Greater Manchester Mental Health NHS Foundation Trust

3. Mr G complains Greater Manchester Mental Health NHS Foundation Trust prematurely discharged him in October 2024.

4. Mr G says the actions of the Trust have exacerbated his post-traumatic stress disorder (PTSD). Mr G says he is anxious about his safety and has trouble sleeping.

5. As an outcome to his complaint, Mr G would like further explanation and a financial remedy to recognise his experience.

6. Mr G had concerns about criminals being at his home address. He did not feel safe at home and he was experiencing significant mental distress. He also had a diagnosis of emotionally unstable personality disorder (EUPD) and bipolar affective disorder. For these reasons, he was admitted as a voluntary inpatient at the Trust in September 2024.

7. Mr G’s mental health improved and the psychiatrist felt it may be beneficial to discharge him back home. On 18 October, staff considered if it was appropriate to begin the process of discharging him back home. Staff held a multidisciplinary team (MDT) meeting to discuss this in detail. As Mr G still had concerns about being discharged to his home address, staff decided it had to speak with his social worker, housing officer and the police before making a decision.

8. On 21 October, the inpatient team spoke to Mr G’s social worker, housing officer and the police again to discuss Mr G’s inpatient care, discharge and housing situation. As there were no concerns about Mr G returning to his home address, the Trust decided to discharge Mr G later that same day. It referred him to the Home-Based Treatment Team (HBTT) on discharge so they could provide him with outpatient support.

12. Mr G is concerned the Trust discharged him to his home when he felt his house was unsafe. He explains he was initially admitted because of concerns surrounding his home address so should not have been discharged back there.

13. The Trust explains it discussed Mr G’s concerns with the police who advised they had no safety concerns in relation to his property. It explains the team did not discharge him to his address without careful consideration of the risks and clarification from the police, housing officer and his social worker.

14. MHA guidance explains detention should only happen if the risk is caused by the person’s mental health condition, not just because of their social situation or surroundings.

15. NICE guidance states that admissions should be used only for short-term management of crises involving significant risk that cannot be managed in the community. It also states that admission should be kept as short as possible and used with a clear purpose.

16. It explains that community-based care should be prioritised and inpatient admission is not intended to address the long-term difficulties associated with a mental health condition. Discharge should be collaborative and appropriately paced.

17. The BPD foundation explain when making decisions, staff should focus on positive risk taking. This means it should identify the risks associated with an activity and then assess how that activity can be completed in a way that minimises the risks identified.

18. We have reviewed the outcome of the MDT meetings on 18 and 21 October, where staff discussed if Mr G was ready for discharge.

19. The psychiatrist felt Mr G’s admission was no longer clinically necessary and a longer admission would not be therapeutic or beneficial. This is because Mr G was managed on standard observations and was able to take unescorted leave without reporting any serious ongoing mental health difficulties for most of his stay.

20. Our advisor explained this shows that Mr G’s risk was considered low for much of the admission and he no longer needed inpatient care for his mental health. Mr G’s concerns about returning home were primarily related to alleged criminal activity at his home address, rather than deterioration in mental health. As detailed by the MHA guidance, this does not alone justify remaining in hospital.

21. Staff recognised Mr G still had concerns about his home, so did not discharge him on 18 October but held another meeting on 21 October to discuss this in detail with his social worker and the housing officer.

22. The police had already explained to the psychiatrist it had investigated Mr G’s concerns but not did not find any criminal concerns with Mr G’s property. The police confirmed he did not need a safe house or police protection and could not identify any reasons why he should not return to his previous address.

23. Staff also checked with a housing officer if Mr G could have alternative accommodation. The housing officer explained it had opened a homeless application on the basis that it was not safe for him to return home, however police were not supporting this as they believed the home was safe to go back to. As a result of this the housing officer discontinued the application.

24. Mr G’s social worker also explained that as his tenancy runs out on the 8 November, the council had offered Mr G accommodation in a different area.

25. We can see the Trust carefully considered Mr G’s mental health, social situation and surroundings in considering if discharge was appropriate. It relied on the police as the appropriate authority to assess criminal risk about his home address. Our advisor says the Trust would not usually be expected to override or challenge this assessment.

26. The Trust also explored alternative accommodation too with the housing officer and Mr G’s social worker. Importantly, the psychiatrist felt that the inpatient team could not provide Mr G with further support and it would be more beneficial for him to receive this from the community mental health team. These actions all work in line with the MHA and NICE guidance.

27. Mr G also said his mental health could worsen if he was discharged home. We can see the Trust considered this concern during this meeting and recognised Mr G’s risk might increase after discharge.

28. Our advisor explains this type of presentation is commonly seen in people with EUPD. Their mental health can worsen, including more frequent distressing thoughts can occur at the point of discharge, particularly where there are concerns about returning to stressful environments. However, this does not in itself show that discharge is unsafe.

29. The records show the Trust did not discharge Mr G immediately after he raised concerns. The Trust held a MDT meeting, made safeguarding referrals and involved the police, housing services and a social worker before making a decision on if he should be discharged.

30. We can see that the Trust was aware of the psychological impact discharge would have had on Mr G. It carefully considered this prior to discharge but by balancing the risk of discharge against the risks of continuing admission, it felt it was more appropriate to discharge Mr G.

31. Our advisor also explains that that prolonged admission would not have provided further clinical benefit and may have been counterproductive. This is because inpatient treatment was no longer therapeutic or beneficial and Mr G’s mental health could be supported in the community setting. Staff referred Mr G to the home-based treatment team for intensive community support. This allowed close monitoring of his mental health and provided a pathway for further intervention if needed. The Trust’s actions here were in line with guidance from the BTD foundation.

32. We recognise the impact the discharge had on Mr G, but we have found the Trust’s actions work in line with guidance and that we hope our decision reassures Mr G that his discharge was managed appropriately.

33. We will not investigate this complaint further.

1. We are sorry to learn of Mr G’s concerns following his experience with Greater Manchester Health NHS Foundation Trust (the Trust). We have carefully considered Mr G’s complaint. Having done so, we have decided we will not investigate this complaint further. This is because we have not seen any indications Mr G was discharged prematurely.

2. We understand the discharge was a very difficult and upsetting experience for Mr G. We also recognise that he remains concerned about how he was discharged. We hope our statement provides Mr G with some reassurance and answers to his concerns.