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Emergency Access to Mental Health Crisis Services in Lambeth

Angie Meader made this Freedom of Information request to South London and Maudsley NHS Foundation Trust

This request has been closed to new correspondence. Contact us if you think it should be reopened.

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Dear South London and Maudsley NHS Foundation Trust,
Freedom of Information Request

Emergency Access to Mental Health Crisis Services in Lambeth

In the best of possible worlds, mental health services would provide excellent care in the community, and the need for an emergency admission to hospital for a patient already 'known to services', would rarely arise.

Sadly, this is not always the case. It is often left to carers and friends to cope alone, as best they can, with a friend or family member in extreme crisis as appropriate community mental health services seems to be in short supply and stop completely over weekends and public holidays.

In this context I am asking SLaM to provide the following information to enable a 'Nearest Relative' as defined by the MHA, to apply to the 'Hospital Managers' for a mental health assessment, as I believe they have the legal power to do under section three and section four (emergency section) of the Act.

I am not seeking advice on the appropriateness of such an application, just to clarify the process for a nearest relative to exercise the power the MHAct bestows if it becomes necessary.

Please could you provide me with the following information -

1. The Mental Health Act refers to the 'Hospital Managers' as the gatekeepers of compulsory admissions under the Act. Please could you explain to me exactly who the 'Hospital Managers' are, who they are accountable to, and how they fit into the process of detention under the MHA?

2. I am aware that the usual process to apply for detention under a section of the MHA, is for an 'Approved Mental Health Professional' to apply to the 'Hospital Managers'. However, the Act states that a 'Nearest Relative' can also apply to the 'Hospital Managers' for admission under section 3 and also for an emergency admission under section 4 of the Act. This would seem to be a very important right in a situation where no other help is available.

Please could you provide me with clear contact details for your 'Hospital Managers', a telephone number that is not left ringing out or permanently on answer phone, an email address and a named person/s who can be contacted 24hrs a day, 7 days a week, to fulfil SLaM's duty to respond to a 'Nearest Relative' for an emergency application under section 4. It would also be helpful to have contact details for the AMHP service in case they are able to offer any kind of support.

3. I understand that in order to be detained under section 3, a person needs to be seen by two 'section 12 approved' doctors within the previous 24 Hours and that they both need to agree that an admission under section 3 is necessary. I believe that an emergency section (section 4) requires just one doctor.

Please could you confirm that this is correct and advise me whether the single doctor required for section 4 needs to be 'section 12 approved' or can be a regular GP.

4. In the case of 'section 12 approved' doctors, do they each need to be registered formally with SLaM in some way or can the 'section12' role be carried out by any suitably qualified doctor?

If they have to be registered with SLaM, please could you provide me with a list of 'section 12 approved' doctors who are eligible to fulfil this role for SLaM in Lambeth.

If the role can be carried out by any doctor, provided they are suitably qualified, could you please tell me how I can get access to the list of doctors with this qualification.

5. I understand that if an assessment ends up in a hospital admission, a section 3 can last up to six months during which time a patient can be treated without her/his consent.

I believe that a section 4 lasts for 72 hours and does not involve compulsory treatment unless the 'Responsible Clinician' considers an application for a section 3 is necessary.

Could you please confirm that I have understood the length and status of treatment under section 4 correctly.

6. Please could you tell me how many applications for mental health assessments resulting in admission to hospital under section 3 have been made directly by a 'Nearest Relative' during the last year.

7. Please could you also tell me how many section 4 admissions have been carried out in past year, by AMHPs as well as nearest relatives. I am asking for statistical information only, not to identify individuals in any way.

I look forward to your response

Yours faithfully,

Angie Meader
Lambeth

Kazeem, Toyin, South London and Maudsley NHS Foundation Trust

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[1]Picture (Device Independent
Bitmap)

Information Governance Office

Clinical Records-CR2

Maudsley Hospital

Denmark Hill

London SE5 8AZ

Email: [2][South London and Maudsley NHS Foundation Trust request email] 

Dear Ms Meader,

I am writing to acknowledge receipt of your recent request for information
about emergency access to mental health crisis services in Lambeth. Your
request was received on 20^th July 2013  and we are dealing with it under
the terms of the Freedom of Information Act (2000).

We aim to provide you with the information requested within the 20 working
days. In certain exceptional circumstances a fee may be payable and if
that is the case, I will let you know the likely charges before
proceeding. You will receive a notification if an exemption applies to the
disclosure of this information under the Freedom of Information Act
(2000).

