Explaining and understanding Section 117 Aftercare
What is section 117 aftercare?
If you or your loved one have experienced a hospital stay under section 3, 37,45A, 47 or 48 of the Mental Health Act 1983 and if you are placed on a Community Treatment Order (section 17A), after discharge from hospital, you should be entitled to free aftercare when you leave. This is known as ‘section 117 aftercare’ and is not means tested. The aim of this aftercare is to reduce the risk of you or your loved one becoming unwell again and needing hospital readmission.
What Legislation says:
The main objective is to provide aftercare services that “meet a need arising from or related to the patient’s mental disorder and [reduce] the risk of a deterioration of the patient’s mental condition...” (Mental Health Act 1983: Code of Practice, 2015, paragraph 33.3).
What will the aftercare cover?
You or your loved one may get specialist housing, social care, help to meet other people, help with work or education and free prescriptions for mental health medication.
Who organises Section 117 funding?
The responsibility of arranging a person's funding for Section 117 aftercare falls to either:
- Local Authority / Social Services
- Local NHS Clinical Commissioning Group (CCG)
They will either provide the aftercare services or organise for them to be provided with the help of voluntary agencies.
Clinical Commissioning Groups - what are they?
Clinical Commissioning Groups (CCG’s) are responsible for arranging NHS services. Clinical Commissioning Groups were National Health Service organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. They replaced the old Primary Care Trusts.
Section 117 aftercare assessment process
It is likely that the following may happen:
- A section 117 planning meeting will be arranged. The team that has supported you or your loved one on the ward and your named practitioner should also be there.
- A care plan will be drawn up describing the support you will receive and any services to be provided and who is responsible for them. A copy of the care plan should be offered to you.
- The NHS and social services have a legal duty to commission any aftercare services. The people identified as responsible for each service at the planning meeting have the duty of ensuring that the care plan is in place by the time you are discharged from hospital.
- Following discharge, the care plan will be implemented by the care home providing your support.
The amount awarded by the local authority must be the amount that it costs the local authority to meet the person’s needs. So, while section 117 aftercare is described as free aftercare, the Local Authority may decide that they will award a certain budget and this may not be enough to cover the care home costs in their entirety.
If you choose accommodation which costs more than the Local Authority budget awarded to you or your loved one, you may be required to make a First Party Top Up (where you or your loved one can Top Up there own care fees) or to find someone who will pay a Third Party Top.
Please be aware that any care home chosen may also want to complete their own assessment to ensure they can meet your needs before you are accepted into the care home.
What does legislation say regarding choice of care home?
- The Secretary of State may by regulations provide that where -
- the local social services authority under section 117 is, in discharging its duty under subsection
- of that section, providing or arranging for the provision of accommodation for the person concerned;
- the person concerned expresses a preference for particular accommodation; and
- any prescribed conditions are met, the local social services authority must provide or arrange for the provision of the person's preferred accommodation.
However, the following conditions must be met:
- The preferred accommodation is of the same type that the LA has decided to
provide or arrange;
- It is suitable for the person’s needs (i.e. the needs identified in the Care Programme Approach care plan);
- It is available;
- Where the accommodation is not provided by the LA, the provider of the accommodation agrees to provide the accommodation to the person on the LA’s terms; and
- Where the cost of the preferred accommodation is in excess of what the LA would expect to pay, the LA must be satisfied that the person being provided with accommodation is willing and able to make a top up payment for the additional cost and the payer enters into a written agreement with the LA to pay this additional cost
Mental Health Advocacy
Independent Mental Health Advocates can offer an additional safeguard and support for you or your loved one to empower you to be meaningfully involved in your care.
Mental Health Advocates were introduced in 2007 as part of some amendments to the Mental health Act 1983.
What is an independent mental health advocate? (IMHA)
IMHAs will support individuals to inform them of their rights under the MHA1983 and any aspect of their care or treatment under compulsion. You have a legal right to access to an IMHA if you are liable to be detained or are detained under the Mental Health Act 1983. IMHA’s can give people information about their rights under section 117, and also their after-care care planning and also their package of care. They can also help you or your loved one to access legal advice, make a complaint about your treatment and represent you and speak on your behalf at review meetings or hospital manager meetings
You or your loved one can request support from an IMHA at any time after you are likely to be detained or are detained under the Mental Health Act 1983 under section 3, you can request this support via:
- Your responsible clinician (the mental health professional in charge of your care and treatment while you are sectioned under the Mental Health Act- this is usually a Doctor)
- A member of the ward staff
- An approved mental health professional (social workers,nurses,occupational therapists, psychologists.)
