This chapter sets out when a person can be provided with aftercare, including supported accommodation, under section 117 of the Mental Health Act 1983.

Aftercare services are not classed as a public fund for immigration purposes and can be provided to a person regardless of their immigration status. Therefore a person with no recourse to public funds should not be refused aftercare solely on the basis of their immigration status or lack of access to benefits. Schedule 3 of the Nationality, Immigration and Asylum Act 2002 does not apply to section 117, so a human rights assessment should not be undertaken when a person who is without lawful status in the UK qualifies for aftercare.

Additionally, the Department of Health and Social Care has also clarified in the Overseas NHS visitors: implementing the charging regulations guidance that aftercare services are not chargeable to overseas visitors.

10.1 When can aftercare be provided?

A person who has been detained (sectioned) in order to undergo urgent treatment for a mental health condition may qualify for aftercare when their detention ends and they leave hospital.

A person will be eligible for aftercare services if they were admitted to hospital under one of the following provisions of the Mental Health Act 1983:

  • Section 3 (detained in hospital for treatment)
  • A hospital order made under section 37 or 45A (ordered to go to hospital by a court)
  • Section 47 or 48 (transferred from prison to hospital)

Aftercare services are defined at section 117(6) of the Mental Health Act 1983, as follows:

In this section, “after-care services”, in relation to a person, means services which have both of the following purposes—
(a) meeting a need arising from or related to the person’s mental disorder; and
(b) reducing the risk of a deterioration of the person’s mental condition (and, accordingly, reducing the risk of the person requiring admission to a hospital again for treatment for mental disorder).

Therefore, aftercare services must meet a need arising from or related to the person’s mental disorder with the purpose of reducing the risk of deterioration in the condition and therefore reduce the risk of readmission to hospital for treatment for the disorder.

Aftercare services are jointly arranged and provided by the NHS Clinical Commissioning Group (CCG) (Integrated Care Board) and local authority (adult social care).

The NHS will usually be responsible for providing any health-related services and the local authority will usually provide the social care element.

When assessing eligibility and providing aftercare, the CCG and local authority must follow the Mental Health Act 1983: Code of Practice. The Parliamentary and Health Service Ombudsman and the Local Government and Social Care Ombudsman have also issued guidance for CCGs and local authorities in order to clarify their responsibilities.

Patients with no recourse to public funds who are experiencing homelessness will need to be identified at the point of admission, so that planning for their aftercare, including how their accommodation needs may be met is undertaken in good time prior to discharge. For more information about which local authority will be responsible for providing aftercare, see section 3.2.6.

The Code of Practice states:

33.10 Although the duty to provide after-care begins when the patient leaves hospital, the planning of after-care needs to start as soon as the patient is admitted to hospital. CCGs and local authorities should take reasonable steps, in consultation with the care programme approach care co-ordinator and other members of the multidisciplinary team to identify appropriate after-care services for patients in good time for their eventual discharge from hospital or prison.

A comprehensive assessment of the person’s needs using the Care Programme Approach must be undertaken and a care plan prepared, which should record whether the person is entitled to Section 117 aftercare and what services will be funded on this basis. The Code of Practice states that the care plan must include ‘support provided in relation to social needs such as housing, occupation, finances etc.’ (Paragraph 34.3)

10.2 When can accommodation be provided under section 117?

The CCG and local authority have a broad discretion to determine what services can be provided as aftercare.

The Code of Practice provides examples of the types of services that aftercare can encompass:

33.4 CCGs and local authorities should interpret the definition of after-care services broadly. For example, after-care can encompass healthcare, social care and employment services, supported accommodation and services to meet the person’s wider social, cultural and spiritual needs, if these services meet a need that arises directly from or is related to the particular patient’s mental disorder, and help to reduce the risk of a deterioration in the patient’s mental condition.

Aftercare can include the provision of accommodation, when that is required for the purpose of meeting a need arising from or related to the patient’s mental disorder and will help to reduce the risk of their mental condition deteriorating. It is most likely that this would be limited to supported or specialist accommodation that will meet the person’s mental health-related needs, rather than ordinary accommodation, such as a private-rented flat.

Therefore, when a person with no recourse to public funds who is experiencing homelessness is being considered for aftercare, the CCG and local authority would need to determine whether supported or specialist accommodation is required. This decision must be based on an assessment of the person’s mental health-related needs.

When a person is provided with accommodation under section 117, they will also require financial support (subsistence payments). Financial support can be provided as part of the aftercare package. The local authority may wish to incorporate this group within in any policy that has been established to set basic levels of subsistence support for people who are supported under the Care Act. For more information about subsistence payments, see section 5.3.

When a person is accommodated under section 117, the local authority must ensure that steps are taken to identify and assist the person to establish a long-term route out of homelessness, such as accessing immigration advice to make an application to the Home Office. If no such action is taken, when the individual’s needs reduce to the extent that supported accommodation is no longer required under section 117 or they no longer require for aftercare services, the person may face homelessness and the local authority may find withdrawing accommodation more challenging. For more information about pathways off support, see chapter 13.

If the person continues to qualify for other aftercare services following the withdrawal of their supported accommodation, the local authority will need to determine whether accommodation can be provided under the Care Act. If the person has no lawful status, such a decision will also be subject to a human rights assessment. For more information about eligibility for care and support see chapter 4.

10.3 Ending aftercare services

The duty to provide aftercare services exists until both the CCG and local authority are satisfied that the patient is no longer in need of such services. Any change in the person’s needs is most likely to be identified when aftercare services are reviewed, either following a planned review or a change in circumstances.

With regards to timeframes for undertaking a review, the Ombudsman guidance states:

Eligibility for Section 117 should be reviewed within six weeks of discharge from in patient services, then annually thereafter, or sooner if circumstances change. The care coordinator is responsible for arranging these reviews and involving the person and other relevant parties. Often, CPA reviews do take place but Section 117 aftercare is not monitored (and documented) as it should be. (Page 4)

The failure to properly end aftercare services, when a person is no longer in need of such services, may mean that the local authority retains responsibility for providing aftercare should the person subsequently be readmitted to hospital under the Mental Health Act. For more information about responsibility for providing aftercare, see section 3.2.6.

The Code of Practice states that after-care services may be reinstated if it becomes obvious that they have been withdrawn prematurely. (Paragraph 33.22)

When preparing to discharge a person from aftercare accommodation, regard should be given to their immigration status and entitlement to public funds, so that the correct referrals can be made to prevent the person from becoming homeless. Adult social care will usually need to undertake a Care Act needs assessment to determine whether the person qualifies for care and support, including accommodation. Accommodation can be provided by adult social care whilst the needs assessment is being undertaken. For more information about assessing need, see chapter 4.