CXF, R (on the application of) v Central Bedfordshire Council & Anor

The duty to provide after-care services under Mental Health Act 1983, section 117, is not triggered by every period of absence authorised under section 17. The statutory conditions require the patient to have ceased to be detained and to have left hospital. A patient may remain detained and admitted to hospital while taking a short, escorted excursion outside its grounds. The question is fact-sensitive and depends on the circumstances of the leave, including the continuing custody, supervision and control of hospital staff.

The claimant, an 18-year-old detained under section 3 of the Mental Health Act 1983, lived in a hospital 120 miles from his mother’s home. His mother sought reimbursement of the travel costs of weekly visits, contending that the visits and associated activities were after-care services under section 117.

The claimant was granted daily escorted leave under section 17 for short bus trips. The central issue was whether that leave meant that he had ceased to be detained and had left hospital for the purposes of section 117(1). The court also identified, but did not decide, questions concerning the scope of after-care services and responsibility for funding.

1. The claim was dismissed. The section 117 duty had not been triggered.
2. Section 117(1) requires both that the patient has ceased to be detained and that the patient has left hospital. Those conditions cannot be equated simply with permission to leave the hospital perimeter. Their application depends on the facts.
3. A patient may remain detained despite being permitted to leave temporarily, particularly where the patient remains under the continuous supervision and control of hospital staff. Similarly, being absent from a hospital does not necessarily mean that the patient has left hospital. The ordinary language of “left hospital” points to discharge from the hospital’s care, whether permanently, temporarily or on a trial basis.
4. This construction was consistent with the purpose and wording of section 117. The references to after-care, discharge, residence or being sent on discharge, and reducing the risk of readmission all indicated that the provision was directed to patients no longer under the care of the detaining hospital. The Code of Practice could inform implementation policy but could not override the clear statutory language.
5. On the facts, the claimant remained resident in and admitted to the hospital. His excursions were short, required two staff escorts and supervision, and left him under the hospital’s care and control. He therefore remained detained and had not left hospital.
6. The court declined to determine the remaining issues hypothetically. It observed that, had section 117 applied, the evidence would have required reconsideration of whether the mother’s visits were therapeutically necessary and whether they reduced the risk of deterioration within section 117(6).

First-instance judicial review claim. No appellate history is stated in the judgment.