Section 117 After-care

This page explains if you can get free after-care under section 117 of the Mental Health Act 1983. ‘117’ is pronounced ‘one-one-seven’. This page explains what services you might get and when your care will end.

Overview

  • ‘After-care’ means the help you get when you leave hospital.
  • You are entitled to section 117 after-care if you have been in hospital under sections 3, 37, 45A, 47, or 48 of the Mental Health Act 1983.
  • Section 117 after-care is free.
  • The NHS and social services will give you after-care.
  • Your mental health might affect you in different ways. The NHS and social services call these things your ‘needs’.
  • Your after-care will help you with your ‘needs’. You may get specialist housing, help to meet other people, help with work or education, or free prescriptions for mental health medication.
  • Your after-care might be organised under the Care Programme Approach (CPA).
  • Your after-care should only stop when you no longer need it to stay well.
  • If you have any problems or questions, talk to your care coordinator, or another member of your care team. An advocate might be able to help you do this. If this does not work, you could think about making a complaint.

About

What is section 117 after-care?

Some people who have been in hospital under the Mental Health Act 1983 (‘sectioned’) can get free after-care when they leave hospital. This is called section 117 (‘one-one-seven’) after-care. ‘After-care’ means help you get after you leave hospital that:

  • meets needs that you have because of the mental health condition that caused you to be detained, and
  • reduces the chance of your condition getting worse, so you don’t have to go back into hospital.

Section 117 begins when you leave hospital, but hospital staff should start planning your after-care as soon as you go in to hospital.

You can find more information about the ‘Mental Health Act’ by clicking here.

Will I get section 117 after-care?

You will get free after-care if you have been in hospital under certain sections of the Mental Health Act. You can get it if you have been:

  • detained in hospital for treatment under section 3,
  • transferred from prison to hospital under sections 47 or 48, or
  • ordered to go to hospital by a court under sections 37 or 45A.

You will only start getting after-care services when you leave hospital.

You will not get free after-care if you have been in hospital under sections 2, 4, 5, 35, or 38 of the Mental Health Act.

What if I go on leave from hospital?

You may be allowed to leave the hospital for a short time. This is called ‘going on leave’ or ‘section 17 leave’. If you go on leave while you are in hospital under sections 3, 37, 45A, 47, or 48, you will be able to get free after-care when you are on leave.

What if I stay in hospital?

You might want to stay in hospital after you have been discharged from the Mental Health Act sections 3, 37, 45A, 47, or 48. This is called being a ‘voluntary’ or ‘informal’ patient. If you don’t leave hospital straight away, you will still get free after-care when you do leave.

What if I go back to hospital?

If you go back into hospital, your section 117 should not end. Some people worry that if they are sectioned under section 2 in the future, section 117 after-care will end. This should not happen.

Community Treatment Orders (CTOs)

You may be discharged from hospital under Supervised Community Treatment (SCT). This is called being on a ‘Community Treatment Order’ (CTO). If you are under a CTO, you will get free after-care.

You can find more information about ‘Community Treatment Orders’ by clicking here.

Payment & services

Who should arrange and pay for my after-care?

Your after-care will be arranged by the following organisations.

  • Your local social services authority (LSSA), which is a part of your local authority.
  • Your local NHS ‘clinical commissioning group’ (CCG). The CCG is a group of GPs that decides what services should be available in your area.

Social services

The LSSA in the area where you usually lived before you went into hospital will have to pay for your care.

If two local authorities cannot agree who should pay for your care, someone at the Department of Health will decide which local authority should pay.

NHS

Working out which CCG should pay for your after-care will depend on when you were discharged from hospital.

Discharge between 1st April 2013 and 31st March 2016
If you were discharged between 1st April 2013 and 31st March 2016, the CCG that should pay for your after-care is the CCG that was responsible for paying for it on 31st March 2016.

They will be responsible for paying for your after-care for as long as you need it.

Discharge on, or after, 1st April 2016
If you were discharged on, or after, 1st April 2016, the CCG that pays for your after-care should be the CCG that covers the area where you usually lived before you went into hospital. They will be responsible for paying for your after-care for as long as you need it.

If you were discharged on, or before, 31st March 2013, you can contact Rethink Mental Illness Advice Service for advice. Our contact details are on the website on the Contact page.

Direct Payments

Direct payments are when you are given the money to arrange and pay for your own support. This means you can choose how you get the support you need. You can ask for direct payments, as long as you have the mental capacity to manage them. ‘Mental capacity’ means being able to make decisions for yourself.

