Key findings from Section 117

Key strengths identified

The engagement identified areas of strength across local authorities, NHS partners and wider mental health systems. These strengths demonstrate that effective, integrated and recovery-focused S117 aftercare is achievable and already evident in parts of the country.

System readiness and appetite for improvement

Across all regions, partner agencies expressed a clear commitment to improving S117 pathways, governance and practice. Local authorities, ICBs, NHS Trusts and voluntary sector partners described S117 as a priority area for strengthening joint accountability, addressing legal risks, and enhancing the quality of support offered to individuals leaving hospital. This collective readiness provides a strong foundation for system-wide change.

Established examples of high-quality practice

The programme identified several locally developed approaches that reflect emerging national best practice:

• Calderdale: A jointly developed draft S117 Partnership Policy which clearly sets out roles, funding responsibilities and joint governance arrangements across the system.
• Leicestershire: A coordinated, jointly owned S117 assessment and review process, supported by consistent tools, documentation and training across health and social care.
• East Midlands ADASS Regional Group: Collaborative regional work to clarify accommodation-related decision making, funding responsibilities and use of the statutory test, providing a coherent approach across multiple local areas.

These examples demonstrate that consistent, lawful and person-centred S117 arrangements can be delivered through effective partnership working and clear, shared frameworks.

Impact of specialist mental health social care professionals 

Areas with dedicated, professionally led mental health social care teams, particularly where AMHPs, PSWs, POTS and senior practitioners have strong mental health legal literacy, showed:

• more consistent application of the statutory test
• higher-quality assessments and reviews
• better integration with clinical teams; and
• more robust governance and challenge on unlawful practice.

These findings indicate that access to skilled, knowledgeable mental health social care professionals and leaders significantly improves S117 compliance and outcomes for people.

Role of peer support and recovery-focused approaches 

Peer workers, recovery colleges and other lived experience-led services were consistently identified as contributing to positive outcomes by:

• supporting individuals to develop wellness and relapse prevention plans
• providing continuity and trusted relationships beyond clinical services
• promoting self-management and recovery; and
• enabling people to stay connected to their communities.

•    more consistent application of the statutory test
•    higher-quality assessments and reviews
•    better integration with clinical teams; and
•    more robust governance and challenge on unlawful practice.

These findings indicate that access to skilled, knowledgeable mental health social care professionals and leaders significantly improves S117 compliance and outcomes for people.

Effective community-based crisis alternatives 

The availability of community crisis alternatives was highlighted by people with lived experience and practitioners as essential in preventing deterioration and avoidable hospital admissions. Examples identified included:

• VCSE-led, 24/7 mental health helplines providing immediate access to support
• safe crisis cafés offering early, face-to-face intervention in non-clinical environments
• short-term supported crisis accommodation, enabling stabilisation while avoiding hospital admission
• local models providing rapid assessment and de-escalation in community settings.

These services were particularly valued where they were well-publicised, easy to access, and linked directly to S117 aftercare pathways.

Strengthening partnership and system structures

Several systems have taken concrete steps to strengthen structures supporting integrated aftercare delivery. These include:

• establishment of mental health alliance groups bringing together NHS, local authority and Voluntary, Community, and Social Enterprise (VCSE) partners to coordinate strategy and pathways
• appointment of dedicated housing leads within mental health systems to address accommodation issues, improve pathways, and reduce delays in discharge
• development of joint panels, shared documentation and multi-agency review processes to support consistent decision making.

These structures improve joint ownership, reduce fragmentation, and support more effective problem-solving across organisations.

Key challenges identified

The engagement also highlighted a system under pressure, with dedicated professionals striving to provide effective aftercare amidst significant systemic challenges. This section summarises the key challenges that have informed the development of this guidance.

Legal literacy failures and inconsistent understanding and application

Widespread confusion regarding legal entitlement (detention vs. diagnosis), the interface between S117, CHC, and the Care Act, and the specifics of funding and charging arrangements. Common themes identified:

• confusion about the statutory test
• misuse of Care Act assessments to determine S117 need
• misunderstanding of CHC/Care Act/MHA interfaces
• unilateral ending of S117
• misinterpretation of Worcestershire ruling (ordinary residence but now reversed as result of Mental Health Act 2025)
• insufficient awareness of Stennett, Tinsley, Mwanza, Afework cases.

