Social Circumstances Report

If the person is detained in hospital the social circumstances report must include relevant information about:

1. Whether there are any factors that might affect the patient's understanding or ability to cope with a hearing, and whether there are any adjustments that the tribunal may consider in order to deal with the case fairly and justly;
2. Details of any index offence(s) and other relevant forensic history;
3. A chronology listing the patient's previous involvement with mental health services including any admissions to, discharge from and recall to hospital;
4. The patients home and family circumstances;
5. The housing or accommodation available to the patient if discharged;
6. The patient's financial position (including benefit entitlements);
7. Any available opportunities for employment;
8. The patient's previous response to community support or Section 117 aftercare;
9. So far as is known, details of the care pathway and Section 117 aftercare to be made available to the patient, together with details of the proposed care plan;
10. The likely adequacy and effectiveness of the proposed care plan;
11. Whether there are any issues as to funding the proposed care plan and, if so, the date by which those issues will be resolved;
12. The strengths or positive factors relating to the patient;
13. A summary of the patient's current progress, behaviour, compliance and insight;
14. Details of any incidents where the patient has harmed themselves or others, or threatened harm, or damaged property, or threatened damage;
15. The patient's views, wishes, beliefs, opinions, hopes and concerns;
16. Except in restricted cases, the views of the patients Nearest Relative unless (having consulted the patient) it would be inappropriate or impractical to consult the Nearest Relative, in which case give reasons for this view and describe any attempts to rectify matters;
17. The views of any other person who takes a lead role in the care and support of the patient but who is not professionally involved;
18. Whether the patient is known to any MAPPA meeting or agency and, if so, in which area, for what reason, and at what level-together with the name of the Chair of any MAPPA meeting concerned with the patient, and the name of the representative of the lead agency;
19. In the event that a MAPPA meeting or agency wishes to put forward evidence of its views in relation to the level and management of risk, a summary of those views (or an Executive Summary may be attached to the report); and where relevant. A copy of the Police National Computer record of previous convictions should be attached;
20. In the case of an eligible compliant patient who lacks capacity to agree or object to their detention or treatment, whether or not a deprivation of liberty under the Mental Capacity Act 2005 (as amended) would be appropriate and less restrictive;
21. Whether (in Section 2 cases) detention in hospital, or (in all other cases) the provision of medical treatment in hospital, is justified or necessary in the interests of the patients health or safety, or for the protection of others;
22. Whether the patient, if discharged from hospital, would be likely to act in a manner dangerous to themselves or to others;
23. Whether, and if so how, any risks could be managed effectively in the community, including the use of any lawful conditions or recall powers; and
24. Any recommendations to the tribunal, with reasons.

If the person is subject to a Community Treatment Order the social circumstances report must include relevant information about:

1. Whether there are any factors that might affect the patient's understanding or ability to cope with a hearing, and whether there are any adjustments that the tribunal may consider in order to deal with the case fairly and justly;
2. Details of any index offence(s), and other relevant forensic history;
3. A chronology listing the patient's previous involvement with mental health services including any admissions to, discharges from and recall to hospital;
4. The patient's family home and circumstances;
5. The housing or accommodation currently available to the patient;
6. The patient's financial position (including benefit entitlements);
7. Any employment or available opportunities for employment;
8. Any conditions to which the patient is subject under Section 17B, and details of the patient's compliance;
9. The patient's previous response to community support or Section 117 aftercare;
10. Details of the community support or Section 117 after care that is being, or could be made available to the patient, together with details of the current care plan;
11. Whether there are any issues as to funding the current or future care plan and, if so, the date by which those issues will be resolved;
12. The current adequacy and effectiveness of the care plan;
13. The strengths or positive factors relating to the patient;
14. A summary of the patient's current progress, behaviour, compliance and insight;
15. Details of any incidents where the patient has harmed themselves or others, or threatened harm, or damaged property, or threatened damage;
16. The patient's views, wishes, beliefs, opinions, hopes and concerns;
17. The views of the patients Nearest Relative unless (having consulted the patient) it would be inappropriate or impractical to consult the Nearest Relative, in which case give reasons for this view and describe any attempts to rectify matters;
18. The views of any other person who takes a lead role in the care and support of the patient but who is not professionally involved;
19. Whether the patient is known to any Multi Agency Public Protection Arrangements (MAPPA) meeting or agency and, if so, in which area, for what reason, and at what level-together with the name of the Chair of any MAPPA meeting concerned with the patient, and the name of the representative of the lead agency;
20. In the event that a MAPPA meeting or agency wishes to put forward evidence of its views in relation to the level and management of risk, a summary of those views (or an Executive Summary may be attached to the report); and where relevant, a copy of the Police National Computer record of previous convictions should be attached;
21. Whether it is necessary for the patient's health or safety, or for the protection of others, that the patient should receive medical treatment and, if so, why;
22. Whether the patient, if discharged from the CTO, would be likely to act in a manner dangerous to themselves or others;
23. Whether, and if so how, and risks could be managed effectively in the community;
24. Whether it continues to be necessary that the Responsible Clinician should be able to exercise the power of recall and, if so, why; and
25. Any recommendations to the tribunal, with reasons.