You can find more information about:

  • Direct payments by clicking here.
  • Mental capacity and mental illness by clicking here.

What services should I get, and how will these be planned?

There are no limits to what services you can get. But, the services should:

  • meet needs that you have because of the mental health condition that caused you to be detained, and
  • reduce the chance of your condition getting worse, so you don’t have to go back into hospital.

You may get:

  • certain types of housing,
  • services in your home or in a day centre, and
  • help to get supported employment.

You may also get free prescriptions. But this would only cover medication you've been prescribed to treat the mental health condition that caused you to be detained.

The NHS and social services should ask you what kind of things you would like help with. Your carer could be involved in this too, if you want.

Other people that could be involved are your:

  • psychiatrist,
  • community psychiatric nurse (CPN),
  • GP,
  • psychologist,
  • social worker,
  • occupational therapist,
  • advocate,
  • local authority housing officer,
  • attorney, if you have made someone your ‘lasting power of attorney’ (LPA), and
  • deputy, if you have been given one by the Court of Protection.

Your mental health might affect you in different ways. For example, you may find it hard to do some things for yourself. These things are called your ‘needs’. The NHS and social services should give you services that help you to do these things. This is called ‘meeting your needs’.

When everyone has agreed how your illness affects you, and what services you need, they will write this down. This is called an ‘after-care plan’ or a ‘care plan’. You care plan might include:

  • where you will live,
  • what treatment you will get,
  • what you will do during the day,
  • what services will help you to stay well,
  • what help you will get to go to work or study,
  • what help you will get with physical health problems,
  • what help with drug or alcohol use you will get, if you need it,
  • things that might help you to keep in contact with your family, or to raise children,
  • what you should do in a crisis, and
  • what help you will get with benefits and managing your money.

Rachel's Story

Rachel has a diagnosis of borderline personality disorder, and a history of using drugs. She was in prison for a drugs offence, and was transferred to hospital under section 47. Rachel has now returned to prison. She has a care coordinator who is writing a plan about what help she will get when she leaves prison. The plan says that Rachel will have help at home on a weekly basis, help with finding employment, help to manage her drug use, and details of what she should do in a crisis.

Rachel

What if my needs change?

You might have a care coordinator who you can talk to about this. A care coordinator helps to organise the help and support you get. If you don’t have a care coordinator, you can speak to someone else in your care team.

If your care coordinator agrees your needs have changed, they will look again at the help you need. They may call this a ‘review’ or a ‘reassessment’.

Your care coordinator should review your plan regularly, even if your needs have not changed. This should happen at least once a year.

When your care coordinator reviews your needs, they will hold a meeting. They may call this a ‘review meeting’ or a ‘needs assessment’. Other people may be able to go to the meeting too, such as your GP, your psychiatrist, and your carer, if you have one.

Care Programme Approach (CPA)

What is the Care Programme Approach (CPA)?

Most people who are entitled section 117 after-care should get help under CPA.

CPA is a package of care, where different health professionals work together to meet your needs. Under CPA, you will have a care plan and someone to coordinate your care.

CPA aims to support your mental health recovery by helping you to understand your:

  • strengths,
  • goals,
  • support needs, and
  • difficulties.

Under CPA you should:

  • be involved in planning your care,
  • have a care plan covering all of your care needs, and
  • have your care needs reviewed regularly.

You can find more information about the ‘Care Programme Approach (CPA)’ by clicking here.

Housing

Can I get free housing?

The rules about what housing you can get for free under section 117 are complicated. Normal housing is very unlikely to be free. But specialist housing might be free if it:

  • meets needs that you have because of the mental health condition that caused you to be detained, and
  • reduces the chance of your condition getting worse, so you don’t have to go back into hospital.

The law is not clear about who will be able to get free housing under section 117. If your local authority says you are not entitled, make sure you challenge them as soon as possible.

Ordinary housing

Ordinary housing will not usually be free under section 117.

‘Ordinary housing’ means a house, flat, or room that you rent from the council, or a private or social landlord.

If you feel your housing should be free because it:

  • meets needs that you have because of the mental health condition that caused you to be detained, and
  • reduces the chance of your condition getting worse, so you don’t have to go back into hospital,

you would need legal advice. You can find more information about getting legal advice further down this page.

Supported housing

Supported housing is housing where you get care, support, or supervision at home. This housing is not the same as a ‘care home’.

You may be charged separately for your rent and care. A lot of local authorities will charge you for rent, even if you are under section 117. But they should pay your care costs under section 117, unless they are paid for by another scheme.

