Section 2 MHA – First-tier Tribunal Mental Health
The client was detained under section 2 of the Mental Health Act, which lasts for up to 28 days but in the end thanks to a discharge by a Mental Health Tribunal they spent only 12 days detained.
The client was detained on an acute admissions ward in a psychiatric hospital, which was miles away from their family and who therefore could not visit.
The client had a diagnosis of schizo-affective disorder for which they were prescribed medication and Cognitive Behavioural Therapy.
The client was admitted to hospital regularly because they stopped taking medication in the community, indeed this was the second admission that year.
When unwell and depressed the client had a history of making serious suicide attempts.
At the Tribunal Georga argued that the client was well on the day of the hearing and not exhibiting any symptoms, therefore the legal criteria were not made out. The Tribunal agreed and the client was discharged.
Section 3 – First-tier Tribunal Mental Health
The client was detained for over 12 months on an acute admissions ward in a psychiatric hospital under S. 3 MHA. The client had been admitted because they were exhibiting symptoms of anxiety and depression arising out of Asperger’s Syndrome. The client had been unable to cope in the community prior to this admission due to a lack of sufficient support, which had led to serious self-harming and suicide attempts.
It was completely inappropriate that the client was detained on a general adult ward as the specialist treatment that they needed could not be provided there, and the environment was detrimental when other patients were distressed. Georga was instructed therefore to do what she could to persuade the authorities to provide appropriate after-care in the form of a bespoke community placement with 24 hour staff support.
The client had not applied for a Mental Health Tribunal and therefore they were referred for a Tribunal. At the hearing Georga asked the Tribunal to make a recommendation that the client be sent to appropriate accommodation in the community on extended section 17 MHA leave. Georga argued that the client was not receiving the specialist treatment that they needed in hospital, and that the client was exhibiting risky behaviours because of the environment, it was harmful therefore for them to be in that environment. Georga argued that the client could cope if they were in the community with 24 hour support but that this should be provided in a bespoke placement so that the client did not have to live with other people.
In order for such a placement to be provided, funding had to be agreed by the local authority but they were not willing to do so. Georga argued at the Tribunal that the failure to provide appropriate after-care, which extended the period of time the client was in hospital was a breach of the client’s human rights.
The Tribunal made the recommendation as requested and periodically reviewed the progress with a view to reconvening if necessary to force the authorities to carry out their legal responsibilities.
Section 3 - First-tier Tribunal Mental Health
The client was detained under S. 3 MHA in following aggressive behaviour, including being aggressive towards the community consultant psychiatrist in the community.
Despite a diagnosis of Autism Spectrum Disorder and a learning disability the client was detained in a general psychiatric hospital but in full-time seclusion with 3 to 1 nursing because they could not cope with other patients.
While in hospital the client continued to be unable to regulate their emotions or manage their challenging behaviour, which included sexually inappropriate behaviour towards staff.
The client had been assessed and accepted for a community placement, but it had not been possible for them to go there, and no other community-based specialist unit was willing to take them with the current risks.
Georga represented the client at a Care and Treatment Review held by NHS England under their Transforming Care policy and the Panel agreed that the client needed to have specialist behavioural management treatment in hospital prior to taking up a placement made specifically for him in the community.
Another legal issue was that the client lacked capacity. While the client was clear what they wanted to happen they could not give specific instructions. They were therefore referred for a Tribunal by the Department of Health, and Georga was appointed to act for the client, which meant that she could act in their best interests.
At the Tribunal Georga argued that the client needed expert treatment in a specialist unit and that they were not able to access any appropriate treatment while detained on the current unit. Georga argued that with appropriate behavioural management treatment the client would be able to learn to manage their behaviour and therefore would be able to take up a placement in the community. However, this community placement had to be designed specifically for them because the client had difficulties being around others. The Tribunal made the recommendation that the client be transferred to a specialist hospital.
Unfortunately, it took months for this to be accomplished due to a shortage of beds so Georga made sure that the impetus was kept up as the client remained in seclusion. Georga also liaised with the local authority to ensure that plans were put into effect to prepare for the client’s bespoke community placement.
Notional section 37 MHA - First-tier Tribunal Mental Health
The client had been sentenced to 3 years imprisonment following conviction, and had spent months in prison before being transferred to a forensic psychiatric unit due to a deterioration in their mental health. The client was transferred under SS. 47/49 MHA, and at the end of the sentence the client was placed on a notional S. 37 MHA.
The client was diagnosed as suffering with paranoid schizophrenia for which they were prescribed antipsychotic medication. The client also received psychological therapy to look at the circumstances surrounding the index offence thereby lowering the chances of reoffending.
At the Tribunal Georga argued that the majority of the previous offences were due to the client’s previous drug habit and not to any mental illness and therefore were irrelevant for the Tribunal. Georga also argued that because the client had received a prison sentence rather than being sent by the court to a psychiatric hospital the index offence was not linked to the mental disorder and therefore was an irrelevant consideration for the Tribunal.
The client was eventually discharged to supported placement in the community on a Community Treatment Order.
