Georga provides legal opinions to several NHS Trusts dealing with issues raised in specific cases. The majority of these legal opinions have been to enable clinicians to discharge high-profile forensic patients, both adults and children, under viable legal frameworks so as to manage risk, protect the patient’s human rights, and allow for quicker discharge and funding arrangements.
Benefits
Georga provides legal opinions for each individual case that sets out the legal frameworks that are the most appropriate for the patient in hospital, during the transition to life in the community, and for the long-term management of risks to the patient and others.
As part of the legal opinions best practice in the implementation of the law is reviewed and alternative models for discharge are examined. This ensures that staff are able to work within the legislative framework to put in place restrictions and boundaries in the least restrictive manner possible, and provide clear discharge pathways to help remove barriers, and address inequalities so that discharge can be achieved more quickly and with smoother transitions.
Moving out of hospital will benefit patients, as they will be maintained in less restrictive settings, it will also aid therapeutic relationship as patients will see their clinicians gathering evidence to help them achieve discharge. Further, taking patients out of hospital to community placements saves money for the NHS Trusts both in terms of reducing inpatient hospital costs and increasing the repatriation of patients from the private sector.
How Georga can help
The issues Georga can help you with include:
Discharge pathways
- Legal frameworks in the community;
- Lawful risk management strategies;
- How to evidence necessity for particular discharge pathways;
- Gathering evidence for discharging patients with historical risk;
- Legal implications of unlawful deprivation of liberty;
Conditional Discharge
- Obtaining a Conditional Discharge for patients detained on SS. 37/41 MHA from the First-tier Tribunal Mental Health;
- Conditional Discharge, capacity, and Deprivation of Liberty Safeguards;
- Varying conditions on a Conditional Discharge;
- Obtaining Absolute Discharge for patients detained in hospital and in the community;
Legal frameworks for community patients
- Discharge from MHA;
- Extended S. 17(3) MHA;
- Use of nominal beds for patients on extended S. 17(3) MHA;
- Community Treatment Orders;
- Guardianship Orders;
Lawful deprivation of liberty
- Deprivation of Liberty Safeguards;
- Capacity and competence assessments;
- High Court inherent jurisdiction;
Risk management strategies
- Managing risk for community patients not detained under the MHA.
Further, in order to assist with discharge pathway planning Georga has also drafted legal guidance and Capacity Assessment matrixes to assess capacity and competence in respect of all issues that arise as part of risk-management strategies.
Given the barriers to discharge in respect of liaison between various authorities and resource and funding issues Georga advises clinicians and teams on the evidence needed to persuade colleagues to move patients on quickly and safely and to implement risk management strategies that will encourage more patients to be managed in community settings.
List of sample opinion topics
Georga has provided legal opinions in the following areas:
1. Legal frameworks, to use both in hospital and in the community
- How best to manage the risks of a patient in the community when discharged from hospital and what legal framework would be the most appropriate;
- The correct legal framework to be used following discharge from S. 3 MHA, for a patient who lacks capacity;
- The correct legal framework to be used following discharge from S. 3 MHA, for a patient who has capacity;
- How to manage the cross-over for a patient detained on S. 3 MHA who is going through proceedings for a Deprivation of Liberty Order;
- What legal framework can be used in the community for a patient who is awaiting a standard DOLS authorization;
- The appropriate legal framework to manage a patient who is detained on SS. 37/41 MHA in the community based on their capacity;
- The lawful use of extended S. 17(3) MHA leave for patients in the community;
- What legal framework should be used to detain a patient in the community both until and following the granting of a DOLS;
- The use of the MHA in conjunction with a DOLS;
- The correct legal framework to be used to provide treatment ancillary to that provided for a mental disorder, and possible use of restraint to deliver that treatment and avoid further acts of deliberate self-harm that will undermine that treatment;
2. What capacity assessments are necessary given the risk-management measures to be put in place
- The necessity for a capacity assessment to be carried out on the issues of accommodation and care & support, the use of internet and social media, contact with children, engaging in sexual relations;
- What issues need to be assessed with regard a patient’s capacity regarding the risk management restrictions and how to lawfully protect the patient’s rights under Article 5 ECHR;
- Whether a person’s capacity to offend can be assessed;
- Whether the capacity assessment regarding contact can be made in respect of specific groups of people;
- Whether the capacity assessment regarding contact can cover contact with children;
- Whether the patient’s capacity needs to be assessed regarding their agreement to consent to undergoing capacity assessments;
- Whether information taken from assessments, observations, and medical notes can be used rather than a direct assessment of the patient when assessing capacity;
- Whether it is necessary to discuss the relevant information with the patient in person if doing so would overwhelm and elevate the patient’s anxiety levels;
