In the recent case of R (Mwanza) v Greenwich LBC and Bromley LBC [2010] EWHC 1462 (Admin), Mr Justice Hickinbottom clarified the meaning of section 117 of the Mental Health Act 1983 and the scope of the aftercare services which authorities must provide.

The case concerned a patient who was discharged from section 3 in January 2001.  He initially engaged with services in the community but from late 2001 onwards had little contact with them and generally appeared to be doing well.  The services did not hear from him again until mid 2009 when his mental health was reported to have deteriorated.  It was clear to the court that the reasons for this deterioration were linked to his immigration status and were, in the main, the effect of destitution and his inability to work.

The patient argued that the scope of section 117 is wide and includes any services which could be provided to prevent a possible deterioration in his mental health and reduce his chances of relapse or readmission.  The London Borough of Greenwich (against whom the section 117 argument was made) said that section 117 only required the provision of services to meet needs arising from or related to his mental disorder.  Greenwich said that therefore ordinary accommodation and basic living costs (e.g. food) did not fall within its scope.

The judge, in the main, preferred Greenwich’s interpretation and stated that section 117 was to provide for the specific needs of those with mental disorders and not to provide general support to those who needed it.  He gave an example of a person’s need for assistance to find employment or housing (which may fall within section 117) as opposed to a person’s need for that employment or housing.  However, he disagreed with Greenwich’s submission that ordinary accommodation could never fall within section 117 (although he appeared to admit that it was difficult to envisage when this may occur). 

The judge also made it clear that it was for the authorities, who have the necessary professional expertise, to decide what needs a person has and that they have a degree of discretion as to what services are required to meet those needs.  The Judge approved the following quote from the judgment of Lord Phillips MR in R (K) v Camden and Islington Health Authority [2001] EWCA Civ 240 at [29]:

“The nature and extent of those [after-care] facilities must, to a degree, fall within the discretion of the [authorities] which must have regard to other demands in [their] budget.”

This judgment provides much needed clarification on the extent of section 117 services.  When determining what services fall within section 117, authorities should consider the patient’s needs arising from their mental disorder first and provide services to meet these needs.  If a patient has a need for accommodation or similar services for reasons other than their mental disorder, they should be directed to other sources.  Further, a service which, if provided, is likely to reduce the patient’s chances of relapse or readmission does not have to be provided under section 117 unless required to meet an assessed mental health need.

What should you do as a result of this judgment:

  • Consider issuing guidance to relevant staff on the scope of
    section 117 and/or review existing guidance
  • Ensure staff making decisions about the provision of
    section 117 services are cautious not to widen the scope of services beyond those needed for mental health
  • Review existing section 117 care arrangements to ensure
    you are only providing services required to meet an assessed mental health need.

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