Restricted service users
What is a restricted service user?
A restricted service user refers to somebody who has been detained under Part 3 of the Mental Health Act usually because they were detained as a means of protecting the public. People can be detained on several different sections of the Mental Health Act. The main one used within restrictions is Section 37/41 which means that someone will be living within a secure hospital.
Another section can relate to people been transferred from prison, known as Section 47/49. What does restriction mean? It means that the Ministry of Justice have the authority over somebody leaving hospital either on planned leave or discharge. The doctor cannot make that decision.
What is the role of a social supervisor?
'Social supervisor' refers to the professional involved in providing reports to the Ministry of Justice following a restricted service user being discharged from the hospital. The person discharged from the hospital is subject to Section 37/41 under Mental Health Act. Following discharge the service user will be 'conditionally discharged'. The social supervisor has to report on a service user’s care in the community, rehabilitation and risk to the public on a regular basis. A statutory report has to be completed initially within 28 days of the discharge and quarterly thereafter. This report will be shared with the responsible clinician.
The social supervisor will often visit the service user once a week initially and that would decrease when the service user becomes more settled in the community.
The social supervisor role is to provide statutory reporting to the Ministry of Justice on the service user’s care in the community and report on the conditions, so it might be about the service user allowing access to their care team, it might be reporting on the service user’s mental state or their risk to the public. The key element is that the social supervisor has established a good rapport with the service user, ensuring a supportive role within their work rather than a policing role. Any change in circumstance needs to be reported to the Ministry of Justice on a regular basis, and the Ministry of Justice case worker. The social supervisor also has power to seek permission from the Ministry of Justice to recall the service user from the community if the risk is significant or the person is a risk to the public.
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What is the difference between a social supervisor and a care co-ordinator or social worker?
The difference between the care co-ordinator and social supervisor is that the care co-ordinator often works for mental health services in the community, and deals with people with mental health problems with complex needs working in the mental health trust. Generally, the service user will have a care co-ordinator responsible for assessing and co-ordinating care, providing a care plan, a crisis contingency plan and supporting the individual in the community. Where there are social needs this process will be worked through in tandem with a social worker from the local authority too. Both the care coordinator and the social worker will review and monitor the person’s care plan. This differs from the social supervisor in that it's a specific statutory role that has to report to the Ministry of Justice on a regular basis.
Can a person be discharged from restrictions?
A service user can be discharged from restriction under the Mental Health Act via a 'first-tier tribunal (mental health)' or via the Ministry of Justice. This is known as 'absolute discharge'.
Can a person appeal against restrictions?
A service user can appeal against restrictions under the Mental Health Act in two ways. If you're in hospital you can appeal via first-tier tribunal (mental health) for a conditional discharge or an absolute discharge in the community. If you're subject to a conditional discharge with oversight from a social supervisor, you can apply again to a first-tier tribunal (mental health) for absolute discharge. This has particular timescales attached to it.
How does social supervision work in practice?
A case example of social supervision in practice relates to a male service user who is supported by the local mental health trust with an allocated psychiatrist, and by Shropshire Council with an allocated social supervisor (with the profession of social work).
The individual concerned unfortunately committed serious offences against a relative and was subsequently detained under Section 37/41 under the Mental Health Act.
Treatment was provided in a secure hospital setting for a significant period of time. Due to progress in rehabilitation and treatment he was later discharged by a first-tier tribunal (mental health) under a conditional discharge and discharged to the community to a supported setting.
It's a condition of returning to the community that a social supervisor is allocated. The local authority is responsible for allocating a professional to carry out this role in partnership with the allocated responsible clinician - typically the psychiatrist. Having been allocated a social supervisor a report is sent monthly, initially to the Ministry of Justice, regarding initial care and treatment and the presenting risks.
Over coming weeks and months the input that was offered may be reduced as risk assessments undertaken by all key individuals identify progress.
In this case, due to him remaining safe and supported in the community, contact was reduced to the set timescales of a monthly basis, with the social supervisor and responsible clinician then continuing to report to the Ministry of Justice every quarter.
Useful websites
Forensic services in Shropshire
Midlands Partnership Foundation Trust - Forensics
Carers
As a carer you can expect to be asked your opinion, unless there are exceptional reasons why this can’t happen for the interests of the individual or for the carer.
As a forensic carer you'll have a fairly unique experience and the MPFT guidance will help you through some of the specifics that you may wish to refer to, the people and the processes.
As a carer you should know you have the right to address your own needs - this may be through your GP, through self-referral to IAPT, or it may be that you choose private counselling - the important thing is to address your needs, and that you can be supported through what for many is a traumatic process. To engage effectively with the changes that will be taking place you'll benefit from addressing your own needs. Find out more from our 'Caring for someone-else' page.
Journey to community discharge
Every individual’s journey through this process is different. You or your loved one will have the right to expect support from the mental health teams in assessing and planning the most appropriate route of discharge, and then ongoing community support. The journey through forensic services can vary.
Example 1
A lengthy stay in a secure setting, step down to an NHS rehab community placement, then supported by family into own tenancy.
Example 2
Lengthy stay in a secure setting, step down to community-supported accommodation, relapse in mental health and recalled back into hospital for further treatment. Treatment ongoing.
Example 3
Stay in secure setting transferred between medium to low secure hospital setting. Then move into a 24-hour supported residential setting.
The Shropshire Council role in this process can vary. We're not always actively involved until the point of discharge, as the local trust has a multi-disciplinary team around the person.
The Ministry of Justice has to approve all steps in progression, and doesn't always agree with community recommendations
If an individual has needs associated to the Care Act anyone can refer to Shropshire Council, and assessment will take place in due course.
Glossary of terms and abbreviations
- RC - responsible clinician
- RMN or CMHN - community mental health nurse
- MPFT - Midlands Partnership Foundation Trust