- What are the issues regarding the capacity to enter into a tenancy agreement;
- A review of previous capacity assessments that disagreed, a review of the law, and drafting of a definitive capacity assessment;
3. Aftercare provision, funding issues etc
- Advice regarding funding streams for aftercare provision;
- How to secure funding for aftercare provision, for an accommodation and support package under S. 117 MHA;
- Which authority should take financial responsibility for aftercare services under S. 117 MHA;
- Whether the NHS Trust should continue to pay for an inpatient bed for a patient who is in the community on extended S. 17(3) MHA leave;
- Advice regarding how funding provided to cover both a bed in a private locked rehab word and residential housing can be cut;
- The legality of an apparent ‘policy’ of an authority to fund extended S. 17(3) MHA for only four weeks;
- Advice regarding the lawfulness of maintaining a patient in the community given the lack of Care Coordination;
- Advice as to which authority should apply to the Court of Protection for a community Deprivation of Liberty Safeguard order, either the local authority, Integrated Care Board, or NHT Trust;
4. First-tier Tribunal Mental Health & Evidence
- What submissions to make to the FTTMH regarding which clinician should give evidence;
- What can be argued to secure an Absolute Discharge at FTTMH for a patient currently on a Conditional Discharge when the patient has an untreatable personality disorder;
- Advice regarding how the clinical team should proceed in a FTTMH given the lack of clarity regarding an aftercare package and how risks would be managed in the community found in a Social Circumstances Report;
5. Miscellaneous
- What reasonable adjustments should be made to allow a patient with autism to bid for social housing;
- The legal issues of the possible transfer of a patient from an EU country to England and how such a transfer can be organised;
- The lawfulness of a geographical exclusion zone and the process by which this was put in place;
6. Risk-Management Measures to be put in place
- What measures can be taken to minimise the detrimental effects of the behaviour a patient’s family’s on the hospital and prospective placement staff;
- What legal measures can be taken in the community to manage the patient’s contact with his family when they undermine the treatment and risk-management strategies put in place by the professions in circumstances when the family’s behaviour increases the patient’s risk profile;
- Advice regarding the management of a patient’s finances;
- What measures can be taken to ensure that a family member who holds a Court of Protection deputyship to manage the patient’s finances provides the patient with funds, and what measure to take if they do not;
- What measures can be put in place to manage a patient who makes nuisance telephone calls to family and organizations;
- How to manage a patient’s mental disorder and risks when they are not detained on a section of the Mental Health Act;
- The use of the criminal justice system for disposal following any future offending behaviour for a patient who is considered untreatable;
- How to lawfully place restrictions on a patient’s use of the internet and social media, and what restrictions can lawfully be applied to the patient to manage risks to their mental health and others in the community;
- Advice regarding care plan boundary setting, inherent jurisdiction, and criminal justice proceedings to manage a patient’s potential criminal use of a smartphone;
7. How to avoid potential breaches of the European Convention of Human Rights.
- Whether a placement provider was acting lawfully when they confiscated a patient’s key fob and thereby stopped the patient from being able to leave the property;
- The legality of depriving a person’s liberty once an application for an order has been made to the court but before the order has been agreed;
- Whether it was allowable under the then current legal framework to implement more restrictive measures to manage a patient’s risks;
- Whether it was possible under the then current legal framework to stop a patient from leaving the placement or whether further legal measures needed to be taken;
- Whether it was possible under the then current legal framework to put in place sufficient restrictions to stop a patient from re-offending;
Testimonials
Trusted by clients and professionals alike.
A helpful refresher of everything MCA / DOLS related…helpful for supporting colleagues and also thinking about patient pathways
Speaker was excellent – very clear and detailed information, engaging presentation. | Speaker was really excellent and provided good insight into how to deal with the MH legislation around people with PD. | Georga is very lovely to listen to. She makes the dry legal matters, more palatable
Really enjoyed all the caselaw updates and examples as how these are used in practice. Thank you. Really informative, very knowledgeable.
Working across health and criminal justice Georga’s training in legal frameworks, complex discharge planning and the mental capacity act has been invaluable in supporting the best outcomes for our patients.
Georga has provided expert legal advice which has helped our patients with an absolute discharge from hospital – without her input we would still have patients on long delays without the quality of life they deserve.
The content of her presentations has been highly relevant, thought provoking, well-structured and delivered in a very professional and engaging way, resulting in lots of helpful group discussion. Her overall knowledge, expertise, use of up-to-date case law, and amusing anecdotes were all very well received too.