Section 117 Aftercare

1. What are Aftercare Services?

Aftercare services are:to Section 117 should have their care needs assessed in line with the CPA frame

‘Services which meet a need arising from/related to a person's mental disorder which reduce the risk of a deterioration in their mental health condition and thus reduce the risk of them requiring admission to hospital again.’

They can include healthcare, social care and employment services, supported accommodation and services to meet a person's wider social, cultural and spiritual needs.

Aftercare should aim to support the person in regaining or enhancing their skills, or learning new skills, in order to cope with life outside hospital.

The ultimate aim is to maintain mental wellbeing in the community, with as few restrictions as necessary, wherever possible.

2. The Duty to Provide Aftercare Services

Section 117 of the Mental Health Act 1983 requires Integrated Care Boards (ICBs) and local authorities to provide aftercare services to eligible people:

‘People who were, but are no longer, detained in hospital for treatment under section 3, 37, 45A, 47 or 48 of the Act’.

It also includes situations where eligible people have remained in hospital informally after ceasing to be detained under these sections.

The duty to provide aftercare services continues as long as the person is in need of such services.

3. Ordinary Residence

Under Section 117(3) the responsible Integrated Care Board (ICB) and local authority are those in the geographical area in which the person was considered ordinarily resident immediately before being detained.

For further guidance on determining ordinary residence see: Ordinary Residence Procedure

You can also refer to the Who Pays? framework for establishing which NHS commissioner is responsible for commissioning and paying for an individual's NHS care.

3.1 Case law and government guidance

In August 2023, the Supreme Court ruled on an ordinary residence dispute between Worcestershire County Council and the Secretary of State for Health and Social Care (referred to as the Worcestershire case).

When the person was first admitted for treatment under the Mental Health Act 1983, they had been ordinarily resident in Worcestershire. In line with Section 117(3), when they were discharged, Worcestershire County Council assumed responsibility for their Section 117 Aftercare.

Worcestershire arranged and funded Aftercare services in a care home close to family that was geographically located in Swindon.

A year later, the person’s mental health deteriorated, and they were readmitted to hospital for treatment. The dispute arose at the point when they were discharged from this second admission as Worcestershire County Council were of the view that responsibility for their Section 117 Aftercare now lay with Swindon Borough Council.

The Supreme Court agreed with Worcestershire on the following basis:

1. When a person is provided with Section 117 Aftercare services in another geographical area, their ordinary residence changes in line with its natural meaning;
2. If the person is subsequently compulsorily detained for further treatment in hospital (under Section 3 of the Mental Health Act 1983), the duty placed upon the original Integrated Care Board and Local Authority area to provide Section 117 Aftercare ends (because the duty only applies at the point of discharge);
3. When the person is discharged from hospital the second time, a new duty to provide Section 117 Aftercare arises. This has no relation to any previous duty that applied prior to their readmission. The new duty applies to the Integrated Care Board and Local Authority in which the person was ordinarily resident immediately prior to their second admission.

In light of this ruling, it is anticipated that the government will provide updated guidance but, until such time, legal advice should continue to be sought as necessary.

4. Funding

Integrated Care Boards (ICB’s) and local authorities have a joint duty to provide or arrange free aftercare for eligible people. However, this does not necessarily mean the cost of services will be shared equally between the two organisations. The allocation of costs will depend on the specific aftercare services the person needs. For example, if the person has a greater need for healthcare services, the cost is likely to be greater for the ICB.

Local authorities and ICBs should each maintain a record of people for whom they provide or commission after-care and what after-care services are provided.

5. Aftercare Planning and Assessment

5.1 Aftercare Planning

Although the duty to provide aftercare services begins when the person leaves hospital, planning should start as soon as possible after they are admitted.

Integrated Care Boards (ICBs) and local authorities should take reasonable steps to identify appropriate aftercare services for people in good time for their eventual discharge from hospital.

5.2 Aftercare Planning Assessment

Aftercare planning requires a thorough assessment of the person's needs and wishes. It is likely to involve consideration of:

• Continuing mental healthcare;
• The psychological needs of the person (and of any informal carers);
• Physical healthcare;
• Daytime activities or employment;
• Appropriate accommodation - if the aftercare plan includes the provision of accommodation, and the person has committed one or more criminal offences, the circumstances of any victims of the offence(s) and of their families should be taken into account when deciding where the person should live;
• Identified risks and safety issues;
• Any specific needs arising from, for example, co-existing physical disability, sensory impairment, learning disability or autistic spectrum disorder;
• Any specific needs arising from drug, alcohol or substance misuse;
• Any parenting or caring needs;
• Social, cultural or spiritual needs;
• Counselling and personal support;
• Assistance in welfare rights and managing finances;
• The involvement of authorities and agencies in a different area, if the person is not going to live locally;
• The involvement of other agencies, for example the National Probation Service or voluntary organisations;
• Any conditions likely to be imposed by the Secretary of State for Justice or the Tribunal;
• Contingency plans (should the person's mental health deteriorate); and
• Crisis contact details.

