"I do not think my illness warrants continued detention"

About: Lancashire Care NHS Foundation Trust / Inpatient mental health care

(as the patient),

I am still detained in Guild Lodge. I have been here for over a year from the very start of my detention. I asked how long I would be here for (more or less). I feel I have never had a straight answer to this question. I don't think I have put a foot wrong since I came, I have engaged with staff and attended a full activities programme, and I am still on a medium secure unit with no plans to release me - at the moment, I should have been told 'at least 18 months to 2 years', but instead there has been no reference to any time scale. This is cruel and I believe it is undignified and against my human rights. I consider myself to be mentally stable, but am frustrated as there is no apparent end to this nightmare. I still have had no clear care pathway designated apart from a referral to a low secure unit which again, I have not time-scale for.

I was sent here on a mental health section against my will and have never once considered that my illness is of a nature or degree that warrants continued detention.

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Response from Lancashire Care NHS Foundation Trust

Firstly, I am very sorry you do not feel satisfied with your care and treatment within our in- patient unit Guild Lodge, and that you are understandably frustrated with the lack of certainty around your discharge arrangements. Despite your distress, it is commendable that you have engaged in all aspects of your treatment.

Unfortunately the anonymous nature of this forum, to protect confidentiality, limits the scope of my response but I welcome this opportunity to address your queries, and would welcome any further discussion if you feel able on a more individual level.

You have referred to being detained in Guild Lodge for longer than twelve months. This is a long period for anyone to stay compulsorily in a psychiatric hospital. Unfortunately the length of detention is never fixed at the outset. The decision to discharge anyone from detention is guided by the clinical progress made and any future risks to self or others. Although it could be extremely frustrating for the individual, one cannot predict at the time of admission as to how long it could take for anyone to be ready for discharge.

Detention in a psychiatric hospital under the Mental Health Act 1983 is distinct from a determinate prison sentence which stipulates the date of release from prison. A determinate prison sentence has a punitive element – it is intended to punish the defendant for the offences convicted. On the other hand, detention in a psychiatric hospital has a therapeutic purpose, to support and care for the person on the road to recovery. The law provides that a person should be detained for treatment as long as it is clinically necessary, ensuring that individuals receive appropriate care and treatment for the necessary length of time. It therefore is not always possible to give a precise time scale for discharge from a psychiatric hospital. If an established set length of time was committed to initially this may hinder recovery and undermine treatment goals by colluding with idea of time ‘served’ rather than time used for appropriate treatment. Your detention is reviewed regularly to ensure that it is necessary and the only option available to meet your mental health needs and manage your risks. The Trust always endeavours to treat anyone using the least restrictive option.

The Act contains provisions aimed at protecting your rights and liberties. Within Guild Lodge you have full access to this process supported by free legal advice if required. The Trust encourages all the individuals admitted to Guild Lodge to actively participate in their treatment and recovery. We have adopted the ‘My shared Pathway’ recently to improve the communication between the clinical teams and the service users, empowering individuals to take responsibility for their own progress. It allows, and actively encourages service users to negotiate outcomes during their recovery.

At Guild Lodge we have a number of mechanisms to promote participation of the detained service users in their treatment and progress. Service users and their families are given relevant information about Guild Lodge as soon as they are admitted. Ward Rounds (also known as Patient Care Team Meetings – PCTMs) and Care Programme Approach Meetings (CPAs) are held regularly to review clinical progress. We encourage active participation of all service users in these meetings. We also encourage the clinical teams to share the necessary reports and minutes of the meetings with the detained individuals (as appropriate). Active engagement in therapeutic activates greatly enables the clinical team to monitor progress of an individual.

When a clinical team concludes that the individual could manage in conditions of lesser security, a referral is made to that part of the service. Sometime there is a waiting list for availability of a place as the resources within the Guild Lodge are limited. The clinical teams regularly monitor such transfers to minimise any delays and make every effort to prevent delays in transferring of service users to less secure areas.

Individually service users who have concerns about any specific aspects of their treatment can raise this in a number of different ways, by contacting the advocacy service (which is independent to the trust), writing to the ward manager or the Responsible Clinician, contacting the solicitor, or by writing to the Customer Care Department of the Trust.

We also have a number of service user forums and events where we actively listen to service user feedback. This forum include service user champion meeting which is held once month and a champion business meeting that is held on a weekly basis. If you feel you would like to discuss any aspect of your care and treatment with me directly, please contact me at Guild Lodge on 01772 406637.

Thank you

Susan Tighe

Deputy Network Director

Specialist Services

Guild Lodge