Summary: The Ombudsmen will not investigate this complaint about a decision to detain someone under the Mental Health Act. We are unlikely to find fault in the actions of the Trust’s mental health team before the assessment. Investigation into the actions of the Approved Mental Health Professional is unlikely to find significant failings in the process they followed.

The complaint

1. Mrs T complains about Leeds City Council (the Council) and Leeds & York Partnership NHS Foundation Trust (the Trust). Her complaints concern events leading up to her admission to hospital under the Mental Health Act (MHA).
2. In particular Mrs T complaints that:
• she was wrongfully sectioned based on false allegations;
• the Council used section 135 of the Mental Health Act (MHA) to forcibly enter her home;
• the Approved Mental Health Practitioner (AMHP) ignored information available to them during the MHA assessment about Mrs T not being a mental health patient.
3. Mrs T says the failing led to her being deprived of her liberty. She says she no longer trusts the NHS or the Council and she feels vulnerable to false allegations.
4. Mrs T says she wants apologies, records correcting and compensation.

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The Ombudsmen’s role and powers

5. The Ombudsmen investigate 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).
6. When doctors make recommendations under sections 2, 3 or 4 of the MHA they are acting under powers which have been given to them under the MHA. They are acting as individuals and not on behalf of the NHS. This means we cannot investigate complaints about their actions and recommendations. (Health Service Commissioners Act 1993, sections 2, 2A, 2B and 3)  
7. The Ombudsmen cannot question whether an organisation’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended, and Health Service Commissioners Act 1993, sections 3(4)- 3(7))
8. 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. (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

9. I considered information from Mrs T, the Council and the Trust including relevant complaint correspondence and responses. Mrs T had an opportunity to comment on a draft decision statement and I considered her comments before reaching a final decision.

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What I found

Relevant legislation and guidance

10. Under the 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. The AMHP is responsible for deciding whether to go ahead with an application to detain the person. Admission should be in the best interests of the person and they should not be detained if there is a less restrictive alternative.
11. The Ombudsmen cannot make or remake professional judgements about whether detention under the MHA is right. The LGSCO’s role is to consider if the AMHP followed the steps set out in the MHA and the associated Code of Practice. Where an AMHP has followed process, we would not question the judgements they made at the end of it.
12. Section 135 of the MHA allows the police to enter someone’s home so a mental health assessment can be done. The police must have a warrant from the magistrate's court allowing them to enter a home. An application for a warrant must be made by an AMHP. The AMHP may ask for a warrant if the person is likely to refuse the health professionals entry to where they live.

Brief background

13. In February 2022 the school Mrs T’s daughter attended contacted the Single Point of Access at the Trust (a service connecting people needing urgent help for their mental health) with concerns about her mental health. A senior practitioner from the Trust contacted Mrs T to discuss this directly with her. During the call, the senior practitioner had concerns and asked to arrange a face-to-face mental health assessment. Mrs T declined an assessment.
14. The senior practitioner sought advice from one of the Trust’s psychiatrists. They decided to attend Mrs T’s home to offer a mental health assessment the following day. Mrs T declined to answer the door and said she did not need any help.
15. A multidisciplinary team discussed the events and Mrs T’s mental health history. They considered because Mrs T would not engage face-to-face, the only option available was to request a MHA assessment. The AMHP applied to the Courts for a warrant to enter Mrs T’s property to carry out a MHA assessment.
16. The AMHP and two doctors attended Mrs T’s home the following day and completed a MHA assessment. The doctors felt Mrs T was experiencing a relapse of psychotic symptoms that needed treatment. They and the AMHP agreed Mrs T needed admission to hospital. Mrs T was admitted to hospital under section 2 of the MHA.

My assessment

17. The Trust has a duty to consider information it receives about someone’s mental health. The MHA Code of Practice sets out that any care and treatment should be the least restrictive option. The Trust tried to engage with Mrs T by telephone and by visiting her to offer an assessment and help outside of the MHA. The Trust staff also sought advice from clinicians to inform their view.
18. The Trust had a duty to assess Mrs T’s mental health. As she did not engage or agree with any interventions outside of the MHA, this left the Trust with little choice than to arrange a MHA assessment to ensure Mrs T’s safety. I consider we are therefore unlikely to find indications of fault by the Trust about how it dealt with the referral and made its decision to request a MHA assessment.
19. The AMHP needed to ensure the relevant professionals could complete an assessment under the MHA. Mrs T had already refused to engage with the Trust when it tried less restrictive ways to assess her mental health. The AMHP’s decision to request a warrant under section 135 of the MHA therefore appears in line with the Code of Practice. I do not consider there are indications of fault.
20. The Ombudsmen cannot make or remake professional judgements about whether a detention under the MHA is right. The LGSCO’s role is to consider if the AMHP followed the steps set out in the MHA and the associated Code of Practice. Where an AMHP has followed process, we would not question the judgements they made at the end of it.
21. With regards to the AMHP dismissing the fact Mrs T was not a mental health patient at the time, the Council’s complaint response said it was aware of this. A mental health assessment is time specific and a previous discharge from mental health services does not necessarily mean a future admission would not be needed.
22. The doctors' were concerned Mrs T would experience further deterioration in her mental health and that she would not accept required treatment in the community. The AMHP considered this when agreeing to Mrs T’s hospital admission under the MHA. The AMHP appears to have followed the process as set out in the Code of Practice and considered relevant information including the two doctors’ views. We are therefore unlikely to find fault by the Council.

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Final decision

23. My view is we should not investigate this complaint. This is because it is unlikely an investigation into the Trust’s actions prior to the MHA assessment or the actions of the AMHP would lead to findings of significant failings.

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Investigator's decision on behalf of the Ombudsman