This chapter was last reviewed and/or updated June 2021.

1. Introduction

Lincolnshire County Council fulfils its duties to support people experiencing mental ill health through the following functions.

For people aged between 18 and 65: LCC has partnership arrangements made through section 75 of the National Health Services Act 2006 with Lincolnshire Partnership Foundation NHS Trust (LPFT). The section 75 agreement delegates the provision of social care assessment and associated functions and service provision to the trust alongside its wider functions in supporting people experiencing mental ill health.

For people aged over 65: Lincolnshire Adult Care’s Adult Frailty and Long Term Conditions teams provide social care assessment and professional support, often in conjunction with the health professionals in LPFT’s older people’s Community Mental Health Teams

2. Transitions protocol between LPFT and Adult Care

The Joint Transitions Protocol for People aged 65 and Over with Mental Health Needs is intended to ensure smooth transfer arrangement between LPFT and Adult Care teams as people approach the age of 65.

The protocol reflects the practice standards set in the National Service Framework (NSF) for older people and the National Service Framework for Mental Health Needs which require both parties to be clear about their arrangements for collaborative working.

The section 75 agreement between LPFT and LCC, section 3.9.2 states:

“LPFT and LCC shall work together through appropriate and agreed transition arrangements to prepare the council to ensure continuity of mental health and social care for service users aged 64 and above who are:

  • in receipt of individual services under these arrangements; and
  • will – or likely to require continued care arising from mental health needs on or after becoming the age of 65.”

It shall be the responsibility of Adult Care (LCC) to arrange for the provision of such continuing adult social care for eligible people reaching the age of 65.

3. Approved Mental Health Professionals (AMHP)

Lincolnshire County Council is responsible for providing an Approved Mental Health Professional (AMHP) Service for Lincolnshire’s citizens. An AMHP is a professional working with people with mental health issues, most often a social worker but they could also be a psychiatric nurse or therapist who is specifically trained and warranted to undertake assessments under the Mental Health Act.

LCC commissions LPFT to coordinate the daytime AMHP service and rota on its behalf. As part of this agreement LPFT provides 75% of the AMHP capacity on the rota. Lincolnshire County Council provides the remaining 25%.

Referrals for an AMHP assessment should be made through the AMHP Co-ordination Service (see Local Contacts).

AMHP assessments out of core hours are undertaken by the LCC Emergency Duty Team (see Local Contacts).

Any practitioners interested in gaining their qualification and undertaking AMHP duties should discuss with their line manager and contact the Workforce Quality and Development Team.

4. Recording in the Adult Care system

All social care case work activity undertaken by LPFT will be recorded in the Adult Care system using the same recording procedures and forms as LCC Adult Care staff.

Please note: People who are subject to some sections under the Mental Health Act or Mental Capacity Act, including Powers of Attorney, Court Appointed Deputy and DoLS, must have those orders or statuses recorded in their customer record.

5. Care Programme Approach

The Care Programme Approach (CPA) provides a framework for effective mental health care for people with severe mental health problems. The main elements are:

  • systematic arrangements for assessing the health and social needs of people accepted into specialist mental health services;
  • the formulation of a care plan which identifies the health and social care required from a variety of providers;
  • the appointment of a key worker (Care Coordinator) to:
    • keep in close contact with the person;
    • monitor and coordinate care;
    • regularly review and, where necessary, agree changes to the care plan.

6. Mental Health Tribunal, Social Circumstances Reports

If a person is detained under the Mental Health Act (1983 and 2007), it is a requirement of the Human Rights Act 1998 to review the lawfulness of that detention. In England, the task of reviewing the lawfulness of detention is exercised by the Mental Health Tribunal.

In order for a tribunal to be in a position to ‘speedily’ decide whether or not detention is a proportionate response, it must have information about the patient’s social circumstances and the level of support which could be provided in the community.

The main purpose of a Social Circumstances Report is to provide the tribunal with:

  • hard evidence of the patient’s circumstances if discharged from hospital; in particular, what medical, social services and other support will be available in the community;
  • evidence about the views of the nearest relative and non-professional others who play a significant part in the patient’s care;
  • the patient’s own views;
  • an assessment of the patient’s strengths and positive factors;
  • evidence of planned aftercare, in line with the guidance in the MHA Codes of Practice for England and Wales on the duty to provide aftercare under MHA 1983 section 117, and the English and Welsh policy guidance on the Care Programme Approach (CPA);
  • HM5 Hospital Managers Social Circumstances Report (Lincolnshire County Council intranet);
  • MHRT 3 Social Circumstances Report (Lincolnshire County Council intranet).

7. Section 117

Section 117 of the Mental Health Act (1983), as amended by the Mental Health Act (2007), puts an enforceable joint duty on health and social services to provide aftercare services, free of charge, to people who have been detained under section 3, 37, 45A, 47 or 48 of the Act and who cease to be detained in hospital.

Eligible patients, who have informally remained in hospital after ceasing to be detained under the Act, are still entitled to aftercare under section 117 once they leave hospital. This also applies when patients are released from prison, having spent part of their sentence detained in hospital under a relevant section of the Act.

The duty to provide aftercare subsists until such time as health and the local authority are satisfied that the person concerned is no longer in need of such services.

The purpose of section 117 aftercare is to prevent someone needing to go back into hospital. This means that services should meet the person’s immediate needs, as well as supporting them to gain skills to help them cope with life outside of hospital.

8. Guardianship

Guardianship can enable people to receive care outside hospital 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 approved by a local authority (a ‘private Guardian’). Guardians have three specific powers as follows:

  • They have the exclusive right to decide where a person 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 person whilst that person is subject to Guardianship and there is a residence requirement in effect;
  • They can require the person to attend for treatment, work, training or education at specific times and places (but they cannot use force to take them there); and
  • They can demand that a doctor, approved mental health professional (AMHP) or another relevant person has access to the person at the place where they live.

Guardianship therefore provides an authoritative framework for working with a person, with a minimum of constraint, to achieve as independent a life as possible within the community. Where it is used, it should be part of the person’s overall care plan.

More information can be found in Lincolnshire County Council’s Guardianship Policy and Procedures.

For guidance regarding Guardianship, please speak to your lead practitioner and the Lead Professional Team.

9. Community Treatment Orders

A Responsible Clinician can arrange for a patient on section 3 or section 37 of the Mental Health Act (1983) to have supervised community treatment. A Community Treatment Order (CTO) means the patient will be bound by certain conditions, but can be treated and live in the community. The patient’s Responsible Clinician can order the patient back to hospital if the patient has broken a condition of the order or if their mental health has declined.

A patient under section 2 of the Mental Health Act (1983) or a voluntary patient cannot be put on a CTO.

Information regarding CTOs is included in the Rethink website.