In order to ensure that the Aftercare Plan reflects the full range of needs of the person, it is important to consider who needs to be involved. Subject to the consent of the person (or in their best interests if they lack capacity to consent), this may include:

• The person's responsible clinician;
• Nurses and other professionals involved in caring for the person in hospital;
• A practitioner psychologist, community mental health nurse and other members of the community mental health team;
• GP and primary care team;
• Any informal carers who will be involved in looking after the person outside hospital including;
• The persons' nearest relative or other family members;
• A representative of any relevant voluntary organisations;
• MAPPA co-ordinator if applicable;
• National Probation Service if applicable;
• A representative of housing authorities if accommodation is an issue;
• The ICB's appointed clinical representative if appropriate;
• An Independent Mental Health Advocate, if the person has one;
• An Independent Mental Capacity Advocate, if the person has one;
• Attorney/Deputy if applicable;
• An individual to whom the local authority is considering making Direct Payments for the person;
• Any other representative nominated by the person; and
• Anyone with authority under the Mental Capacity Act 2005 to act on the person's behalf.

The practitioners concerned, in discussion with the person, should agree an outline of the person's needs and a timescale for implementing the various aspects of the Aftercare Plan. All key people with specific responsibilities should be identified.

It is important that those who are involved in discussions about the Aftercare Plan are able to make commitments about their own continuing involvement and the services to be provided or commissioned. If the worker needs to seek approval for this from their organisation, extra time must be set aside for planning so that this causes no delay or detrimental impact to the implementation of the Plan.

People with ASD or learning disabilities

Professionals with specialist expertise should be involved in aftercare planning for people with autistic spectrum disorders or learning disabilities.

Young people in transition

Aftercare planning should take account of the young person's age and should involve their parent/carer (as appropriate) to ensure that they will be ready and able to provide the assistance which the young person may need.

5.3 The Aftercare Plan

It should be clearly recorded on the final Aftercare Plan:

1. That the person is eligible for Section 117 aftercare and the basis for this determination;
2. Which services are to be provided as part of Section 117 aftercare;
3. Who the named practitioner is (who has overall responsibility for co-ordinating the preparation, implementation and evaluation of the Plan).

Included within the Aftercare Plan should be:

• A Treatment Plan which details medical, nursing, psychological and other therapeutic support for the purpose of meeting the person's individual needs promoting recovery and/or preventing deterioration;
• Details regarding any prescribed medications;
• Details of any actions to address physical health problems or reduce the likelihood of health inequalities;
• Details of how the person will be supported to achieve their personal goals;
• Support provided in relation to social needs such as housing, occupation, finances etc.
• Support provided by informal carers;
• Actions to be taken in the event of a deterioration of the person's presentation; and
• Guidance on actions to be taken in the event of a crisis.

Aftercare Plans should also include details of any areas of need which are critical to preventing ‘behavioural disturbance’ and should provide guidance on how staff/carers should respond if behavioural disturbance does arise.

Note: Plans should not place undue reliance on the person's carers and other informal networks of support.

5.4 Reviewing the Aftercare Plan

The Aftercare Plan should be regularly reviewed.

It is the responsibility of the named practitioner/agency to arrange reviews of the Plan until it is agreed between all parties, including the person, that it is no longer necessary.

5.5 Reviewing eligibility for Section 117 Aftercare

Section 117 Aftercare: Guidance for Practitioners (Local Government and Social Care Ombudsman and the Parliamentary and Health Service Ombudsman) eligibility for Section 117 should be reviewed by the Integrated Care Board (ICB) and local authority within six weeks of discharge from inpatient services, then annually thereafter, or sooner if circumstances change.

For further guidance see Section 8, Ending Aftercare Services

6. Personal Health Budgets and Direct Payments

6.1 Personal health budgets

People eligible for Section 117 aftercare have a legal right to request a personal health budget (PHB) to meet the cost of services commissioned in their Aftercare Plan by the ICB.

A PHB is planned and agreed between the person and the responsible ICB.

Integrated Care Boards (ICBs) have a duty to publicise the availability of PHBs. They must also provide guidance, advice and support to eligible people to assist them in deciding whether to request a PHB.

ICBs must give due consideration to a request made by, or on behalf of, an eligible person for a PHB.