Notional Section 37
The client was sent to prison in almost fifty years ago following conviction. They were transferred to a special psychiatric hospital (Broadmoor) under SS. 47/49 MHA almost 30 years later. That same year the client was detained on a notional S. 37 MHA because the prison sentence came to an end.
The client was transferred to a forensic medium secure unit 12 years later, and to a forensic low secure unit 4 years after that.
The client had a diagnosis of personality disorder, and had been receiving specialist psychological therapy.
The main legal issues in this case were which local authority had S. 117 MHA responsibility for the client, and therefore who should pay for after-care services. There were three potential authorities but none would accept responsibility.
Georga made arguments to all three authorities that the authority with S. 117 MHA responsibility was the authority covering the geographical area where the client had lived prior to the start of the prison sentence. Georga also argued that failure to accept responsibility and provide funding was a breach of the client’s human rights.
Responsibility was accepted by the correct local authority. Funding is in the process of being agreed for a supported community placement for the client.
Section 37 MHA - First-tier Tribunal Mental Health
The client has been detained under S. 37 MHA for 5 years following conviction for a series of offences.
The client had a diagnosis of bipolar affective disorder and a personality disorder, which was further complicated by an Autism Spectrum Disorder.
The client had been physically scarred that was having a deep psychological effect on their mental state, which was recognised by the client and the clinical team, and both considered it vital that this be remedied as part of their treatment.
When unwell the client could be aggressive and was a risk of suicide. While they were provided with medication and psychological therapy the impact of the scarring on both the client’s mental health and the risks to others as a result of psychological distress was significant.
The client, their GP, and clinical team had made requests for the funding of surgery, but it was disputed who was responsible for such funding, and in any event none of the potential authorities were willing to fund.
Georga contacted the potential authorities and NHS England in order to establish who was responsible for funding the corrective surgery, and then made representations to that authority to ensure that funding was agreed.
The funding authority accepted responsibility, agreed to fund, and corrective surgery was carried out.
Sections 37/41 MHA - First-tier Tribunal Mental Health
The client had been detained under SS. 37/41 MHA for 14 years following a conviction for an offence. They had been discharged on a Conditional Discharge after two years, but recalled the following year. They had been detained on several forensic secure units since recall.
The client had an extensive history of offending; absconding from secure forensic units; and using illicit substances, which for many years they did not wish to stop.
The client was initially diagnosed with schizophrenia but later schizoaffective disorder and was prescribed anti-psychotic medication.
A Tribunal took place but was adjourned because the clinical team decided to support discharge, whereas the reports that have been submitted to the Tribunal and the Ministry of Justice did not support discharge.
Georga therefore made arguments that if the Tribunal discharged the client on that day because the recommendations of the team were so different from the reports, the Ministry of Justice would have grounds to appeal the decision. This was accepted by the Tribunal and they adjourned.
New reports were submitted and at the next Tribunal hearing Georga made arguments that the client could be managed in the community despite the risks because of the support of the forensic Community Mental Health Team and supported accommodation. The client gave evidence that they had changed their mind and would not take illicit substances if discharged. Georga argued that the client had always been honest about their intent to take drugs and that they were being equally honest to the Tribunal, therefore the change of mind was genuine. The Tribunal granted a Conditional Discharged on the day of the second hearing.
Sections 37/41 MHA - First-tier Tribunal Mental Health
The client had been detained on a SS. 37/41 MHA for 15 years following a series of offences. They had been granted a Conditional Discharge twice but been recalled on both occasions after a short period of time. During the detention they had been transferred between several forensic secure units, largely as a consequence of challenging behaviour.
The client was referred for a Tribunal as they had not had a hearing for the previous 3 years.
The client had a history of not taking medication and taking illicit substances both in the community and in hospital. They had a history of assaultative behaviour including against staff and fellow patients, and of becoming sexually fixated on female staff.
The client was diagnosed as suffering with schizophrenia and was taking antipsychotic medication. They had been offered psychological therapy, but had refused to engage and the therapist concluded that client was untreatable. They had also undergone extensive dual diagnosis therapy for illicit substance abuse.
At the Tribunal Georga argued that the client understood that they had a mental disorder and the need for medication and the evidence was that they were self-medicating without any problems.
The client was granted a deferred Conditional Discharge by the Tribunal despite this not being supported by the clinical team.
A second Tribunal was held as the client had not left hospital. At this hearing Georga argued that the client’s continued pushing of boundaries was due to their frustration at the length of time that they had spent in hospital and that they would not behave like that if they were in the community where there would be fewer boundaries for them to push against. Georga also argued that many of the client’s previous offending behaviours were not linked to a mental disorder and therefore irrelevant for the Tribunal. Georga argued that the client could be adequately managed in the community with the support of the accommodation providers and the forensic Community Mental Health Team, and that any future offending behaviour could be managed through the criminal justice system. The second Tribunal agreed, and confirmed the deferred Conditional Discharge.
The client left hospital on a Conditional Discharge as soon as an appropriate placement was ready for them.
Sections 47/49 MHA - First-tier Tribunal Mental Health
The client was given an IPP sentence in 2008 following conviction for a series of offences.
The client was transferred to a forensic medium secure unit under SS. 47/49 MHA after spending 2 years in prison.
