Chapter 7: Assessment of Needs
This chapter offers best practice guidance in relation to the local authority's duty under Part 14 of the Act to assess the needs of an adult for community care services.
Assessment of needs
01 Part 14 of the Act imposes a duty on local authorities to assess the needs of adults for community care services under Section 12A of the Social Work (Scotland) Act 1968 when notified by an MHO that the "patient" may be in need of such services. It also places a duty on local authorities to assess the needs of a child under section 23(3) of the Children (Scotland) Act 1995 when requested to do so by an MHO. In both cases the local authority must carry out an assessment. Furthermore, this Part of the Act places a duty on local authorities to consider whether an assessment of an individual's community care needs should be undertaken when this is requested in writing by the patient themselves, their primary carer or their named person. It would be good practice to consider a written request from the patient's independent advocate on behalf of the patient as if it were from the patient themselves.
02 The Health Board is placed under a similar duty when a request is made in writing by the patient, their primary carer or their named person in respect of the patient's perceived needs for services which are provided by the Health Board. In both cases, the local authority and the Health Board are required to respond to the person making the request within 14 days from when the request was received, indicating whether they intend to undertake an assessment, and if not, why not. It would be good practice for Health Boards and local authorities to ensure robust procedures are put in place for allocating, coordinating and processing any notification or request for an assessment of needs, including procedures for handling urgent referrals.
Request for assessment of need by MHO
03 Section 227 of the Act relates to all people with a mental disorder with whom an MHO comes in contact in carrying out their duties under this Act. It gives an MHO authority to request an assessment of need for community care services and imposes a consequent duty on local authorities to undertake such an assessment. This duty may be triggered, for instance, when an MHO has assessed someone for the purpose of consent to emergency or short-term detention under the Act. It may even be that the MHO decides not to consent to detention but feels the person in question would benefit from a formal assessment of their need for community care services.
04 Normally, it will be for the designated MHO (following a 'relevant event' as defined in section 232 of the Act) to decide, based on their discussions with the rest of the multi-disciplinary team and the patient, whether the patient would benefit from such an assessment. Ideally, this will take place as soon as practicable after the patient becomes subject to compulsion. Information from a formal assessment may provide invaluable information to the designated MHO who will be assisting in the future care planning for the patient. There will also be cases in which the designated MHO will be preparing an application for a CTO and such information, if available, would greatly assist the MHO in devising a proposed care plan as part of that application. Where an MHO requests an assessment of needs, for example to inform a proposed care plan for a CTO application, it would be good practice to coordinate the timing of the assessment to ensure that the information is available to the MHO within the required timescales, where this is practicable.
05 In many cases it will fall to the designated MHO themselves to undertake a formal assessment of the patient's need for community care services as an integral part of their assessment. There will be other situations, however, where the MHO might not be able to undertake a formal assessment for any number of reasons, such as the situation mentioned above where the MHO has assessed a person for detention which does not ultimately go forward. It may be that the patient is already known to another staff member in the local authority who has responsibility for assessment of his/her needs for community care services. The MHO should first establish whether the patient is known to a local authority colleague and whether such an assessment has already been undertaken, and if so, how recently. Where a patient is known and/or where their case is open to another colleague, this person should be consulted by the designated MHO in any case, regardless of whether an assessment has been undertaken already.
06 Another issue the MHO will have to consider is one of timing. There will be situations where there will be insufficient knowledge of the patient and the nature and course of their illness to justify proceeding with a formal assessment of their needs for community care services early in the period to which they are subject to compulsion. Perhaps the patient will not be well enough at an early stage, to actively participate in the assessment, something which is important in helping to secure the future success of any care plan based upon the assessment. The question of whether and when a patient should receive a formal assessment of their needs for community care services is something which should be kept under continual review by the designated MHO and the rest of the multi-disciplinary team. It would be good practice for local authorities to ensure robust procedures are put in place to fast-track and agree funding for the proposed care plans where applications are being pursued for CTOs.
07 All requests for an assessment of needs for community care services must be made in writing to the local authority. The request must be considered whether it "bears to be made" by the patient, their primary carer or their named person, or if it "appears" to be so made. Where a third party has helped the person to make the request, for example a family friend has written on behalf of the patient, named person or primary carer, then such a request would be considered valid. It would be good practice to consider a written request from the patient's independent advocate on behalf of the patient as if it were from the patient themselves.
Requests of assessment of needs by patient, their primary carer, or named person
08 Section 228 of the Act requires the local authority and/or Health Board to consider the need of a person for an assessment of community care and/or health services when this is requested in writing by either the patient themselves, their primary carer or their named person. It would be good practice to consider a written request from the patient's independent advocate on behalf of the patient as if it were from the patient themselves. The local authority and/or Health Board must respond within 14 days of receiving the request, indicating whether they intend to undertake an assessment, and if not, why not.
09 Best practice would be for the local authority in responding to such a request to involve the designated MHO where one has been designated in respect of that person. There will, however, be cases where there will not be a designated MHO at the point of request. In such cases, it may still be prudent to involve an MHO wherever practicable to assist in the process of determining whether such an assessment should be undertaken. Whoever responds on behalf of the local authority should consult with other health and local authority colleagues in determining whether an assessment may be of benefit. Similarly, any health service colleagues who respond to such requests to the Health Board should liaise with all relevant health and local authority staff and relevant others in determining how to proceed.
10 Local authorities and Health Boards should ensure that their staff are aware of the rights of patients, primary carers and named persons to request such assessments and ensure to the extent possible that the wider public are also aware of the rights of people with mental disorder, their primary carers and named persons to request an assessment of their need for community care and/or health services. In publicising the rights of patients, carers and named persons, it would be good practice for local authorities and Health Boards to encourage staff to take a proactive approach in applying the principle of diversity, by taking a targeted approach to communicating with black and ethnic minority communities.