Who Carries the Cost of Mental Illness?

When the state becomes involved in paying for care, there are often complications, as a recent case illustrates.



It involved a mentally ill man who had spent almost half his life detained in psychiatric hospitals. He subsequently became the focus of a row between two local authorities over which of them should cover the heavy cost of caring for him after his discharge into the community.



In its decision, the Court of Appeal gave useful guidance on the correct approach to the concept of ‘residence’ under the Mental Health Act 1983 and ruled that the cost of the man’s aftercare should be borne by Wiltshire Council on the basis that he was born in that county and was living there when he was first committed to hospital.



The man, aged in his 40s, was made the subject of a hospital order in 1995 and was not discharged until 2009, on condition that he resided under 24-hour supervision in a hostel in Hertfordshire. He was recalled to hospital in 2011 but discharged again in 2014 to the same hostel, where he continued to live.



Wiltshire Council argued that the man’s aftercare costs should fall on Hertfordshire County Council on the basis that he ‘resided’ in the hostel within the meaning of Section 117 of the Act. It was also submitted that the man considered Hertfordshire to be his home and that he had no wish to return to Wiltshire.



However, the Court noted that there was no dispute that the man was ‘resident’ in Wiltshire when he was first discharged from hospital and that it was ‘impossible to define’ a moment thereafter when his residence might have shifted to Hertfordshire. There had been an unbroken chain of causation and the terms of his conditional discharge still derived from the original 1995 hospital order.