A PHB may be considered as part of the discharge planning process, when assessing the person's Section 117 aftercare needs during their hospital admission. It may also be considered during any subsequent review of the person's aftercare in the community.

6.2 Direct Payments

People eligible for Section 117 aftercare have a legal right to request a Direct Payment to meet the cost of services commissioned in their Aftercare Plan by the local authority.

The local authority must provide a Direct Payment when:

1. The person has the capacity to request a direct payment; and
2. If there is a nominated person, that person agrees to receive the payment; and
3. The personal who will be receiving the payment is capable of managing it (either on their own or with available help); and
4. The Local Authority is satisfied that a Direct Payment is an appropriate way to meet the needs in question; and
5. The Local Authority is not prohibited from making a Direct Payment (see below).

The local authority must not provide a direct payment when the person is going to be subject to a requirement, license or order under criminal legislation that requires them to undertake drug or alcohol rehabilitation, behaviour therapy or testing.

For further guidance see: Direct Payments

7. Accommodation as a Section 117 Need

The person's Aftercare Plan should set out what type of accommodation would meet a need related to their mental health condition.

Residential or other specialist accommodation can only be funded through Section 117 aftercare if it is in itself meeting a need related to the person's mental health condition.

Where residential or other specialist accommodation is deemed necessary as part of the person’s aftercare arrangements, the costs of this should be met by the Integrated Care Board (ICB) and local authority. If this is the case:

• The person should not be expected to claim housing benefit;
• The person should be able to exercise choice about their preferred accommodation; however
• They may need to pay a top-up payment if their preferred accommodation costs more than the ICB or local authority would otherwise have needed to pay.

8. Ending After-care

The duty to provide aftercare services exists until both the Integrated Care Board (ICB) and local authority are satisfied that their mental health has improved to the point where they no longer need after-care services.

Aftercare should not be withdrawn solely because:

• The person has been discharged by a psychiatrist or specialist mental health service;
• An arbitrary period has passed since aftercare was started;
• The person is deprived of their liberty under the Mental Capacity Act 2005;
• The person has returned to hospital informally or under Section 2 of the Mental Health Act (when the person is detained for a short time for assessment);
• The person is no longer on a Community Treatment Order (CTO) or on Section 17 leave from hospital.

If aftercare services are to end and the person lives in specialist accommodation that previously met their aftercare needs, the ICB and local authority must arrange to move that person to more appropriate accommodation before ending the Section 117 Aftercare Plan and funding.

The person and their carer/advocate if applicable, should be fully involved in the process of ending their aftercare. Aftercare services may be reinstated if it becomes obvious that they have been withdrawn prematurely, e.g., where a person's mental condition begins to deteriorate immediately after services are withdrawn.

ICBs and local authorities should keep a record of when a person has been formally discharged from Section 117.

9. Further Information

9.1 Key messages from Ombudsman investigations

The following information has been taken from Section 117 Aftercare: Guidance for Practitioners (Local Government and Social Care Ombudsman and the Parliamentary and Health Service Ombudsman)

• Councils and ICBs must ensure everyone who is entitled to Section 117 aftercare receives a robust assessment of their mental health needs arising from, or related to, the person's mental health condition;
• Everyone entitled to Section 117 should have their care needs assessed in line with the CPA framework (now Community Mental Health Framework). Care should be planned in line with the outcome of that assessment, which in most cases will mean care should be provided under CPA (now Community Mental Health Framework);
• Care and support plans should clearly state what services will meet needs arising from the person's mental health condition under Section 117. The support should ensure it reduces the chance of them being detained under the Mental Health Act;
• The care plan should be recorded in writing and a copy shared with the person and any other relevant parties;
• Councils and ICBs must not delay arranging Section 117 aftercare. Planning for Section 117 aftercare should start as soon as the person is admitted to hospital;
• Care and support plans should be regularly reviewed. Reviews should include the person and other relevant parties;
• People should not be paying for services which meet their mental health needs under Section 117, including specialist accommodation;
• The decision to discharge someone from Section 117 should be a joint one (by the council and the ICB);
• The council and ICB should fully involve the person when they decide to end that person's Section 117 aftercare;
• Organisations should have clear joint working arrangements around Section 117. This should include clearly defined roles about who will commission and/or provide Section 117.

9.2 Legislation, Statutory and Government Non-Statutory Guidance

Mental Health Act 1983: Code of Practice Chapter 33 After-care

Community Mental Health Framework for Adults and Older Adults

Section 117 Aftercare: Guidance for Practitioners (Local Government and Social Care Ombudsman and the Parliamentary and Health Service Ombudsman)

Self-harm: Assessment, Management and Preventing Recurrence NICE Guidance