How the law decides responsibility for funding mental health care

In a system of localised service delivery, a person’s links with an area are used to determine which public body has funding responsibility. Local authorities therefore want to know how strong those links have to be to fix them with funding responsibilities. A recent Court of Appeal decision (R (Sunderland City Council) v South Tyneside Council, October 2012) shows that, where funding aftercare for former mental health patients is concerned, the links do not need to be particularly strong at all  Seemingly random movements, perhaps not uncommon in this client group, may fix a local authority with funding responsibilities.

What happened?

A young woman had serious mental health problems. She was living in a residential college in Sunderland when she attempted to commit suicide. First of all, the woman was voluntarily admitted to hospital in South Tyneside. After this, the college terminated the woman’s placement. Then, the woman was ‘sectioned’ for treatment in South Tyneside under section 3 of the Mental Health Act 1983.

When patients who have been sectioned for treatment are discharged, they are entitled to free aftercare which normally includes specialist accommodation. This tends to be expensive. The local authority with funding responsibility is that in whose area the patient was ‘residing’ when they were sectioned. South Tyneside and Sunderland councils could not agree who was responsible for funding the woman’s aftercare under section 117 of the Mental Health Act 1983. They both argued that she resided in the other’s area when she was sectioned.

What did the Court of Appeal decide?

The Court of Appeal held that South Tyneside was responsible for funding the woman’s aftercare package. Once the residential college in Sunderland had terminated her placement, she could no longer be considered to reside in Sunderland. From then on she was residing in South Tyneside, in the hospital to which she was voluntarily admitted. Therefore, when that voluntary admission was converted into a forcible admission, the woman was residing in South Tyneside.

The result was that South Tyneside Council were the local authority with responsibility for funding the woman’s aftercare package. It did not matter that the woman had no previous connection with South Tyneside and had only by chance been residing there for a few weeks before being sectioned. She was residing there when sectioned and that was enough.

What does the decision mean in practice?

Arbitrarily, local authorities may find themselves responsible for funding discharge accommodation and aftercare services. Even if an individual has no long-term links with an authority’s area, the mere fact that an individual’s residence was in the authority’s area when ‘sectioned’ fixes the authority with what may turn out to be a lifelong funding responsibility. Financially destabilising as these unexpected funding responsibilities may be, it is how the current law operates.

Ed Mitchell is a solicitor and general editor of the Journal of Community Care Law