Summary: We will not investigate Miss X’s complaint about an Approved Mental Health Professional (for London Borough of Tower Hamlets) and two Section 12 doctors (for East London NHS Foundation Trust and NHS North East London Integrated Care Board respectively). We are unlikely to find fault with their recommendation to detain Miss X under Section 2 of the Mental Health Act 1983.

The complaint

1. Miss X complains about two Section 12 doctors (for East London NHS Foundation Trust and NHS North East London Integrated Care Board respectively) and an Approved Mental Health Professional (for London Borough of Tower Hamlets). She says they wrongly recommended detaining her under Section 2 of the Mental Health Act 1983. She says they did not consider she was physically unwell which impacted her behaviour. They wrongly suggested she wanted to take her son’s cannula out. Also, Miss X says the Approved Mental Health Professional did not inform her of her detention rights.
2. Miss X says events were traumatising for her and the family. She thinks about being detained everyday when she wakes up. She would like an apology and service improvements.

Back to top

The Ombudsmen’s role and powers

3. 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 further investigation would not lead to a different outcome. (Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)
4. When investigating a complaint, if there is a conflict of evidence, the Ombudsmen may make findings based on the balance of probabilities. This means that during an investigation, we will weigh up the available evidence and base our findings on what we think was more likely to have happened. 

Back to top

How I considered this complain

5. I considered information provided by the complainant and the organisations.
6. I considered the Ombudsman’s Assessment Code.
7. Miss X had an opportunity to comment on a draft decision. I considered her comments before making a final decision.

Back to top

What I found

Relevant legislation

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. This is sometimes known as ‘being sectioned’. Usually three professionals need to agree that the person needs to be detained in hospital. These are either an Approved Mental Health Professional (AMHP) or the nearest relative, plus a doctor who has been specially approved in Mental Health Act detentions (Section 12 doctor) and another doctor. The AMHP is responsible for deciding whether to go ahead with the application to detain the person and for telling the person and their nearest relative about this. Admission should be in the best interests of the person and they should not be detained if there is a less restrictive alternative.
9. The purpose of detention under Section 2 of the MHA is to assess a patient’s mental health and to provide any treatment they might need.
10. When Section 12 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. But sometimes those doctors will also be making those recommendations under an NHS contract.
11. In this complaint, the two Section 12 doctors carried out their MHA assessments separately. The first doctor who assessed Miss X worked under their contract with East London NHS Foundation Trust (the Trust). The second doctor did not work for the Trust. Instead, they worked ‘on call’. NHS North East London Integrated Care Board (the ICB) is legally responsible for the actions of the second doctor because the ICB paid them for their work. This explains why the Trust and ICB are both included as organisations in this complaint.

My findings

12. In mid-July 2022, Miss X took her son to the Emergency Department at The Royal London Hospital with symptoms of COVID-19. Staff were concerned about Miss X’s behaviour during her son’s admission, so requested an AMHP arrange a Mental Health Act (MHA) assessment.
13. Later that evening, following an assessment by two Section 12 doctors and an AMHP, the Trust decided to detain Miss X under Section 2 of the Mental Health Act. The AMHP arranged to transport Miss X to another hospital to assess her mental health. Miss X remained at that mental health hospital for three days, when the Trust decided to discharge Miss X from Section 2.
14. Miss X says the Section 12 doctors and AMHP did not consider or treat her physical health before deciding to detain her. She says her physical health caused her concerning behaviour on the ward.
15. In response to Miss X’s complaint, the Trust said: “Although you did not have any physical health checks at [the Royal London Hospital], you had these checks done on your arrival to the ward [at the Trust’s mental health hospital] and further checks whilst on the ward. You did test positive for Covid-19 and your heart rate was initially fast, but this was monitored and noted to improve. There were no other concerning findings.” But it would “endeavour to ensure that basic physical health checks are carried out prior to a Mental Health Act assessment should a person report presenting with a physical illness at the time”.
16. Having reviewed the MHA assessment documents, on the balance of probabilities, I am unlikely to find fault with the decision to detain Miss X. The Section 12 doctors recorded concerns about her irrational thinking, inability to focus on conversation, slapping her head, and wanting to take her baby out of hospital. That posed a significant risk to her and her baby. The evidence showed Miss X could not decide to agree an informal admission. Also, she could not safely receive support at home (because of previous lack of engagement). Miss X disagrees with those recorded concerns.
17. I am not persuaded the outcome would likely have been different even if the Trust considered Miss X’s physical health during the MHA assessment. In any event, the Trust has agreed to implement service improvements around physical health checks. I do not consider an investigation could achieve anything more.
18. Miss X does not agree she wanted staff to remove her son’s cannula. She said a nurse had told her the cannula was not working.
19. In their report, the AMHP noted: “[Miss X] then pointed at her baby’s feeding tube and said “he does not need this, he should be out of hospital, I should take him home”. One of the Section 12 doctors also recorded: “In front of us [Miss X] demanded from the [doctor] that he removes the cannula, she was confrontational said ‘remove it, its not working’”.
20. I understand Miss X’s view that her comment came from a nurse’s earlier comment about the cannula. However, I am unlikely to find fault with the AMHP and Section 12 doctor’s comments about her. Their statements were factually accurate based on Miss X’s actions then.
21. Miss X disagrees the AMHP told her of her detention rights.
22. In their report, the AMHP noted: “I have informed [Miss X] of her detention and outlined her rights to her”.
23. I am unlikely to find fault here. I do not doubt Miss X’s version of events as she remembers them. But I am more persuaded by the written evidence from the time. I consider on the balance of probabilities, the AMHP told Miss X of her detention rights.
24. Overall, I do not doubt how distressing the situation was for Miss X. However, I cannot say the Section 12 doctors or AMHP caused that injustice to her.

Back to top

Final decision

25. I do not consider we would likely find fault with the actions of the Section 12 doctors and AMHP.

Back to top

Investigator's decision on behalf of the Ombudsman