Whilst you are in hospital, you should also have access to a telephone, enabling you to contact an IMHA and talk to them in private.
What is an Independent Mental Capacity Advocate? (IMCA)
Under the Mental Capacity Act 2005, there is a legal duty to refer a patient to an IMCA
Service, if they have been assessed as lacking capacity in making decisions and they have no one (i.e a family member or someone who cares for them) to support them through the decision-making process. If this is the case, you or your loved one should be appointed an IMCA before any decisions are taken with regards to serious medical treatment or a change in accommodation.
You or your loved one may usually not be given an IMCA if:
- you have appointed someone to make your decisions for you, for example under a Lasting Power of Attorney.
- A court appointed Deputy is making decisions for you
- you have nominated someone to be consulted about matters that affect you
- you have a close family member or unpaid carer who can support you in the process of making decisions
- you are detained under the Mental Health Act 1983 (in which case you may have the right to get help from an independent mental health advocate (IMHA).
How can I find an independent mental Health advocate?
Of course, you can access an IMHA via the health professionals who are caring for you or your loved one.
To find advocacy services and groups in your area, you could call Mind's Legal Line on 0300 466 6463 or contact your local Mind
If you're in hospital, you can also contact the Patient Advice Liaison Service (PALS) in England, the Patient advice & support service (PASS) in Scotland
If you live in Northern Ireland, you can contact the Irish Advocacy Network - Directory Listing, you can also contact your local Health and Social Care Trust
If you live in Wales, you can contact your local LLais or your local Patient Advice and Liaison Service (PALS) here
What if I am told I am not eligible for help from an independent mental health advocate?
As long as you are eligible for support from an IMHA, you have a legal right to have that support. You can't, for example, be told that there is no IMHA service in your area, as every local authority has a legal obligation to ensure that there is provision in place. If you or your loved one have been denied the support of an IMHA, we would advise that you seek legal advice from a community care or mental health solicitor.
Section 117 aftercare and CHC
A person eligible for section 117 aftercare should only be considered for NHS
continuing healthcare or NHS continuing care where they have physical health needs
which are not related to their mental health aftercare needs. However, for adults, not
meeting the criteria for full CHC funding does not preclude the CCG from having a joint
funding arrangement with the Council to meet specific physical health care needs
which do not fall within the eligibility of the Care Act. It is not, therefore, necessary to
assess eligibility for NHS Continuing Healthcare if all the services in question are to be
provided as aftercare services under section 117.
However, a person in receipt of section 117 aftercare services may also have, or later
develop ongoing primary health care needs, which may then trigger the need to
consider an assessment for NHS Continuing Healthcare.
NHS Funded Nursing Care
If you or your loved one have been awarded section 117 funding, you may also be eligible to receive Funded Nursing Care if you are in receipt of Nursing Care in a nursing Home.NHS-funded nursing care (FNC) is a universal service available to people under section 117 and on the same criteria as to anyone else placed in a nursing home.
FNC is available in England, Scotland, Wales and Northern Ireland, is free at the point of delivery and is a set weekly amount paid to a care home for the nursing element of a placement.
What happens if I move to another local Authority
If you or your loved one are receiving section 117 aftercare, the ‘responsible authorities’ are normally those in the area where you are registered with a GP and are ordinarily resident. If you move to another area they remain responsible until another authority accepts the responsibility to provide your services. Your authority should not withdraw your funding until alternative funding from your new authority has been agreed and is in place.
How long will it last?
Yours or your loved ones aftercare should only stop when you no longer need the services related to your mental disorder. This can happen if your needs change and they relate to your physical health rather than your mental health. Even if you are doing well outside of the hospital, you may still need aftercare services to make sure you stay well. Before you are discharged from section 117, the NHS Clinical Commissioning Group (CCG) and Local Authority social services responsible for your aftercare must both decide that you no longer need any aftercare services.
Although not stipulated in the MHA Code of Practice (2015), it is generally considered good practice to hold an annual review of Section 117 entitlement to ensure that the person’s needs are being met correctly. They must be able to give clear reasons for their decision and your needs must be reassessed before the aftercare is ended, to see how your mental health and ability to manage would be affected.
How will Section 117 funding affect my benefits?
If you are in a care home then you cannot receive Attendance Allowance, the Care Component of DLA or the Daily Living component of PIP and Section117 funding.
Further Reading:
Code of practice: Mental Health Act 1983 - GOV.UK
Mental health aftercare if you have been sectioned - Social care and support guide -NHS