Summary: Mrs B has complained about a lack of support for her and her son from a Council, Integrated Care Board and Trust leading to distress for her. We do not find fault in the Council, Integrated Care Board and Trust.

The complaint

1. Summary Mrs B has complained about a lack of support and care for her son, Mr C, provided under s117 of the Mental Health Act by Tyneside Metropolitan Borough Council (the Council) and Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust (the Trust) since December 2023. NHS North East & North Cumbria Integrated Care Board (the ICB) was also jointly responsible with the Council for s117 aftercare.
2. Mrs B complains that two mental health assessments carried out by the Trust did not result in her son’s detention for treatment.
3. In addition, she has complained about his Community Psychiatric Nurse (CPN) and the Early Intervention in Psychosis Team (EIP) for not providing him with treatment.
4. Mrs B said the Council and Trust made no attempts to find Mr C alternative accommodation, resulting in Mrs B having to house him and be his sole carer. Mrs B also had to witness his mental deterioration.
5. Mrs B also said the Trust has been unhelpful in its communications with her in not providing her with information and in declining to speak to her.
6. As a result of this complaint Mrs B would like:

• an apology for the dismissive and disrespectful way she was treated,
• staff training at all levels on positive ways to interact with worried relatives and carers.
• clarity on the role of a CPN as she experienced two very different approaches from the ones she dealt with,
• clarity on how the law such as the Mental Health Act, the Mental Capacity Act and Human Rights legislation is interpreted, particularly regarding a patient’s best interests,
• recognition of how the above laws impact on carers and family members who also have human rights,
• willingness to accept a lack of expertise in a particular aspect of a patient’s care and an openness to consult with other areas who may possess expertise and insights into related and underlying conditions which may enhance a patient’s recovery; and
• EIP managers to arrange a meeting with the Carers Service in South Tyneside to hear parent’s experiences of how their current practices impact carers and relatives.

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The Ombudsmen’s role and powers

7. 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).
8. We investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, we 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).
9. If it has, they may suggest a remedy. Our recommendations might include asking the organisation to apologise or to pay a financial remedy, for example, for inconvenience or worry caused.  We might also recommend the organisation takes action to stop the same mistakes happening again.
10. If we are satisfied with the actions or proposed actions of the organisations that are the subject of the complaint, we can complete our investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(1), as amended)

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How I considered this complaint

11. I considered evidence provided by Mrs B, the Council and the Trust as well as relevant law, policy and guidance.
12. Mrs B, the Council and the had an opportunity to comment on my draft decision. I considered any comments before making this final decision.

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What I found

Legal framework

13. The Mental Capacity Act 2005 (the MCA) applies to people who may lack mental capacity to make certain decisions. Section 42 of the MCA provides for a Code of Practice (the Code) which sets out steps organisations should take when considering whether someone lacks mental capacity.
14. Both the MCA and the Code start by presuming individuals have capacity unless there is proof to the contrary. The Code says all practicable steps should be taken to support individuals to make their own decisions before concluding someone lacks capacity. The Code says people who make unwise decisions should not automatically be treated as not being able to make decisions. Someone can have capacity and still make unwise decisions.
15. The Code says, at paragraph 2.11, there may be cause for concern if somebody repeatedly makes unwise decisions exposing them to significant risk of harm or exploitation. The Code says this may not necessarily mean the person lacks capacity but further investigation may be required.
16. A key principle of the Mental Capacity Act 2005 is that any act done for, or any decision made on behalf of a person who lacks capacity must be done, or made, in that person’s best interests. Section 4 of the Act provides a checklist of steps that decision-makers must follow to determine what is in a person’s best interests. The decision-maker must also consider if there is a less restrictive option available that can achieve the same outcome.
17. If there is a conflict about what is in a person’s best interests, and all attempts to resolve the dispute have failed, the Court of Protection might be asked to decide what is in the person’s best interests.
18. Under the Mental Health Act 1983, 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’.
19. 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 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.
20. Before the person is discharged, a social care assessment should take place to assess if they have any social care needs that should be met.
21. Section 117 of the Mental Health Act imposes a duty on health and social services to meet the health/social care needs arising from or related to the person’s mental disorder for patients who have been detained under specific sections of the Mental Health Act.
22. Section 117 aftercare services sometimes include accommodation if this is central to maintaining their mental health and to keep them from needing to be detained again.

Background

23. Mr C was sectioned under the Mental Health Act in 2022 and was discharged from hospital to Mrs B’s home. During his stay with her Mrs B complained about a lack of support for her and Mr C to allow him to move out and maintain his mental health. Mr C was eventually sectioned again in February 2025 and no longer lives with Mrs B.

My investigation

24. Mr C has not given his consent for his mother to have information about his treatment and interactions with the Council or the Trust. We have investigated this case by looking at the records but cannot disclose any details from these records. We have considered whether the Council and Trust offered reasonable support and how it interacted with Mrs B.
25. Regarding the Council’s support of Mr C, specifically with accommodation, I have reviewed the records and am satisfied that the Council made reasonable attempts to support Mr C to find accommodation and it was not through fault on the part of the Council that Mr C did not move out and obtain accommodation.
26. The records do not show that accommodation was part of Mr C’s s117 aftercare and so it was not incumbent on the Council and ICB to accommodate Mr C under this legislation.
27. Regarding the Mental Health Act assessments, these are subjective to the people carrying out the assessment. However, we have reviewed the records and not found any fault with the doctors or Council’s actions.
28. Regarding communication, we could not find instances of missed communication or rudeness from staff to Mrs B. We are not concluding this did not happen, but without any written evidence in the records, we cannot find fault with the Trust and Council.
29. Regarding the Trust, we found evidence in the records that the EIP and CPN attempted to provide Mr C and Mrs B with reasonable support during this period.
30. In view of this we have not found sufficient evidence of fault in this case.

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Final decision

31. Following an investigation, we did not find fault on the part of the Council, ICB or Trust in this case.

Investigator’s decision on behalf of the Ombudsmen

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Investigator's decision on behalf of the Ombudsman