If the person is subject to Guardianship the social circumstances report must include relevant information about:

1. Whether there are any factors that might affect the patient’s understanding or ability to cope with a hearing, and whether there are any adjustments that the tribunal may consider in order to deal with the case fairly and justly;
2. Details of any index offence(s), and other relevant forensic history;
3. A chronology listing the patient’s previous involvement with mental health services including any admissions to, discharges from and recall to hospital, and any previous instances of reception into guardianship;
4. The patient’s family home and circumstances;
5. The housing or accommodation currently available to the patient;
6. The patient’s financial position (including benefit entitlements);
7. Any employment or available opportunities for employment;
8. Any requirements to which the patient is subject under Section 8(1), and details of the patient’s compliance;
9. The patient’s previous response to community support;
10. Details of the community support that is being, or could be made available to the patient, together with details of the current care plan;
11. The current adequacy and effectiveness of the care plan;
12. Whether there are any issues as to funding the current or future care plan and, if so, the date by which those issues will be resolved;
13. The strengths or positive factors relating to the patient;
14. A summary of the patient’s current progress, behaviour, compliance and insight;
15. Details of any incidents where the patient has harmed themselves or others, or threatened harm, or damaged property, or threatened damage;
16. The patient’s views, wishes, beliefs, opinions, hopes and concerns;
17. The views of the Guardian;
18. The views of the patients Nearest Relative unless (having consulted the patient) it would be inappropriate or impractical to consult the Nearest Relative, in which case give reasons for this view and describe any attempts to rectify matters;
19. The views of any other person who takes a lead role in the care and support of the patient but who is not professionally involved;
20. Whether the patient is known to any MAPPA meeting or agency and, if so, in which area, for what reason, and at what level-together with the name of the Chair of any MAPPA meeting concerned with the patient, and the name of the representative of the lead agency;
21. In the event that a MAPPA meeting or agency wishes to put forward evidence of its views in relation to the level and management of risk, a summary of those views (or an Executive Summary may be attached to the report); and where relevant, a copy of the Police National Computer record of previous convictions should be attached;
22. Whether, and if so how, any risks could be managed effectively in the community;
23. Whether it is necessary for the welfare of the patient, or for the protection of others, that the patient should remain under Guardianship and, if so, why;
24. Any recommendations to the tribunal, with reasons.

If the person is subject to a Conditional Discharge the social circumstances report must include relevant information about:

