When something goes wrong in the NHS, patients, families or carers can make a complaint and ask for it to be put right. Individuals must raise their complaint with the organisation involved before bringing it to us. This is so the organisation has the chance to put it right. We know from the number of complaints we receive, and our own research, that people being cared for in inpatient mental health settings are among those least likely to complain about their care or treatment.
The reasons for this are likely to be varied and could include:
- a lack of confidence in how to complain about an NHS mental health trust
- a fear of the repercussions of raising a complaint
- the continuing stigma associated with severe mental health conditions
- the ability to complain while being unwell with a mental health condition.
The complaints landscape for mental health is also complicated, with different types of complaints falling under the responsibility of either ourselves (the Parliamentary and Health Service Ombudsman), the Local Government and Social Care Ombudsman (LGSCO), the CQC or the Mental Health Act Tribunal.
|
Organisation |
Responsibility for mental health complaints |
|
Care Quality Commission (CQC) |
Complaints about how powers or duties have been carried out under the Mental Health Act |
|
Local Government and Social Care Ombudsman (LGSCO) |
Complaints about the actions of individuals employed by local authorities such as Approved Mental Health Professionals |
|
Parliamentary and Health Service Ombudsman (PHSO) |
Complaints about care and treatment commissioned or delivered by the NHS in England |
|
Mental Health Act Tribunal |
Individuals have a right to apply to the Tribunal to ask if they can be discharged from a section |
All of these issues affecting the ability to complain can be made worse by the feeling that mental health inpatient settings are ‘closed off’, with families and carers not as exposed to the realities of day-to-day life and care on the ward. We must consider whether the complaints process is set up to meet the needs of this group of people. We do not have the power to investigate an issue unless we have received a relevant complaint, even if it is a known problem and in the public interest to do so. The cases in this report are likely to be a small sample of a more widespread issue.
Failings in discharge is an issue we have commented on before. Five years ago, we published our report ‘Maintaining momentum: driving improvements in mental health care’, which shared case studies of complaints about:
- diagnosis
- failure to treat
- risk assessment
- a lack of dignity and due regard for human rights in mental health care
- inappropriate discharge and aftercare.
We highlighted the huge difference between the NHS ambitions of the time (as set out in the ‘Five Year Forward View for Mental Health’) and the reality of the real-world discharge process. Since we published that report, the COVID-19 pandemic has undoubtedly had a significant impact on bringing mental health and mental wellbeing to the forefront of the public consciousness.
In April 2022, working with the LGSCO, we published new guidance on providing Section 117 aftercare for people who have previously been detained under certain sections of the Mental Health Act. This drew on our joint investigation into a local authority, NHS trust and clinical commissioning group’s (now integrated care board) failure to provide good care for a young woman in Croydon, South London. The case detailed how the lack of care after her discharge from a section, a legal entitlement, led to a severe deterioration in her mental health, put her at greater risk of harm and placed a huge emotional toll on her family, who struggled to get her the help she desperately needed.