, without obtaining any further information about Mr B, that, as Mr B was a patient of LLAMS, the request for an assessment would be sent to the LAMMS to be triaged.
• She was then contacted by a psychiatrist from LLAMS who visited Mr B later that day.
• She heard nothing further from the Council so rang the Council again to be told that the psychiatrist had recorded that an assessment was not necessary.
• Mrs B said her request for an assessment had not been appropriately responded to. She said the AMHP did not ask for any information from her, the nearest relative. There had been no explanation on how the AMHP reached their decision regarding Mr B without speaking to Mr B or Mrs B. She said nobody asked her why she had made the request or what Mr B’s history was. She felt the Council absolved itself of any responsibility to make enquiries before making its decision.
• Mrs B said that, 18 hours after the decision was made not to further assess Mr B, he left the home and went missing. The police became involved and, in the end Mr B did not return until the evening. Mrs B said that Mr B's physical and mental health deteriorated in the weeks following this incident and there was no further contact from the Council.

Council’s response – February 2025

25. The Council responded to Mrs B’s complaint in February 2025 and said:
• There was uncertainty among the Contact Centre staff regarding the process of actioning a nearest relative request.
• The manager had requested that all Contact Centre staff were reminded that nearest relatives had the right under the Mental Health Act to request a Mental Health Act assist assessment. In addition the Council had requested Contact Centre staff to be reminded of how to access the support from an AMHP.
• The AMHP decided that they would request the psychiatrist from LLAMS to complete a home visit to consider whether an admission to hospital was required. The decision to request the psychiatrist to complete an assessment in the first instance was discussed with Mrs. B.
• Following an assessment, the psychiatrist determined Mr B did not meet the criteria for admission to hospital under the Mental Health Act.
• The AMHP thought that the psychiatrist was going to inform Mrs B of the outcome of their assessment and whether they would progress to a Mental Health Act assessment. This is why the AMHP did not contact Mrs B.
• The Council apologised for this and said that it would ensure that all AMHPs communicate the outcome of nearest relative requests to the nearest relative in writing.

Council’s response – June 2025

26. Mrs. B was not satisfied with this response and the Council sent a further response to Mrs B in June 2025. The Council said:
• All parties failed to listen to what Mrs B actually wanted which was not an assessment from the psychiatrist but the support and advice from the AMHP. This approach failed to meet either the principle of respect and dignity which focused on the need to listen or the wider implications of section 13 of the Mental Health Act.
• The Council would liaise with its training partners to include Mrs B's experience as part of the training for AMHPs. The Council had also liaised with colleagues in the Contact Centre regarding requests from a carer for a Mental Health Act assessment. There had also been a direct discussion and reflection of Mr B’s case within the AMHP forum.
• The Council acknowledged there had been missed opportunities in Mr B's case. The Council acknowledged that it actions had been process driven rather than person centred.

Analysis

27. It is not the Ombudsman’s role to carry out an assessment or to say what the outcome of an assessment should have been. I have considered what the Council’s duties were and compared this with what the Council has done.
28. Mrs B is Mr B’s nearest relative and she therefore had a legal right to request an assessment under the Mental Health Act. The Council’s staff initially told her that she did not have this right. The Council has already upheld the complaint that this advice was wrong and I agree this was fault.
29. Once Mrs B made her request for an assessment under the Mental Health Act, the Council had a duty to properly consider this request. The Council should be able to evidence how it considered the request and should provide the reasoning for any decision in writing.
30. The Council has already upheld Mrs B’s complaint that the Council did not properly fulfil its duties in this respect and I agree there was some fault. It appears to me that the Council decided that, as soon as the psychiatrist had decided that Mr B would not meet the criteria for detention, its duty had been discharged.
31. The Council made this decision without making any enquiries about Mr B or his history. The Council also did not ask Mrs B what her reasons were for making the request. Mrs B had made the request as she hoped that, even if detention was not the decision, the AMHP would have put in place urgent alternative mental health support in the community as it was the AMHP’s duty to consider the less restrictive option for Mr B. I agree with the Council that the decision making was process driven rather than person centred and there was fault in that respect.
32. There was poor communication from the Council both in its failure to properly talk to Mrs B before it made its decision and then in its failure to formally inform Mrs B of the decision and its reasons for making the decision. This was further fault.

Injustice and remedy

33. When the Ombudsman finds fault, we consider whether this has led to any injustice and, if so, whether the injustice can be remedied. The aim of the Ombudsman’s remedy is to put the person in the position they would have been if the fault had not happened.
34. I cannot say, of course, what the outcome would have been if the fault had not happened. Mrs B says the incident on the following day would not have happened, but I cannot speculate. Therefore, the injustice is distress from uncertainty on what the outcome would have been.
35. In cases such as this one, where there has been no direct financial loss because of the fault, we can recommend a small symbolic sum for distress and I recommend the Council pays Mr and Mrs B £100 each.
36. Mrs B has said that her main reason for coming to the Ombudsman was to ensure that practice at the Council improved so that the same mistakes were not made again. I note that the Council has already made significant service improvements because of Mrs B’s complaint. I hope that Mrs B understands that these service improvements were recommended because of her complaint so her complaint has made a difference. I do not recommend further service improvements as the main areas of concerns have been addressed by the Council.

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Action

37. The Council has agreed to take the following actions within one month of the final decision. It will:
• Apologise to Mr and Mrs B in writing.
• Pay Mr and Mrs B £100 each.
38. The Council should provide us with evidence it has complied with the above actions.

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Decision

39. I find fault causing injustice. The Council has agreed actions to remedy injustice.

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Investigator's decision on behalf of the Ombudsman