The client was diagnosed as suffering with paranoid schizophrenia and an antisocial personality disorder. They received antipsychotic medication, psychological therapy, and counselling for illicit substance misuse.
At the hearing Georga argued that the client, who had numerous previous convictions and had been known to psychiatric services since childhood, had been fully engaged with the clinical team and compliant with all treatment plans since arriving at a psychiatric unit the client.
Georga also argued that the client’s engagement with the team and compliance with medication in hospital and their assertion that they would continue to do both was proof that they could be managed successfully in the community. Georga also argued that when released the client should remain under the care of psychiatric services and should go to psychiatric supported accommodation rather than to approved premises as this would ensure that the client’s mental disorder could be appropriately monitored and treated.
As the client was detained under SS. 47/49 MHA Georga asked the Tribunal to confirm that were they detained under SS. 37/41 MHA they would be entitled to a Conditional Discharge, and that the Tribunal recommend to the Secretary of State for Justice that the client should be detained in hospital until released by a Parole Board.
The Tribunal recommended discharge to the Ministry of Justice. The client was then referred for a Parole Board hearing, which released the client into the care of psychiatric services.
Conditional Discharge recall (sections 37/41 MHA) - First-tier Tribunal Mental Health
The client had been detained under sections 37/41 MHA in secure forensic services, following conviction for an offence. After 3 years the client was released on a Conditional Discharge. The client was recalled from the Conditional Discharge after being in the community for 5 years.
The client was automatically referred for a Tribunal because of the recall.
At the time of the Tribunal the client was detained on the acute admissions ward of a medium secure unit and had no leave off the ward, permission for which had been refused by the Ministry of Justice. The clinical team was not in support of discharge.
The client had a history of low grade disengagement with the community team and had committed other offences against the person in the community while on the Conditional Discharge that had been managed through the criminal justice system.
The week prior to recall the client had taken illicit substances for the first time since being on the Conditional Discharge.
The client was diagnosed as suffering with paranoid schizophrenia and was prescribed anti-psychotic medication, with which they had not always been fully compliant in the community.
At the hearing Georga argued that the client had not exhibited any symptoms of mental disorder following admission and therefore that the behaviour that triggered the recall was due only to illicit substances. Georga argued that despite the issues that the clinical team had had in managing the client in the community the client had not come close to recall until this one episode of taking illicit substances.
The client told the Tribunal that they had no intention of taking illicit substances again. Georga therefore argued that the client had managed reasonably in the community and that their behaviour had only worsened in the last few months due to personal circumstances. Georga argued that if the client were to be discharged by the Tribunal they could go back to how things were before recall, and that any offending behaviour would be properly dealt with by the criminal justice system.
The Tribunal granted a deferred Conditional Discharge as accommodation was not available.
Conditional Discharged seeking Absolute Discharge - First-tier Tribunal Mental Health
The client had been detained under section 37/41 MHA in secure forensic psychiatric services for 6 years following a conviction of an offence. At the time of this case the client had been on a Conditional Discharge for another 6 years.
The client was living successfully in the community and was in the process of moving to fully independent housing.
The client had been diagnosed as suffering with paranoid schizophrenia and was taking anti-psychotic medication.
At the hearing the legal test for an Absolute Discharge is much higher than for a conditional Discharge as it concentrates on the index offence far more than the mental disorder. Georga therefore made arguments regarding the level of risk that the client could potentially pose in the future.
Georga argued that the client’s behaviour had been exemplary for the whole of the Conditional Discharge, and that the evidence was that the client was fully concordant with medication and treatment, and fully engaged with the forensic CMHT. Georga argued that none of this would change. Georga explained to the Tribunal that the victim of the offence was someone close to the client and that therefore those at risk were people who were also close to the client, not to the general public. Georga pointed out that there was no evidence of any risk since the index offence.
The Tribunal granted an Absolute Discharge.
Community Treatment Order - First-tier Tribunal Mental Health
The client had been detained in hospital under section 3 MHA for a year. The client had then spent one year in the community on extended section 17 MHA leave, which had then been converted to a Community Treatment Order. At the time of the Tribunal hearing they had been on a Community Treatment Order for 6 years.
The client was living in independent accommodation with members of their family.
The client was diagnosed as suffering with paranoid schizophrenia but the client did not believe that they had a mental disorder and did not believe that they needed medication. They therefore regularly refused medication, which was given as a monthly injection.
The client had a history of drinking alcohol to excess and assaultative behaviour if they did not take the medication.
At the Tribunal the client stated that they would take the medication if discharged. Georga argued that the client, who had always admitted that they would not take medication if discharged, was always honest and that they were still being honest now in saying that they would take the medication.
Georga argued that the client had had no symptoms of mental disorder since before they left hospital, and that the effects of years of consistent medication were now being seen.
The Tribunal discharged the client from detention.
Contact Georga Godwin: Mental Health Solicitor Oxfordshire, Buckinghamshire, Berkshire
Contact Georga using the online contact form or by calling 01865 596717. You can also email Georga on This email address is being protected from spambots. You need JavaScript enabled to view it..
