Tavistock and Portman NHS Foundation Trust

4. Mr V, represented by his wife Mrs V, complains about his discharge from the Trust’s mental health services in 2024. He complains the discharge was not based on a clinical decision and relied on a historic and non-relevant incident from ten years ago.

5. Mr V says because of this he has been feeling extremely anxious and frustrated with the lack of clarity on his discharge. He says he has left without ongoing mental health support which has significantly and negatively affected his personal and family life.

6. Mr V is seeking an explanation, an apology, service improvements and financial remedy to seek alternative therapy from a private provider.

7. Mr V was first referred to the Trust in 2005. He attended a long-term therapy group until 2014 when he left the group following an incident where Mr V disclosed information to the police concerning child safety.

8. Mr V’s GP referred him to the Trust in 2015, and Mr V received individual parenting therapy until 2024.

13. 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.

14. Mr V complains the Trust poorly managed his discharge. Mr V feels the Trust did not discharge him based on a clinical decision which has left him without continuing support unfairly.

15. In its response the Trust said Mr V’s discharge was based on clinical review following the retirement of his individual therapist. It explained that Mr V no longer met the criteria for continued care at the Trust.

16. In its response the Trust recognised that Mr V’s case was unusual for its service as it had been provided Mr V with care for nearly 20 years through therapy and parenting work. It continued that long-term therapy of indefinite length, while sometimes necessary, can risk creating a dependency on therapy rather than fostering independence.

17. It explained that the historic incident which occurred in 2014 did not form part of its review on Mr V’s eligibility for ongoing support. It noted this decision reflected Mr V’s current presentation.

18. The Trust said it held three review meetings with Mr V to discuss his discharge, care alternatives and follow up options. It also noted a crisis plan was completed to support Mr V with his transition though it did recognise there was a delay of six months when administrating Mr V’s case. The Trust apologised for any distress and the delay though it reiterated that its decision to discharge was based on clinical review.

19. Our adviser explained the decision to discharge a patient should be guided by clinical need, eligibility criteria, and a phased approach, in line with established professional standards set out in GMC, NICE QS88 and NICE Care Model.

20. GMC’s good medical practice emphasises the importance of continuity of care and notes that patient’s should be transitioned between services with arrangements for ongoing care communicated prior to discharge.

21. This is further supported by NICE QS88 which says patients should agree on a structured and phased plan before changes to their care are made. This should be evidenced by clearly documented discussions and discharge planning.

22. Our adviser explained that while there is no specific guidance for long term psychiatry support the NICE Care Model says that Interventions should be provided at the least intrusive but most effective level. Higher-intensity interventions, like those offered by the Portman Clinic, are provided for as long as clinically appropriate but should be reviewed periodically to ensure ongoing suitability.

23. Following the retirement of Mr V’s therapist in July 2024, we have seen that he was reviewed three times by the Trust.

24. In September 2024, Mr V was first made aware of the discharge, and it is documented the discussion of the meeting was focussed on Mr V’s feelings and what the plan should be, for example, a discharge or further help.

25. In October 2024, Mr V was reviewed again. In this review the Trust documented that Mr V’s presentation no longer demonstrated problematic violent or sexual behaviour that required high intensity, longer term care. It discussed the need to reduce Mr V to a more suitable stepped down care plan.

26. Our adviser noted the Trust created a crisis plan during this review to help manage risks and support Mr V’s adjustment to discharge.

27. The Trust considered Mr V for group therapy but in its assessment of suitability of group therapy as a step-down option for Mr V it noted the historic incident from 2014. This incident did form a barrier to group therapy being a suitable option though it was not related to the decision to discharge Mr V.

28. Our adviser was pleased with the records of this meeting and highlighted the Trust’s effort to involve Mr V in its decision-making process, exploring his anxieties about his discharge with sensitivity.

29. A final review was held on 13 February 2025 with a second Trust therapist. In this review the Trust explored referrals to local community mental health services and other family therapy options. It is documented that Mr V remained unhappy with the plan to discharge him. Our adviser noted that despite Mr V’s resistance to the discharge the Trust involved him in its discussions and plans in line with standard practice.

30. We consider Mr V’s discharge was based on a documented clinical reasoning. We understand Mr V’s worries that it was linked to a historic incident as this was discussed with him by the Trust. We consider the historic incident was reviewed as part of his suitability for group therapy as an option for stepped down treatment.

31. In its response the Trust recognise that there was a delay in issuing a letter to Mr V to confirm that family therapy was an option. We recognise this would have caused Mr V emotional uncertainty and distress. We consider this was a shortcoming which the Trust acknowledged and put right. We consider this was a short-coming as it was a one-off administrative error and did not fall so far below a standard that we would consider it a failing.

32. We hope our explanation provides Mr V with the reassurance his discharge was appropriately managed in line with expected professional standards, and we have seen no indication of a failing. We are sorry we could not provide Mr V with a more agreeable outcome. We thank Mr V and his wife for bringing this complaint to us.

1. We have carefully considered Mr V’s complaint about Tavistock and Portman NHS Foundation Trust (the Trust).

2. We were sorry to hear of the anxiety and distress Mr V has reported since being discharged from the Trust. We have listened when Mr V has told us how important the support was to his day-to-day life.

3. We have considered Mr V’s complaint that the Trust discharged him based on an incident which occurred ten years ago rather than a clinical decision. We have seen no indication anything went seriously wrong with the management of Mr V’s discharge.