The law is not clear about whether these local authorities are acting properly by charging you rent. You can challenge your local authority by making a complaint or taking legal action.

You can find more information about complaining and getting legal advice further down on this page.

You can find more information about ‘Supported housing’ by clicking here.

Residential care (also known as a care home)

Residential care might be included as part of section 117 after-care. But the law about getting free residential care under section 117 is complicated.

The cost of the home should definitely be paid by the NHS and the local authority if:

  • the need for the residential care is linked to the reason why you were detained under the Mental Health Act, and
  • you don’t have the mental capacity to make a decision about where you live.

If you do have the mental capacity to make decisions about where you live, and the NHS and the local authority try to charge you for residential care you can:

  • complain, or
  • get legal advice.

You can find more information about complaining and getting legal advice further down this page.

Returning to residential care
You might have lived in residential care to meet your mental health needs before you went into hospital.

If you return to residential care after being in hospital, it might be free of charge under section 117 after-care, even if you paid for the residential care before you went into hospital.

If you are in a home under Deprivation of Liberty Safeguards (DoLS)
You might have to go into a home under a DoLS order if you lack mental capacity.

If you are entitled to section 117 after-care, the home should be free of charge.

You can find more information about ‘Mental capacity and mental illness’ by clicking here.

Top up fees
You might want to go into a home that is different to the ones that the local authority has chosen for you. But it might be more expensive.

The local authority will assess your needs and decide how much it will cost to meet them. If the home you have chosen is more expensive, you will need to pay top up fees. This is to cover the difference.

Nursing care
You might get nursing care in the care home. If you are entitled to section 117 after-care this will be free and paid for by the NHS.

Depending on your circumstances your nursing care might be paid for by the NHS under either:

  • Section 117 after-care, or
  • NHS Continuing Healthcare.

You can read more about NHS Continuing Healthcare at
www.nhs.uk/Conditions/social-care-and-support-guide/Pages/nhs-continuing-care.aspx.

Can I choose where I want to live?

New rules from April 2015 say you can choose the care home or supported housing you want to live in. Your local authority will have to let you to live there if:

  • you are over 18,
  • the local authority was going to offer you the same type of housing,
  • it will meet your needs,
  • the housing is available,
  • the housing provider agrees to the local authority’s standard terms, and
  • if your preferred housing is more expensive, you, or someone you know, will pay the difference. Whoever agrees to pay will have to agree in writing.

Roy's Story

Roy has schizophrenia, and is in hospital under section 3 of the Mental Health Act 1983. Roy’s doctors think that he is well enough to leave hospital. They decide that he will need ongoing support in a care home to make sure that he doesn’t become unwell again. Roy’s care coordinator asks him what type of things he might find helpful, and they agree a list of services he needs. Roy’s care coordinator has found three care homes that would meet his needs. Roy chooses the one that is closest to his family.

Roy

Budget

Can I get a personal health budget?

From 2nd December, 2019 you can get a personal health budget if you are entitled to section 117 after-care.

What is a personal health budget?

A personal health budget is an amount of money to support your health and wellbeing needs. It is planned and agreed between you and your NHS mental health team.

A personal health budget allows you to manage your healthcare in a way that suits you.

Together with your NHS mental health team, you will develop a care plan. The plan sets out:

  • your personal health and wellbeing needs,
  • the health outcomes you want to achieve,
  • the amount of money in the budget, and
  • how you are going to spend it.

Your care plan should be regularly reviewed. You can ask for your plan to be reviewed if you think it isn’t meeting your needs.

A care co-ordinator will be responsible for your care.

You can give up your personal health budget at any time. You will still be able to receive care and support in another way.

A personal health budget is different to direct payments for social care.

You can have:

  • a personal budget and direct payments at the same time, or
  • an integrated personal budget, for both your healthcare and social care needs.

What can I spend my personal health budget on?

You should work with your NHS mental health team to identify:

  • your health needs, and
  • what support and treatment you need to meet those needs.

You can spend your personal health budget on care and support to meet your needs. You should agree this with your NHS mental health team. Your local Care Commissioning Group (CCG) might need to be involved too.

You might be able to spend the money on a broader range of care and support than the NHS usually offer. For example, if a side effect of your medication is weight gain, you might be able to use your budget to pay gym fees.

You should be supported by a suitable professional to think through how you would like to use your budget.

Your NHS team is responsible for:

  • giving you advice about your budget, or
  • referring you to a suitable local organisation for advice.