If you have any queries about this letter, please contact us at
[3][South London and Maudsley NHS Foundation Trust request email]

Yours sincerely,

Ms Toyin Kazeem
Information Governance Assurance Officer.
South London and Maudsley NHS Foundation Trust
Information Governance Office | Maudsley Hospital | CR2 | Denmark Hill |
London| SE5 8AZ
Follow us on Twitter for information governance tips:
[4]www.twitter.com/MaudsleyNHS_IG

Visit our website http://www.slam.nhs.uk/

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References

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2. mailto:[South London and Maudsley NHS Foundation Trust request email]
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Dear South London and Maudsley NHS Foundation Trust,

I submitted this Freedom of Information Request to the South London
and Maudsley NHS Trust on 24th July 2013. By Law I should have received a response by 19th August 2013, (yesterday).

Please could you provide me with a response as a matter of urgency.

Yours faithfully,

Angie Meader

Kazeem, Toyin, South London and Maudsley NHS Foundation Trust

1 Attachment

Dear Ms Meader,
Apologies for the delay, please find attached response to your request for information.

Regards

Ms Toyin Kazeem
Information Governance Assurance Officer
South London and Maudsley NHS Foundation Trust
Information Governance Office | Maudsley Hospital | CR2 | Denmark Hill | London| SE5 8AZ
Follow us on Twitter for information governance tips: www.twitter.com/maudsleyNHS_IG

show quoted sections

Dear South London and Maudsley NHS Foundation Trust,

Please pass this on to the person who conducts Freedom of Information reviews.

I am writing to request an internal review of South London and Maudsley NHS Foundation Trust's handling of my FOI request 'Emergency Access to Mental Health Crisis Services in Lambeth'.

Your response doesn't address my main question, which is, given that the Mental Health Act States very clearly that a 'Nearest Relative' has a legal right to apply for a section under the Act as long as the necessary medical recommendation/s are in order, please could you provide me with the correct contact details to make an application 24hrs a day, 7 days a week, particularly in the evenings, weekends and public holidays when community mental health services shut up shop.

It does seem that SLaM has a statutory duty to make provision for a 'Nearest Relative' to make an application, particularly in an emergency under section 4. However, if SLaM is above the law, and has made a corporate decision to refuse to accommodate this aspect of the Mental Health Act, I would appreciate having a statement confirming this.

Your letter states that if I am not happy with your response, I should contact the Information Commissioner. However, I believe I am entitled to request an internal review.

A full history of my FOI request and all correspondence is available on the Internet at this address: https://www.whatdotheyknow.com/request/e...

Yours faithfully,

Angie Meader

Kazeem, Toyin, South London and Maudsley NHS Foundation Trust

Dear Ms Meader,
I am writing to acknowledge your email requesting an internal review of the response sent to you on 20th August 2013. An internal review will be conducted and a response will be provided to you.

Regards

Ms Toyin Kazeem
Information Governance Assurance Officer
South London and Maudsley NHS Foundation Trust
Information Governance Office | Maudsley Hospital | CR2 | Denmark Hill | London| SE5 8AZ
Follow us on Twitter for information governance tips: www.twitter.com/maudsleyNHS_IG

show quoted sections

Tunmore, Ben, South London and Maudsley NHS Foundation Trust

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Dear Ms Meader,
 
Please find attached the response to your email sent on 21st August 2013.
 
Regards, Ben

 

Ben Tunmore

ICT Compliance Manager

South London and Maudsley NHS Foundation Trust

show quoted sections

Angie Meader left an annotation ()

Source: legislation.gov.uk

Please note F4 (4) as it applies to the 'Nearest Relative'

[F1Duty of approved mental health professionals to make applications for admission or guardianship]F1.
[F2(1)If a local social services authority have reason to think that an application for admission to hospital or a guardianship application may need to be made in respect of a patient within their area, they shall make arrangements for an approved mental health professional to consider the patient's case on their behalf.
(1A)If that professional is—
(a)satisfied that such an application ought to be made in respect of the patient; and
(b)of the opinion, having regard to any wishes expressed by relatives of the patient or any other relevant circumstances, that it is necessary or proper for the application to be made by him,
he shall make the application.
(1B)Subsection (1C) below applies where—
(a)a local social services authority makes arrangements under subsection (1) above in respect of a patient;
(b)an application for admission for assessment is made under subsection (1A) above in respect of the patient;
(c)while the patient is liable to be detained in pursuance of that application, the authority have reason to think that an application for admission for treatment may need to be made in respect of the patient; and
(d)the patient is not within the area of the authority.
(1C)Where this subsection applies, subsection (1) above shall be construed as requiring the authority to make arrangements under that subsection in place of the authority mentioned there.]
F2(2)Before making an application for the admission of a patient to hospital an[F3approved mental health professional]F3 shall interview the patient in a suitable manner and satisfy himself that detention in a hospital is in all the circumstances of the case the most appropriate way of providing the care and medical treatment of which the patient stands in need.
[F4(3)An application under subsection (1A) above may be made outside the area of the local social services authority on whose behalf the approved mental health professional is considering the patient's case.]
F4(4)It shall be the duty of a local social services authority, if so required by the nearest relative of a patient residing in their area, to [F5make arrangements under subsection (1) above for an approved mental health professional to consider the patient's case]F5 with a view to making an application for his admission to hospital; and if in any such case [F6that professional]F6 decides not to make an application he shall inform the nearest relative of his reasons in writing.
(5)Nothing in this section shall be construed as authorising or requiring an application to be made by an [F7approved mental health professional]F7in contravention of the provisions of section 11(4) above [F8or of regulations under section 12A]F8, or as restricting the power of [F9a local social services authority to make arrangements with an approved mental health professional to consider a patient's case or of]F9 an [F7approved mental health professional]F7 to make any application under this Act.
Annotations:

