Not being seen until three months after the police referral
12. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the organisation got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any signs that something has gone wrong.
13. The police referral was made on 10 June and received by the Trust on 19 June 2021. Mr O gave the Trust more information and on 22 June its safeguarding team referred Mr O to the Single Point of Access (SPA) team. This team emailed Mr O on 28 June asking him to contact it.
14. An appointment was made for 10 August, but Mr O declined this saying he needed a home visit. SPA wrote to Mr O on 26 July to say it needed to speak to him by phone before arranging a home visit. On 3 August, SPA offered to provide a taxi to take Mr O to and from the appointment booked for 10 August. Mr O declined this. He was told it would leave the appointment as scheduled, for him to attend if he wished.
15. SPA then wrote to Mr O to say that, because he refused an offer of assessment, he would now be discharged by the service and should speak to his GP about reviewing his mental health. When Mr O got the letter, he emailed SPA asking for another appointment, with a taxi provided. Mr O attended an appointment on 26 October 2021.
16. The police referral shows concern about his social isolation and says he would benefit from speaking to social services. It also says Mr O is not ‘known to self-harm, threaten self-harm, have suicidal thoughts or have [sic] attempted suicide’.
17. The Trust SOP says that first contact is by phone or text messaging. In Mr O’s case the Trust attempted first contact by email seven says after the referral, as Mr O did not have a phone. This is within the three weeks recommended for ‘level C’ of the UK Mental Health Triage scale, for someone expressing ‘suicidal ideation with no plan or ongoing history of suicidal ideas with possible intent’.
18. The SOP says practical arrangements for an assessment, such as location, should be considered. In Mr O’s case the Trust offered to arrange a taxi, at its expense, to help him to attend his appointment.
19. We asked our adviser to review the arrangements the Trust had offered and to confirm our understanding of the Mental Health Triage Scale. Our adviser says the SPA team triaged and contacted Mr O in line with the guidance, offering more than one appointment and transport to and from the assessment.
20. Although we understand Mr O’s anxiety about not being seen sooner, the evidence shows the Trust’s acted in line with the guidance in this situation.
21. We have seen no signs of failings in the time the Trust took to arrange an appointment.
Staff did not listen, admit Mr O or give support
22. Trust records for the appointment on 26 October 2021 show Mr O spoke about his mood as consistently low, since his father died four years before. They show he wanted to be admitted to hospital and he expressed suicidal thoughts, but with no plan to act on them. He is noted as saying he will take an overdose ‘one day’.
23. The records show that when the social worker made suggestions about how to help his recovery, such as having a support worker and bereavement counselling, Mr O seemed unwilling or unable to agree. Mr O expressed his dislike of the suggestions. He was advised the normal procedure was to try to help people at home, rather than to admit them, and that a hospital environment is not always a restful one.
24. We asked our adviser if the SPA team assessment was in line with guidance. They advised it was comprehensive and offered support services.
25. The records show a post-assessment plan for the Trust to contact Mr O’s GP for more information and to request a review of his medication. This is something Mr O said he would like during the assessment. The social worker noted Mr O was not open to a support worker, as he had not found that helpful in the past.
26. The social worker sent a summary of the assessment to the GP on the same day as the appointment and followed this with a request for a complete clinical summary.
27. The evidence shows the social worker had an in-depth discussion with Mr O and made suggestions to improve his mental health in line with the Trust’s SOP, with a focus on community-based solutions.
28. The social worker’s assessment that Mr O should not be admitted was in line with the guidance in the UK Mental Health Triage Scale and the Trust SOP.
29. As explained in the Trust complaint response dated 29 October 2021, its focus was on considering ‘the least restrictive option that meet’s someone’s needs’ and having a ‘duty to work with people in the community if at all possible’, rather than admitting Mr O to hospital.
30. Mr O’s feelings about the hospital where the mental health wards are based was also considered, when deciding if the Trust should admit him.
31. The social worker agreed to write to Mr O’s GP and to request a medication review and this shows they were listening to what Mr O wanted. They also agreed to a review at a later time.
32. The assessment was in line with the Trust SOP as it made sure Mr O was directed ‘to appropriate clinical pathways’.
33. The Trust also offered a second opinion, in its complaint response dated 28 January 2022. In this response, it repeated information on how to access mental health services if Mr O was in crisis.
34. Our adviser explained the Mental Health Code of Practice says, where possible, a patient’s ‘independence should be encouraged and supported with a focus on promoting recovery wherever possible’. The Trust did this. It also offered to help Mr O interact with neighbours as a community-based way of support.
35. Records show the Trust contacted Mr O’s GP giving a full summary within 48 hours of the assessment.
36. We have seen no signs that the Trust failed to listen or give appropriate support.
The complaint handling
37. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the event(s) complained about had a negative effect which the organisation has not put right. We have seen the Trust has already done enough to put right the impact its complaint handling had on Mr O.
38. Mr O says he first complained to the Trust on 29 October 2021 and contacted it at different times by email after this, but got no response until 28 January 2022.
39. The complaint file shows the Trust had ongoing email contact with Mr O and it replied to his contact on the same day or within 48 hours.
40. The written complaint response was delayed. The Trust wrote to Mr O on 2 November 2021 and said he should get a full response in 30 working days, but it did not meet this deadline.
41. The final complaint response dated 28 January was emailed to Mr O on 2 February 2022. It apologised for the delay and explains a review of Mr O’s assessment was done and the suggestions made.
42. The Trust offered a second opinion, making it clear another assessment would be done by different members of the team if Mr O wanted that. The response repeated advice about who to contact if Mr O felt unsafe.
43. The Trust told us the response was delayed because of staff annual leave.
44. It says the response was sent to the complaints manager for approval on 21 December 2021 but was not approved until 31 January 2022. As the complaints manager has now left the Trust, it cannot say why this was delayed.
45. We recognise the anxiety and frustration the delay caused Mr O.
46. Our Principles say organisations should keep complainants updated and explain the reasons for any delay. We can see the Trust updated Mr O throughout the complaints process, although it has not been able to fully explain the reasons for the delay.
47. The Trust sent its response within three months of Mr O’s complaint, so we have not seen that the delay meant Mr O did not get a response within a reasonable time.