Your personal health budget should be used for the specialist support and care you need because of your illness or disability. You don’t need to use it to pay to see your GP or to get emergency care, for example.

You might want to know more details about what you can and can’t use your budget for. You can find out more at this link:
www.england.nhs.uk/publication/guidance-on-direct-payments-for-healthcare-understanding-the-regulations/

You can read more about personal budgets by clicking on this link:
www.nhs.uk/using-the-nhs/help-with-health-costs/what-is-a-personal-health-budget/

You can also look on the following website:

People Hub – Personal Health Budgets Network
People with a personal health budget and their families share their
experiences. The website also includes information and resources on
personal health budgets.

Website: www.peoplehub.org.uk

End of care & resolving problems

When will my free after-care end?

The NHS and social services have to give you after-care as long as you need it. Even if you are doing well outside hospital, you may still need after-care services to make sure you stay well.

Ending section 117 is called being ‘discharged’ from section 117. To discharge you from section 117, your local clinical commissioning group (CCG) and local social services authority (LSSA) must decide that you no longer need after-care services. They should not discharge you from section 117 when you are still getting services you need.

If staff want to discharge you from section 117, they should fully involve you in this decision. They may do this through a ‘discharge meeting’. You can bring an advocate, carer, or family member, if you want.

They should not discharge you from section 117 just because:

  • you have been discharged from specialist mental health services, such as a community mental health team (CMHT),
  • a certain length of time has passed since you left hospital,
  • you go back to hospital voluntarily or under section 2,
  • your community treatment order (CTO) ends, or
  • you refuse after-care services.

If they discharge you from section 117, but can see that they have discharged you too soon, you can be put back under section 117. This might happen if your mental health starts to get worse as soon as you are discharged.

How can I deal with problems with section 117?

If you have a problem with section 117, you should talk to your care coordinator. If you do not have a care coordinator, talk to a member of your care team.

Advocacy

If you are worried about talking to your care coordinator or care team, you may be able to get help from an advocate. Advocates can help you to understand information, and get your point across. The type of advocate you need depends on your situation.

Independent Mental Health Advocate (IMHA)
If you are on a Community Treatment Order (CTO), you can get help from an IMHA. Ask your care coordinator, psychiatrist, or another member of your care team, how to get in touch with an IMHA.

Care Act advocate
A Care Act advocate can help you when your care is being planned or reviewed, if you need help to make some decisions because you find it hard to:

  • understand information you need to make the decision,
  • retain the information,
  • use or weigh up the information to make a decision, and
  • tell someone your decision.

Care Act advocates are sometimes called independent advocates.

NHS complaints advocates
If you are making a complaint about an NHS service, you can get help from a specialist complaints advocate. They are also sometimes called an Independent Health Complaints Advocate (IHCA).

Community advocates
If you can’t get help from any of the above advocates, you might be able to get help from a community advocate.

Community advocates are general advocates that can help with lots of different issues. But they’re not available everywhere. You can look on the internet, or ask your care team if there’s community advocacy in your area.

Complaints

If you cannot solve the problem by talking it through, you can make a complaint. If you are not happy with the outcome of your complaint, it may be possible to complain to an Ombudsman service.

Ombudsman services can investigate complaints. They are independent of the NHS and social services. You can find their contact details in the ‘Useful Contacts’ section below.

Legal action

You could get advice from a solicitor, who could help you to get the services you are entitled to. You need to do this quickly because the time limit for taking the NHS and the local authority to court can be as little as 3 months.

You can find more information about:

  • Advocacy by clicking here.
  • Complaints by clicking here.
  • Legal Advice by clicking here.

Useful contacts

Parliamentary & Health Service Ombudsman (PHSO)
They investigate complaints about the NHS in England.

Telephone: 0345 015 4033. Open Monday-Friday, 8.30am-5.30pm.
Email: They use a secure email service. For details on how to use it please see this link: www.ombudsman.org.uk/about-us/contact-us/using-our-secure-email-service
Website: www.ombudsman.org.uk
Address: Millbank Tower, Millbank, London, SW1P 4QP

Local Government and Social Care Ombudsman
They investigate complaints about the local authority and social services.

Telephone: 0300 061 0614. Open Monday-Friday, 8.30am-5.30pm.
Email: via form here: www.lgo.org.uk/forms/showForm.asp?nc=QG1E&fm_fid=81
Website: www.lgo.org.uk
Address: PO Box 4771, Coventry, CV4 0EH

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