1. The patients full name, date of birth, and current address;
2. The full official name of the Responsible Authority;
3. Whether there are any factors that might affect the patient's understanding or ability to cope with a hearing, and whether there are any adjustments that the tribunal may consider in order to deal with the case fairly and justly;
4. Details of the patient's index offence(s), and any other relevant forensic history;
5. A chronology listing the patient's involvement with mental health services including any admissions to, discharge from and recall to hospital;
6. Any conditions currently imposed (whether by the tribunal or the Secretary of State), and the reasons why the conditions were imposed;
7. Details of the patients compliance with any past or current conditions;
8. The patient's home and family circumstances;
9. The housing or accommodation currently available to the patient;
10. The patient's financial position (including benefit entitlements);
11. Any employment or available opportunities for employment;
12. Details of the community support or Section 117 aftercare that is being, or could be made available to the patient, together with details of the current care plan;
13. Whether there are any issues as to funding the current or future care plan and, if so, the date by which those issues will be resolved;
14. The current adequacy and effectiveness of the care plan;
15. The strengths or positive factors relating to the patient;
16. A summary of the patient's current progress, behaviour, compliance and insight;
17. Details of any incidents where the patient has harmed themselves or others, or threatened harm, or damaged property, or threatened damage;
18. The patient's views, wishes, beliefs, opinions, hopes and concerns;
19. The views of any partner, family member or close friend who takes a lead role in the care and support of the patient but who is not professionally involved;
20. Whether the patient is known to any Multi Agency Public Protection Arrangements (MAPPA) meeting or agency and, if so, in which area, for what reason, and at what level-together with the name of the Chair of any MAPPA meeting concerned with the patient, and the name of the representative of the lead agency;
21. In the event that a MAPPA meeting or agency wishes to put forward evidence of its views in relation to the level and management of risk, a summary of those views (or an Executive Summary may be attached to the report); and where relevant, a copy of the Police National Computer record of previous convictions should be attached;
22. In the case of an eligible compliant patient who lacks capacity to agree or object to their placement or treatment, whether or not a deprivation of liberty under the Mental Capacity Act 2005 (as amended) would be more appropriate;
23. Whether the patient, if absolutely discharged, would be likely to act in a manner harmful to themselves or others, whether any such risks could be managed effectively in the community and, if so, how;
24. Whether it continues to be appropriate for the patient to remain liable to be recalled for further medical treatment in hospital and, if so, why;
25. Whether, and if so the extent to which, it is desirable to continue, vary and/or add any conditions currently imposed; and
26. Any recommendations to the tribunal, with reasons.

If a social circumstances report is being written for a patient under the age of 18, all of the above requirements apply as appropriate, depending upon the type of case.

In addition to the normal requirements, the report must also state:

1. The names and addresses of any people with parental responsibility, and how they acquired parental responsibility;
2. Which public bodies either have worked together or need to liaise in relation to aftercare services that may be provided under Section 117 of the Act;
3. The outcome of any liaison that has taken place;
4. If liaison has not taken place, why not-and when liaison will take place;
5. The details of any multi-agency care plan in place or proposed;
6. Whether there are any issues as to funding the care plan and, if so, the date by which those issues will be resolved;
7. The name and contact details of the patient's Care Co-ordinator (now Co-ordinator under the Community Mental Health Framework), Community Psychiatric Nurse, Social Worker/AMHP or Social Supervisor;
8. Whether the patient's needs have been assessed under the Children Act 1989 or the Chronically Sick and Disabled Person's Act 1970 and, if not, the reasons why such an assessment has not been carried out and whether it is proposed to carry out such an assessment;
9. If there has been such an assessment, what needs or requirements have been identified and how those needs or requirements will be met;
10. If the patient is subject to or has been the subject of a Care Order or an Interim Care Order;
    • The date and duration of any such order;
    • The identity of the relevant Local Authority;
    • The identity of any person(s) with whom the Local Authority shares parental responsibility;
    • Whether there are any proceedings which have yet to conclude and, if so, the court in which proceedings are taking place and the date of the next hearing;
    • Whether the patient comes under the Children (Leaving Care) Act 2000;
    • Whether there has been any liaison between, on the one hand, social workers responsible for mental health services to children and adolescents and, on the other hand, those responsible for such services to adults;
    • The name of the social worker within the relevant Local Authority who is discharging the function of the Nearest Relative under Section 27 of the Act.
11. If the patient is subject to Guardianship under Section 7 of the Act, whether any orders have been made under the Children Act 1989 in respect of the patient, and what consultation there has been with the guardian;
12. If the patient is a Ward of Court, when the patient was made a ward of court and what steps have been taken to notify the court that made the order of any significant steps taken, or to be taken, in respect of the patient;
13. Whether any other orders under the Children Act 1989 are in existence in respect of the patient and, if so, the details of those orders, together with the date on which such orders were made, and whether they are final or interim orders;
14. If a patient is a looked after child under Section 20 of the Children Act 1989, when the child became looked after, why the child became looked after, what steps have been taken to discharge the obligations of the Local Authority under Paragraph 17(1) of Schedule 2 of the Children Act 1989, and what steps are being taken (if required) to discharge the obligations of the Local Authority under Paragraph 10 (b) of Schedule 2 of the Children Act 1989;
15. If a patient has been treated by a Local Authority as a child in need (which includes a child who has a mental disorder) under Section 17 (11) of the Children Act 1989, the period or periods for which the child has been so treated, why they were considered to be a child in needs, what services were or are being made available to the child by virtue of that status, and details of any assessment of the child;
16. If a patient has been the subject of a secure accommodation order under Section 25 of the Children Act 1989, the date on which the order was made, the reasons it was made, and the date it expired;
17. If a patient is a child provided with accommodation under Sections 85 and 86 of the Children Act 1989, what steps have been taken by the accommodating authority or the person carrying on the establishment in question to discharge their notification responsibilities, and what steps have been taken by the Local Authority to discharge their obligations under Sections 85, 86 and 86A of the Children Act 1989.

