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Who Are the Hospital Managers?

The hospital managers are a dedicated panel with the primary role of assessing potential discharges. They operate independently from the hospital, integrated care board, local health board, or any affiliated organisation. This independence is essential as they are not allowed to serve as officers or employees within these entities.

If you were sectioned or placed on your CTO, information on contacting these managers should have been provided. If not, you can always access it on your ward or at your clinic. Alternatively, seeking assistance from an IMHA can prove helpful.

Criteria for Discharge Consideration

Hospital managers have the discretion to review your discharge at any point. They can either deliberate on your discharge directly or delegate this authority to a 'managers' panel'.

They are compelled to instigate a review under the following circumstances:

However, the managers are not empowered to discharge you if you're under the purview of sections 35, 36, 38, 5, 135, or 136.

Guardianship

Hospital managers can also approve your shift to guardianship, contingent on your local authority's consent. This generally means a transition to a non-hospital care setting. Often, the task of discharging you into guardianship is entrusted to your responsible clinician.

Restricted Patients or Conditional Discharge

For those classified as restricted patients or on a conditional discharge, the hospital managers can only green-light your discharge with the affirmation of the Secretary of State for Justice. Nevertheless, you can still urge the managers for a detention review. For comprehensive details, our section on 'mental health and the courts' is available.

Discharge Protocols: Hospital Managers vs Responsible Clinician

The hospital managers adhere to discharge protocols similar to your responsible clinician. They also shoulder the responsibility of independently assessing certain situations that might arise during your time under section, separate from the clinician and ward staff.

However, they are restricted in certain areas. They cannot :

Such decisions are solely within the jurisdiction of your responsible clinician.

Discharge by Hospital Managers

Can Hospital Managers Discharge Me Against a Responsible Clinician's Barring?

Yes, the hospital managers will review the barring report provided by the responsible clinician. They will then draw their own conclusions on whether there's a likelihood of danger to you or others upon discharge.

Criteria for Discharge Evaluation

The factors hospital managers consider for discharge depend on whether you're under a:

If You Are on a Section

The managers have the discretion to discharge you if the original reasons for your sectioning no longer hold. They will assess:

To make an informed decision, they will likely analyse reports from your responsible clinician, care coordinator, named nurse, and other healthcare professionals involved in your care. This comprehensive review will encompass your care history, future plans, and potentially, your care plan under the Care Plan Approach or Care and Treatment Plan, should you have one.

Special attention will be accorded to any recent risk assessment or risk management plans, and any past incidents of self-harm or violence.

You ought to have access to these reports, barring instances where disclosure might be detrimental to you or others. Should they withhold any report, a valid rationale must be presented.

Other individuals who might receive these reports, contingent upon your agreement, include your:

While these factors guide the managers, they retain the discretion to discharge you based on unique circumstances. The principle of 'least restrictive treatment option' and your independence maximisation are paramount in their considerations.

Upon being discharged from the section, whether you depart from the hospital immediately hinges on:

Additionally, they will consider the perspectives of:

If You Are on a CTO

For those on a CTO, the discharge procedure mirrors that of a section. However, the underlying considerations undergo slight modifications.

Requesting Discharge from Hospital Managers

How Do I Approach Hospital Managers for Discharge?

There are no stringent protocols or forms to follow. You can petition for your discharge as frequently as you desire. Nonetheless, the managers might resort to a 'paper review' rather than a comprehensive hearing if:

Procuring Support

If you're seeking assistance in your appeal to the managers for discharge, consider approaching:

If you lack the mental acumen to liaise with the managers directly, these channels can also offer help:

For a broad understanding of mental capacity, our 'Mental Capacity Act' section is recommended.

What if My Tribunal Hearing Predates the Managers' Meeting?

For those under section 2, an applied tribunal will precede your managers' hearing. However, if you're transitioned to section 3 post the tribunal, only then will the managers' hearing be scheduled. Should you fall under section 3 or another prolonged section, your tribunal takes precedence. If it doesn’t result in discharge and you're still pursuing it, the managers will set a subsequent date for their hearing. Any alterations in your situation might propel them to conduct a comprehensive hearing or prompt another tribunal referral via the Ministry of Justice.

What Transpires During the Managers' Meeting?

While there isn't a rigid procedural template, the process adopted by the panel must be just and equitable.

Prior to the meeting, the panel delves into all pertinent details, encompassing recent reports from your responsible clinician and other healthcare professionals. This data should be relayed to you well in advance to enable adequate preparation for the meeting.

Meeting Location

The venue isn't fixed; the managers, considering your best interests, determine it. For those on a CTO or on hospital leave, a non-hospital environment might be more suitable. Alternative, practical venues should be contemplated by the managers.

The Meeting Process

Here's an outline of what to anticipate:

Post deliberation, the panel will reach an independent verdict, prioritising the least restrictive treatment that augments your independence. Occasionally, they might adjourn the hearing, deeming additional medical or professional counsel necessary.

Support During the Discharge Process

The managers are committed to ensuring your active participation in the process. They'll provide ample information to enhance your understanding and effective engagement in the procedure.

Additional Support Options

If you desire extra support, the managers will accommodate this by scheduling hearings with sufficient notice. This offers you the opportunity to be joined by:

Communication of the Decision

Upon conclusion of the review, the managers are obligated to promptly convey their decision, detailing their reasons. Additionally, they will:

If they opt not to discharge you, they'll elucidate their rationale, with a panel member availing themselves for a face-to-face explanation. This discussion will encompass the decision's record, its rationale, and review documents, which will subsequently be appended to your medical notes. You'll also be swiftly apprised of your rights to petition the tribunal for discharge.

Aftercare Planning

A deliberation session will be organised by the managers, contemplating the implications of your discharge on future care. Prior, your responsible clinician and multi-disciplinary team will evaluate the prospective care you might necessitate post-discharge. Possible considerations include community care arrangements, a Deprivation of Liberty Safeguards Authorisation (DoLS), or a Court of Protection order. Meetings might be paused if requisite aftercare details are lacking or certain practicalities need addressing pre-discharge.

Potential Transfer to Another Hospital

While managers can sanction a hospital transfer, they lack the authority to mandate a place for you in another hospital or secure funding for your care. Transfer motivations could encompass better care provisions, specialised services, or proximity to home. Decisions are influenced by:

Central to their decisions is your well-being. This entails respecting your human rights, ensuring you're at the heart of decision-making, and preventing unwarranted transfers. Should you desire a transfer, they'll endeavour to honour your request. Denials will be communicated in writing, elucidating their rationale.

Appealing Against the Managers' Decision

Can I Contest the Decision?

If you wish to challenge a decision that retains your sectioning, please refer to our section titled Getting my section lifted.

If you're convinced that the managers' decision overlooked pertinent details or didn't adhere to the correct procedure, it's advisable to consult a legal adviser or mental health solicitor (see Useful contacts). They can provide insights on the feasibility of seeking a court review of the decision, especially given the intricacies of pursuing such a legal claim and the challenges of obtaining legal aid.

When Might Managers Refer My Case to the Tribunal?

There could be instances when the managers opt to present your case to the tribunal, especially if you haven't approached the tribunal yourself due to health constraints. This is plausible if, for example, you were detained under section 2 or 3.

Secretary of State/Welsh Ministers' Involvement

The hospital managers, contingent on whether you're a patient in England or Wales, might contemplate soliciting the Secretary of State or the Welsh Ministers respectively, to advocate your case to the tribunal. This is especially pertinent if a considerable delay ensued in tribunal engagement post your initial sectioning. Such delays might infringe upon your rights under the European Convention on Human Rights.