Summary: Mr A complained about a Mental Health Act assessment. We will not investigate his complaint because we are not likely to find an Approved Mental Health Professional for Liverpool City Council, or two Section 12 doctors for Mersey Care NHS Foundation Trust and NHS Cheshire and Merseyside Integrated Care Board acted with fault.

The complaint

1. Mr A complains about the way his Mental Health Act assessment was conducted in March 2024 by a doctor from Mersey Care NHS Foundation Trust (the Trust), another doctor on behalf of NHS Cheshire and Merseyside ICB (the ICB) and an Approved Mental Health Practitioner from Liverpool City Council (the Council).
2. Mr A says the assessment contained false information which led to him being wrongly detained under Section 2 of the Mental Health Act 1983. Also, the Trust’s doctor was not impartial and ignored his evidence during the assessment.
3. Mr A says the decision to detain him as had a significant impact on his employment opportunities and progression in life.
4. Mr A would like the organisations to acknowledge their fault, an apology, systemic improvements and financial redress for the impact on his employment opportunities.

Back to top

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)

Back to top

How I considered this complaint

7. I considered information provided by the complainant and the organisations.
8. Mr A had an opportunity to comment on my draft decision. I have considered his comments before making my final decision.

Back to top

What I found

Relevant law and guidance

9. 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 include an Approved Mental Health Professional (AMHP) and usually (but not always) two doctors who have been specially approved to carry out MHA assessments (Section 12 doctors). 
10. The AMHP is responsible for deciding whether to go ahead with the application to detain the person and for telling the person. Any admission to hospital under the MHA should be in the best interests of the person and they should not be detained if there is a less restrictive alternative. Local authorities are responsible for the actions of AMHPs.  
11. When Section 12 doctors make recommendations under Sections 2 or 3 of the MHA, they are acting under powers which have been given to them under the MHA. Ultimately, the doctors are providing their medical recommendations on behalf of the NHS. Because of this, the Parliamentary and Health Service Ombudsman can consider complaints about this work.
12. The ‘Mental Health Act 1983: Code of Practice’ (the Code) provides statutory guidance to professionals on how they should carry out functions of the MHA. Specifically, at point 14.73, it says: “Where practicable, at least one of the medical recommendations must be provided by a doctor with previous acquaintance with the patient…It is sufficient for the doctor to have had some previous knowledge of the patient’s case.”
13. In March 2024, one of the Section 12 doctors was working on behalf of the NHS Trust that detained Mr A under Section 2. The ICB had a legal responsibility to pay the other Section 12 doctor for attending to complete the MHA assessment. The ICB is therefore the responsible commissioner. This explains why we are holding the Trust and the ICB responsible for the Section 12 doctors.
14. The purpose of detention under Section 2 of the Mental Health Act 1983 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.
15. People who have been detained under the MHA (or their nearest relative) can apply for a hearing to the First‑Tier Tribunal (Mental Health) if they disagree with the decision. The Tribunal must discharge the person from detention if, on the day of the hearing, they do not meet the criteria needed for detention. 

Background

16. In March 2024, following concerns about Mr A’s mental health, an AMHP called a MHA assessment. Following recommendations from two doctors (one Section 12 approved), the Trust detained him under Section 2 of the MHA and admitted him to a mental health ward.
17. Mr A appealed his detention to the Tribunal a few days later, who decided he should remain under detention.
18. The Trust later discharged Mr A from Section 2 in July 2024.

My view

19. I will not investigate Mr A’s complaint. I will explain why.
20. Mr A’s complaint is about the decision making of the Section 12 doctors and AMHP when they recommended detaining him under Section 2. He says his detention was based on false information including that he wrongly suffered with delusional disorder.
21. The AMHP’s report noted that Mr A did not accept he had a “delusional belief system” or that he needed support from mental health services. I understand Mr A says the AMHP and Section 12 doctors ignored his evidence to refute the delusional disorder diagnosis. However, I have seen the AMHP considered Mr A’s views, his psychiatric history, recent lack of engagement with mental health services and clinical diagnoses when recommending he should be detained. That was in line with the Code. I am unlikely to find the AMHP and Section 12 doctors acted with fault.
22. Mr A also appealed his detention under Section 2 to the Tribunal. The Tribunal upheld his detention and agreed he need further assessment of his mental illness Based on this, I would not likely find the AMHP and Section 12 doctors acted with fault by deciding he needed assessment for delusional disorder.
23. Mr A says the Trust’s doctor had a conflict of interest. The Trust had previously assigned that doctor to provide a second opinion on Mr A’s mental health diagnoses before the Trust detained him under the MHA. But that second opinion did not ultimately go ahead.
24. I do not consider we would find the Trust acted with fault. The Trust’s doctor had previous knowledge of Mr A’s situation, given he was assigned to provide a second opinion. While the Trust’s doctor did not personally review Mr A before the MHA assessment, I consider the Trust acted in line with the Code by asking that doctor to carry out the medical examination.

Back to top

Decision

25. I will not investigate Mr A’s complaint because I am not likely to find the AMHP or Section 12 doctors acted with fault during the MHA assessment.

Back to top

Investigator's decision on behalf of the Ombudsman