Whenever it is practicably possible you must always consult with the person before preparing the report, especially if you have not met them before.

This can be consultation:

1. In person;
2. Via telephone;
3. In writing, including e-mail.

The nature of consultation should reflect the communication needs, capacity and circumstances of the person, taking into account any steps that you can take to ensure their involvement (including the involvement of an advocate).

When consulting with the person you are seeking to establish:

1. Their views, wishes, beliefs and opinions; and
2. Their hopes and concerns; about
3. Their current circumstances and any proposed plans for discharge.

Capacity and substantial difficulty

When consulting with the person it is likely to become clear whether they are:

1. Likely to have difficulty being involved in the tribunal; or
2. Likely to lack capacity to be involved.

Details of any mental capacity assessment, or other evidence upon which this judgement is made should be recorded in the social circumstances report.

If you are unable to consult

Sometimes it may not be possible to consult with the person before writing the report. For example:

1. They may refuse to speak with you;
2. They may be too unwell; or
3. The timeframe for completing the report does not allow it.

If this happens you must:

1. State in the report that you have not consulted the person; and
2. State in the report the reason that you have not done so; and
3. Try to speak with the person to ascertain their views after the report is submitted; and
4. If able to do so, provide this information as an addendum; and
5. If not able to do so, try to speak with them on the day of the tribunal; and
6. If able to do so, provide their views to the tribunal.

You must consult with the person's Nearest Relative (or the person exercising that function) when:

1. The person is detained in hospital; or
2. The person is subject to a Community Treatment Order; or
3. The person is subject to Guardianship; unless
4. The case is restricted; or
5. Having consulted the person, you decide it would be inappropriate or impractical to consult with the Nearest Relative.

If you have decided it would be inappropriate or impractical to consult with the Nearest Relative, you must:

1. Provide a rationale for your decision in the report; and
2. Explain what steps you are planning to take to resolve any issues so that the Nearest Relative can be consulted.

When consulting with the Nearest Relative you should:

1. Seek their views about the person's current circumstances; and
2. Seek their views about any proposed plans to discharge the person; and
3. Establish whether or not they intend to use their powers to challenge or object to any proposed discharge or on-going detention.

For more information about the Nearest Relative, including how to identify who is the Nearest Relative, their role and responsibilities, see: Safeguards under the Mental Health Act 1983.

You must consult with any Guardian whenever the person is subject to Guardianship.

When consulting with a Guardian you should:

1. Seek their views about the person's current circumstances; and
2. Seek their views about any proposed plans to discharge the person.

For more information about Guardianship, see: Treatment and Support in the Community.

You must consult with any informal carer who you deem to be taking a lead role in the care and support of the person, regardless of where they are being treated.

When consulting with a carer you should:

1. Seek their views about the person's current circumstances; and
2. Seek their views about any proposed plans to discharge the person.

In particular, you should ascertain the carer's views about:

1. Their own role in any proposed plan; and
2. How the proposed plan will support them in that role.

If you are unable to consult a carer

Sometimes it may not be possible to consult with a carer before writing the report (for example if they are not available or the timeframe for completing the report does not allow it).

You must state in the report:

1. The name and role of any carer you have not been able to consult; and
2. The reason that you have not been able to do so; and
3. The impact of this on the report's recommendations.

If the person is known to a MAPPA meeting or agency, you must consult with the lead representative to ascertain:

1. The reason that they are known;
2. The level of risk assigned by the MAPPA meeting or agency; and
3. Their views on the level of risk; and
4. Their views on the risk management proposed.