Dear Tunmore, Ben,

The responses to this FoI request have been passed on to the Information Commissioner as advised in the replies I have received from SLaM.

Yours sincerely,

Angie Meader

Angie Meader left an annotation ()

Source: Mental Health Act Code of Practice 2012.

Please note:

4.33
"To fulfil their statutory duty, LSSAs must have arrangements in place in their area to provide a 24-hour service that can respond to patients’ needs."

4.34
"LSSAs must make (such) arrangements if asked to do so by (or on behalf of) the nearest relative.
Responsibilities of local social services authorities

4.33 LSSAs are responsible for ensuring that sufficient AMHPs are available to carry out their roles under the Act, including assessing patients to decide whether an application for detention should be made. To fulfil their statutory duty, LSSAs must have arrangements in place in their area to provide a 24-hour service that can respond to patients’ needs.

4.34 Section 13 of the Act places a specific duty on LSSAs to arrange for an AMHP to consider the case of any patient who is within their area if they have reason to believe that an application for detention in hospital may need to be made in respect of the patient. LSSAs must make such arrangements if asked to do so by (or on behalf of) the nearest relative.

4.35 If a patient is already detained under section 2 as the result of an application made by an AMHP, the LSSA on whose behalf that AMHP was acting is responsible for arranging for an AMHP to consider the patient’s case again if the LSSA has reason to believe that an application under section 3 may be necessary. This applies even if the patient has been detained outside that LSSA’s area.

4.36 These duties do not prevent any other LSSA from arranging for an AMHP to consider a patient’s case if that is more appropriate.

Angie Meader left an annotation ()

I have formalised this request as a complaint to the Information Commissioner. I have received an acknowledgement from them and am waiting to be allocated a caseworker. I will update this website on any progress.

Angie Meader

Angie Meader left an annotation ()

Cut and paste of the email I sent to the Information Commissioner on 10th September 2013....

(FAO Information Commissioner)

Good afternoon

I recently made this FoI request to the South London and Maudsley NHS Trust. They have responded to my original request and my subsequent request for an internal review.

The information they have provided does not completely answer my question, or indeed seem to satisfy the requirements of the mental health act. It's not entirely clear to me whether they haven't answered my question, or whether they don't actually provide the option for a 'Nearest Relative' to exercise their legal right to apply for an emergency section, or any other section, under the Mental Health Act.

At this point I think I have to assume that they haven't answered my question and would like to make a complaint on these grounds to the ICO.

Regards

Angie Meader

Link to my FoI request made via the 'whatdotheyknow' website

https://www.whatdotheyknow.com/request/e...

Soncul, Murat, South London and Maudsley NHS Foundation Trust

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Dear Ms Meader
 
Please find enclosed letter in response to your complaint to the
Information Commissioner's Office.
 
Yours sincerely,
 
Murat Soncul
Head of Information Governance
South London and Maudsley NHS Foundation Trust
 

Visit our website http://www.slam.nhs.uk/

Disclaimer
This e-mail and any files transmitted with it are confidential. If you are
not the intended recipient,
any reading, printing, storage, disclosure, copying or any other action
taken in respect of this e-mail is prohibited
and may be unlawful. If you are not the intended recipient, please notify
the sender immediately by using the reply
function and then permanently delete what you have received. Incoming and
outgoing e-mail messages are routinely monitored
for compliance with the Department of Health's policy on the use of
electronic communications. For more information on the
Department of Health's e-mail policy click here
http://www.doh.gov.uk/emaildisclaimer.htm

We don't know whether the most recent response to this request contains information or not – if you are Angie Meader please sign in and let everyone know.