Mid and South Essex Integrated Care Board

4. Ms B and her son Mr B complain about Mid and South Essex Integrated Care Board’s (the ICB’s) decision to not provide a service whereby Mr B could access ADHD medication urgently.

5. Ms B also complains about the way in which the ICB handled her complaint as it delayed her response and did not communicate effectively with her.

6. Mr B says he had nowhere to turn to and was unable to access medication he needed. He says he was left without medication even though he was under a section 117 at the time.

7. Mr B attempted to take his own life on two occasions. Both he and Ms B say this was because he was no longer taking medication that controlled his impulses. Ms B adds that Mr B would not have attempted to take his own life if he had access to his medication.

8. Ms B adds her and her son have lost faith in the system, which is problematic as Mr B will need to access this all of his life. Mr B also says he has missed out on his education and all of his family have been troubled and upset at having to witness him attempting to take his own life.

9. Mr B was attending school until the problems with his medication occurred and now he is unable to go back.

10. Ms B says this caused a huge amount of distress and upset for Mr B and her family.

11. Ms B and Mr B would like service improvement to make sure that no matter where you live you can access the correct services. They also want an acknowledgement of what has gone wrong and financial compensation.

12. Mr B has autism (a lifelong developmental disability which affects communication and interaction), ADHD (a behavioural condition which makes people restless, inattentive and impulsive), impulsive disorder (a disorder categorised by impulsivity) and depression (a mental disorder which involves a depressive mood or a loss of pleasure or interest in activities).

13. In January 2020, Mr B was admitted to a psychiatric hospital where he stayed until June 2020. He was discharged under the care of child and adolescent mental health services (CAMHS) and was doing well on his medication.

14. In November 2020, Mr B was hospitalised again and he stayed as an inpatient until January 2021.

15. In January 2021, Mr B was discharged from being an inpatient at a hospital.

16. On discharge he was referred to another service, for them to carry out an ADHD assessment.

17. In March 2021, the service attempted to schedule an appointment to carry out Mr B’s ADHD assessment however, they were unable to make an appointment and Ms B said that she did not feel Mr B needed the help from the service at this time.

18. On 30 March 2021, the service wrote to Mr B’s GP and CAMHS to explain he had been discharged due to Mr B and his mother feeling that an appointment was no longer required.

19. In April 2022, Mr B began to have problems with his ADHD medication. Miss B contacted the service to make a review appointment and was told Mr B had been discharged due to a review appointment in March 2021 not being made. She therefore requested an emergency appointment but was told the service does not offer emergency appointments.

20. In August 2023, Ms B complained to the ICB as to why it does not offer emergency appointments for ADHD medication.

25. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

26. Ms B has raised concerns her son could not access ADHD medication on an emergency basis. We recognise the impact not being able to access ADHD medication has had on Mr B and his family.

27. The ICB says it has acted in line with the relevant NICE guidance in that ADHD medication should be initiated by a healthcare professional with the relevant training and expertise.

28. The NICE guidance says, ‘All medication for ADHD should only be initiated by a healthcare professional with training and expertise in diagnosing and managing ADHD’. It also says, ‘Before starting medication for ADHD, people with ADHD should have a full assessment’.

29. We understand Mr B was referred to a service following his inpatient stay in January 2021. In March 2021 it discharged him as both Mr B and Ms B felt an appointment was no longer needed as he was doing well at this time. We understand when Mr B began to have problems with his ADHD medication in April 2022, he contacted the service but as he had been discharged it could not help him.

30. We consider the NICE guidance referred to by the ICB is appropriate here and medication needs to be initiated and managed by an appropriate specialist. Our adviser says an emergency relating to a patient’s mental health is unlikely to be solely related to their ADHD medication, or lack of it, and would require a broader, holistic assessment. Therefore, ADHD medication is not offered on an emergency basis.

31. Our adviser also says if Mr B required further ADHD medication, he would need to be re-referred to the service. A referral could be made by his GP or another healthcare professional. This referral would be triaged for urgency and a healthcare professional with expertise in ADHD would assess, treat and prescribe any required medication.

32. We understand Ms B’s view that her son was discharged from hospital under a section 117 which should have allowed him to access support. Section 117 applies to people who have been detained under section 3 of the Mental Health Act and following discharge are entitled to access relevant aftercare, not emergency care and treatment. We consider section 117 care was offered when he was discharged for hospital as he was referred to the appropriate service.

33. We have not seen anything has gone wrong with the ICB not providing emergency access to ADHD medication. It is unable to offer a service whereby ADHD medication can be prescribed on an emergency basis due to the national guidance which is in place.

34. We are saddened to hear Mr B was unable to access the medication he required and the about the impact this had on him and his family. We wish him well with his ongoing health issues and thank him and his mother for bringing their complaint to us.

1. We have carefully considered Ms B and Mr B complaint about Mid and South Essex Integrated Care Board (the ICB). We have seen no indication that anything went seriously wrong.

2. Ms B and Mr B have raised concerns the ICB left Mr B without any attention deficit hyperactivity disorder (ADHD) medication. We consider as Mr B had been discharged from a service which he was referred to following his discharge from being an inpatient, the ICB would not be expected to provide ADHD medication on an emergency basis. We consider there has been no maladministration here.

3. We are recognise the circumstances surrounding Ms B and Mr B’s complaint and how their family life and Mr B’s schooling has been affected by his illness. Whilst we know our consideration may not be what they will be expecting but we hope they understand how we have come to this decision.