You must also invite them to provide a summary of their views regarding the level and management of risk posed by the person, which should be attached to the social circumstances report when it is submitted.

With the exception of those persons that you are required to consult (see above) it is your responsibility to decide:

1. Whether it is relevant to consult anyone else; and
2. If so, to make appropriate arrangements to consult those persons.

Non-statutory consultation should:

1. Be carried out with regard to confidentiality and consent of the person; and
2. Be relevant to the social circumstances report.

The people you consult will vary, depending on the information to be gathered and the specific circumstances of the case. The table below sets out:

1. Some of the people you may need to consult with; and
2. The nature of the information that you may need to gather.

If you are unable to consult

Sometimes it may not be possible to consult with all relevant persons before writing the report (for example if they are not available or the timeframe for completing the report does not allow it).

You must state in the report:

1. The name and role of anyone you have not been able to consult; and
2. The reason why it is important to consult with them; and
3. The reason that you have not been able to do so; and
4. The impact of this on the report's recommendations.

A range of Care and Support functions may need to be carried out, including:

1. Assessment;
2. Care and Support Planning;
3. Safeguarding enquiry.

The social circumstances report should set out:

1. What functions have been carried out;
2. The outcome of those functions;
3. What functions are outstanding;
4. When they may be completed;
5. How decisions have been made about any proposed Care and Support Plan (i.e., what alternative options have been explored);
6. Any potential barriers to the proposed Care and Support Plan (e.g., funding barriers); and
7. When any issues may be resolved.

Current risk

Information about current risk should be based on recorded incidents where:

1. The person has harmed themselves;
2. The person has harmed someone else;
3. The person has threatened to harm themselves or others;
4. The person has damaged property; or
5. The person has threatened to damage property.

All of these records should be available from the agency responsible for providing their current care (either in hospital or in the community).

Depending on the number of incidents you can either:

1. Provide a full chronology in the report; or
2. Provide a summary in the report and provide more detailed information (for example ABC charts) as an attachment.

Future risk and risk management

Based on the proposed discharge plan you must identify:

1. The likely future risks to the person; and
2. The likely impact of those risks for the person; and
3. The likely future risks to others; and
4. The likely impact of those risks for others; and
5. What can and cannot be done to reduce the future risks.

When identifying risks this should:

1. Be based on evidence (and not perception);
2. Have regard for information about current risks;
3. Take into account the person's current progress, behaviour, compliance and insight; and
4. Consider the views of people consulted.

Any plans to reduce risk should be:

1. Available;
2. Sustainable; and
3. A contingency plan should also be explored.

Depending on the number of risks and the detail of the proposed risk management plan you can either:

1. Provide full details in the report; or
2. Provide a summary in the report and provide more detailed information (for example a risk assessment) as an attachment.

As well as providing the range of information set out in the previous section of this procedure you are also required to provide professional, evidence based recommendations about the following matters, as set out in the Practice Direction.

You are permitted to make any recommendations in the report that you feel it is appropriate and relevant to make, so long as your reasons for doing so are evidence based and clearly recorded.

Regardless of the person's circumstances or the recording template being used the report must:

1. Be up to date;
2. Be prepared specifically for the tribunal (or hearing);
3. Contain numbered paragraphs and pages;
4. Be signed; and
5. Be dated.

The sources of information and evidence described in the report must be clear.

Unless instructed otherwise, the report should be recorded using the correct downloadable form from the government website.

There are 2 forms available. The one that you use will depend on whether the person is in an in-patient or community setting:

• Form T133: In-patient: Social circumstances report;
• Form T138: Community patient: Social circumstances report.

If the person is not yet 18, supplementary information will be required:

• Form T135: Social circumstances report: Supplementary information required for patients under the age of 18.

1. Write plainly and make sure that you understand what you have written;
2. Only record what is relevant, and do so as concisely as possible;
3. Do not copy and paste from other reports-summarise and then attach them instead;
4. Make sure your rationale for judgements and recommendations are clear;
5. Only state something as a fact if you have evidence to support it;
6. Clearly record the evidence sources you have used and attach them when it is relevant to do so;
7. Use specific dates and times when it is relevant to do so (for example when describing several incidents in one day);
8. Be honest-if there is evidence or information you haven't gathered, say so and explain why;
9. Refer to the practice directions to make sure that all requirements of the report are met; and
10. Proof read the report before submitting it.

