17/03/2014
Social services need to make arrangements to ensure that the bills and finances of a patient who is detained in hospital are properly managed when there is no one else able to do so.
Who is responsible for a patient’s finances/ensuring bills continue to be paid, if a patient is brought into hospital under a section and is kept there for a period of time but has no friends/family to keep an eye on things?
Although you might think there must be a quick and simply answer to this question, by reference to the Mental Health Act 1983 (MHA) and its associated Code of Practice (CoP), you’d be wrong. The Act and the Code are remarkably quiet about whose job it is to sort out the affairs of some one detained in hospital who is simply unable to do so themselves.
And this is not an uncommon problem. Some people who have become unwell enough to require detention for assessment or treatment may not have been properly looking after their affairs prior to admission and thus may have incurred debt or failed to pay bills on time. They may not be in receipt of appropriate benefits; or their job may be at risk. Others may be on benefits and need to ensure that they do not claim benefits to which they are not entitled. Disability Living Allowance, for example, stops after you have been in hospital for 4 weeks, but the onus is on the recipient of the benefit to inform the DLA office in Blackpool of the change of circumstances. Sorting all these things out is difficult at the best of times and almost impossible if you are not even able to get hold of the correspondence and contact details you need.
It is probably fair to say that generally families will step in and ensure that correspondence is brought in as necessary and action taken as necessary to sort out any particular problems.
But if you don’t have family members, or friends, who can assist, then who do you turn to? The short answer is that this is clearly a function of the responsible social services department. i.e. the social services department operating in the area where you were resident prior to admission – even though neither the MHA nor the CoP deal with this issue.
Under the NHS & Community Care Act 1990, however, social services are required to assess the needs of any one in their area who presents with an appearance of need. If you have been detained under the MHA then you will have “an appearance of need” sufficient to justify an assessment and services if eligible. Additionally, you are likely to qualify for Care Program Approach (CPA) services. Further, the National Service Framework for Wales (updated 2005) is non statutory guidance setting out the Welsh Government’s strategies for improving mental health care in Wales – and includes as key aims the promotion of social inclusion and empowerment and support of service users and carers. If your needs include practical assistance to address bills/debt/benefit issues, because due to being kept in a hospital under section you cannot take the necessary action yourself, and failure to do so in a timely manner is likely to have serious consequences, then it would appear clear that social services must offer assistance. This is work that the allocated care manager would need to undertake. If the allocated care manager is a health employed member of the Community Mental Health Team (CMHT) then in my view that person would still have this responsibility – but this is perhaps less clear cut. The underlying responsibility lies, in my view, with social services.
They can do so either by simply making arrangements to collect relevant papers, provided the patent agrees, or by arranging to accompany the patient on agreed leave (if granted by the consultant) to collect these, and then assisting with making arrangements to address issues arising. Such arrangements will need either the consent of the patient, if capable, or to be undertaken in the client’s best interests if not capable of consent. A referral to a suitable voluntary sector advice agency could also be made.
In essence this responsibility is an extension of the clear statutory duty placed on social services departments under the National Assistance Act 1948 to make suitable arrangements to secure property in premises left vacant due to a hospital admission.
In my view, as it is highly foreseeable that problems may arise following compulsory admissions in terms of unpaid bills, benefits entitlement and the like. Thus social workers should be proactive in assessing need and then offering support and assistance in this regard. Of course if a capable patient declines the offer of help then this will discharge the social worker from any on going responsibility. But if problems subsequently came to his/her attention then a fresh offer of assistance should be made. Staff caring for a patient in this position in hospital, or indeed any one working as an advocate, should do their best to ensure that the patient’s needs are brought clearly to the attention of the responsible social work department and all necessary arrangements to address the problems thus made.
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