Matthew Jones

: From Nadine Dorries MP

Parliamentary Under Secretary of State for Mental Health,
Department Suicide Prevention and Patient Safety

of Health &
Social Care SL beat
SW1H OEU
020 7210 4850

Our Ref: PFD-1178841

Ms Emma Whitting
HM Coroner's Office
The Court House
Woburn Street
Ampthill MK45 2HX

_ | | th September 2019

Dew EMMA,

Thank you for your correspondence of 4 June to Matt Hancock about the death of
Matthew Jones. I am replying as Minister with responsibility for mental health and I
am grateful for the additional time in which to do so.

Firstly, I would like to say how saddened I was to read about Mr Jones’s death. I can
appreciate this must be a very difficult time for his family and friends and I offer my
sincerest condolences.

I have noted carefully the concerns raised in your report about a lack of recognition
among mental health professionals and others of the importance of coordinated,
multi-agency working in relation to patients for whom a Community Treatment Order
(CTO) is in place.

It is not clear the circumstances under which Mr Jones was discharged from Ash
Ward at Oakley Court, Luton. However, when discharging a patient from inpatient
care, we would expect support to be provided to meet the individual needs of the
person concemed. This might include liaison with community services providing
treatment under a Mental Health Treatment Requirement’.

The National Institute for Health and Care Excellence (NICE) guidance, ‘Transition
between inpatient mental health settings and community or care home settings”,
advises that before discharging people with mental health needs, health and social
care practitioners in the hospital and community should discuss the patient’s housing
arrangements to ensure they are suitable for them and plan accommodation
accordingly.

Mental health practitioners should carry out a thorough assessment of the person’s
personal, social, safety and practical needs to support discharge. The assessment
should include risk of suicide and cover aspects of the person’s life including any
pre-existing family and social issues and stressors that may have triggered the
person’s admission, as well as suitability of accommodation.

The guidance also requires mental health practitioners to give people with serious
mental health issues who have recently been homeless, or are at risk of homelessness,
intensive, structured support to find and keep accommodation. This support should
be started before the patient is discharged and continue after discharge for as long as
the person needs support to stay in secure accommodation. The support should focus
on joint problem-solving, housing and mental health issues.

Organisations commissioning and delivering services are expected to take the
recommendations within NICE clinical guidelines into account when planning and
delivering services. We expect the local NHS to look closely at the circumstances of
this case and to take action where necessary to ensure services are safe and of high
quality.

You may also wish to note that when considering whether a patient should be
detained in hospital or receive continuing treatment in the community, the Mental
Health Act 19833 provides for three options. These are guardianship, leave of
absence, and CTOs.

e Guardianship (section 7 of the Act*) is social care-led and is primarily focused
on patients with welfare needs. Its purpose is to enable patients to receive care
in the community where it cannot be provided without the use of compulsory
powers. Such care may, or may not, include specialist medical treatment for
mental disorder. A guardian may be a local authority or someone else

https://www.nice.org.uk/guidance/ng53

+ hups://www.legislation.2ov.uk/ukpea/ 1983/20/part/[I/crossheading/ guardianship

approved by a local authority (a ‘private guardian’). Guardians have three
specific powers as follows:

o They have the exclusive right to decide where a patient should live,
taking precedence even over an attorney or deputy appointed under the
Mental Capacity Act 2005°. The Court of Protection also lacks
jurisdiction to determine a place of residence of a patient whilst that
patient is subject to guardianship and there is a residence requirement in
effect;

o They can require the patient to attend for treatment, work, training or
education at specific times and places (but they cannot use force to take
the patient there); and

o They can demand that a doctor, approved mental health professional or
another relevant person, has access to the patient at the place where the
patient lives.

e Leave of absence (section 17°) is primarily intended to allow a patient detained
under the Act to be temporarily absent from hospital where further inpatient
treatment as a detained patient is still thought to be necessary. It is suitable for
short-term absences for a fixed period or a specific purpose, i.e., to allow visits
to family and to trial living more independently; and,

e ACTO(section 17A’) is used where it is necessary for the patient’s health or
safety, or for the protection of others, to continue to receive treatment after
their discharge from hospital. It seeks to prevent the ‘revolving door’ scenario
and the harm which could arise from relapse. It is a more structured system
than leave of absence and has more safeguards for patients. A key feature of
the CTO framework is that it is suitable only where there is no reason to think
that the patient will need further treatment as a detained inpatient for the time
being, but where the responsible clinician needs to be able to recall the patient
to hospital if necessary.

When considering these options, clinicians should take into account the individual
circumstances, and the likely effectiveness, for the patient in question.

The Mental Health Act Code of Practice® provides statutory guidance to registered
medical practitioners; approved clinicians, managers and staff of providers; and
approved mental health professionals on how they should carry out functions under
the Mental Health Act in practice. It is statutory guidance for registered medical
practitioners and other professionals in relation to the medical treatment of patients
suffering from mental disorder.

All those for whom the Code is statutory guidance must ensure that they are familiar
with its contents. Others for whom the Code is helpful in carrying out their duties
should also be familiar with its requirements.

I hope that my response is helpful and provides assurance of the national guidance
that is available to support mental health professionals and others in managing the

transition of patients from inpatient to community care settings, and to ensure their
individual needs are met. Thank you for bringing these concerns to my attention.

Via Neds cf

NADINE DORRIES