Depending on the circumstances, this may not be the first social circumstances report to be written regarding the person's current detention or treatment under the Mental Health Act.

Where a previous report exists, it is appropriate to:

1. Read and understand the previous report;
2. Consider what has changed or happened since the report was written; and
3. Reference paragraphs of the previous report in the current report when relevant to do so.

However, it is not appropriate to:

1. Copy and paste from previous reports;
2. Submit a previous report as a current report (even if circumstances have not changed); or
3. Attach a full previous report to a current report.

Unless instructed otherwise the completed, signed report must be submitted:

1. To the mental health administrator;
2. No later than 3 weeks before the date of the tribunal or hearing; unless
3. The person is detained under Section 2; when
4. The report must be provided as soon as is practicable.

The mental health administrator will then co-ordinate all the statutory reports and make them available to the tribunal (or hearing) and relevant parties to the proceedings. If the patient is a 'restricted patient' copies of the report will also be sent to the Secretary of State (the Ministry of Justice).

If you have not been able to gather all the information required to finalise the report, you can either:

1. Contact the mental health administrator to request an extension; or
2. Submit the report thus far, clearly indicating where information is outstanding; and
3. Advise the mental health administrator that information is outstanding; and
4. Agree with the mental health administrator when and how the outstanding information will be submitted; and
5. Submit outstanding information as agreed or, if no agreement is made no later than 1 hour before the tribunal or hearing is due to begin.

Where outstanding information is being submitted 1 hour before the tribunal or hearing is due to begin, you must

1. Make sure that a copy of the information is also provided to the person's representative (e.g., an advocate or legal representative); unless
2. The mental health administrator advises you that they will be doing so.

If information remains outstanding at the time of the tribunal or hearing, you should provide a summary of:

1. The information that is outstanding;
2. The reason it is outstanding; and
3. The impact of this on the report's recommendations.

If you are not able to provide the social circumstances report within the agreed (or required) timeframe you must seek an extension from the mental health administrator.

The extension is only granted when you have received formal confirmation to this effect. If you do not receive such confirmation, you:

1. Must not assume an extension is granted; and
2. Must continue to complete the report within the original timeframe.

Unauthorised late submissions without an extension will lead to significant criticism of you and of the Local Authority, so should be avoided.

If, after submitting the report the person's circumstances change before the tribunal or hearing date you should send an addendum to the mental health administrator, setting out what has changed.

Where the addendum is being submitted 1 hour before the tribunal or hearing is due to begin, you must:

3. Make sure that a copy is also provided to the person's representative (e.g., an advocate or legal representative); unless
4. The mental health administrator advises you that they will be doing so.

As author of the social circumstances report you are required to attend the tribunal unless the mental health administrator confirms that your attendance is not required.

If you are genuinely not able to attend the tribunal, you:

1. Must notify the mental health administrator;
2. Must provide reasons for your non-attendance;
3. Must, wherever possible arrange for an appropriate Local Authority representative to attend on your behalf.

If another Local Authority representative is to attend on your behalf, you must:

1. Provide them with a copy of the social circumstances report; and
2. Provide them with a copy of any other relevant information; and
3. Prepare them to answer any questions that you anticipate may be asked.

You (or anyone attending the tribunal on your behalf) should try to speak with the person to ascertain their most up-to-date views on the day of the tribunal (or the days leading up to it) when:

1. The person will not be attending the tribunal themselves; or
2. You have not yet met the person; or
3. You were not able to consult with them when preparing the report; or
4. You have not seen them since the report was submitted; or
5. There is reason to believe that their views, wishes, beliefs, opinions, hopes or concerns may have changed from those in the report.

Regardless of the building or environment where a tribunal is held, the room where the tribunal takes place is considered a court of law, and normal rules of court apply.

For example, you:

1. Must dress for court;
2. Must arrive on time;
3. Must wait to be called into the room;
4. Must address the judge presiding appropriately;
5. Must wait for the judge presiding to address you before speaking;
6. Must be prepared to be examined and cross examined regarding the content of your report;
7. Must not attempt to leave the courtroom during proceedings.