Inconsistent joint working, joint ownership and governance

In many areas, S117 is not treated as a shared responsibility. For example, in some areas Councils are being expected to manage the entire process with minimal ICB input, leading to delayed discharges and non-compliant practice.

The lack of a unified mental health strategy, ineffective partnership boards, and the absence of a single, shared S117 register is not uncommon, and this is resulting in poor accountability and high levels of disputes resulting in poorer outcomes.

Weak assessment and planning practice and poor experience for individuals and carers 

People with lived experience and their carers reported not being involved in planning, not understanding their entitlement, and struggling to navigate the system, especially during relapse. The following are regular themes shared with the S117 programme team:

• assessments, reviews and support plans not co-produced with the person
• sssessment and support plans written during a one-off MDT hospital discharge meeting
• docial care not being informed the person is being discharged/has been discharged and no S117 assessment or support in plan in place
• limited strengths-based or trauma-informed approaches
• carers excluded
• no relapse or contingency planning
• people unaware they are eligible to S117 aftercare services.

Crisis and relapse failures 

Despite the intention of S117 to provide coordinated, preventative support, many people told us that help often becomes fragmented when they are most vulnerable. They reported that systems frequently fail to identify relapse early, offer proactive support, or ensure that clear, multi-agency contingency plans are in place. This results in people being passed between services, escalating avoidably into crisis, and being re-detained under the Mental Health Act. The following issues were commonly reported across all system types:

Accommodation and funding confusion/disputes: Nationally, there are significant issues with understanding when accommodation should be funded under S117, leading to illegal charging and disputes that delay support. Numerous examples were identified:

• misuse of Housing Benefit
• unlawful charging
• lack of clarity on accommodation-plus
• inconsistent top-up decisions.

Workforce capability  

Variable levels of knowledge, confidence, and legal literacy across the multi-agency workforce is a common concern, with many practitioners expected to learn about S117 “on the job,” with limited access to structured training or supervision specific to aftercare duties. This inconsistency creates significant risks for practice quality, decision-making, and person and carer experience. 

Prevalence of the medical model

The dominance of a medicalised approach to mental health is often felt to overshadow person-centred and strengths-based practice. This limits creativity, narrows the focus onto symptoms rather than whole-life recovery, and restricts collaboration with housing, community, and VCSE partners. The following issues were repeatedly identified:

• Assessments driven by diagnosis and symptoms rather than individual goals, strengths and social context
• Over-reliance on clinical language that does not reflect the person’s lived reality and experience
• Limited use of recovery-focused tools such as WRAP, co-production, and peer support
• Outcomes defined by service processes (e.g., “compliance”, “stability”) rather than personal outcomes and life ambitions
• Professionals prioritising risk avoidance over autonomy, confidence building and independence
• Creativity in aftercare planning constrained by siloed budgets and rigid medical pathways
• The role of housing, meaningful activity, community connection and relationships undervalued in relapse prevention
• Lack of multi-disciplinary/organisational ownership, with aftercare perceived primarily as a “medical” responsibility rather than a whole-system duty

People with lived experience survey findings

Introduction

This section draws on findings from a lived experience survey of 53 people who have been eligible to S117 Mental Health Act aftercare. The survey provides direct insight into how S117 is understood, experienced, planned, reviewed, and delivered in practice.

The findings reveal a consistent gap between the legal intent of S117 and the reality experienced by people, particularly in relation to clarity of rights, early planning, involvement, and continuity of support. Alongside quantitative responses, qualitative feedback highlights the human impact of inconsistent practice, poor communication, and fragmented system working.

These findings should be used by local systems (NHS and local authority partners) to strengthen compliance, improve outcomes, and reduce legal and quality risks.

1. Awareness and Understanding of Section 117

Key finding

• 47 of 53 respondents reported that they had heard of S117 before completing the survey.
• However, qualitative responses indicate that understanding was often incomplete, informal, or self-acquired rather than clearly explained by professionals.
• 6 respondents (4 “No”, 2 “Not sure”) were unaware or uncertain, despite being eligible to S117.

People described learning about S117 only after experiencing problems or having to “push” the system themselves.

Lived experience survey statements

• “I didn’t know anything about S117 and had to start looking for information myself.”
• “No one explained what I was eligible to — I found out by chance.”

Implications

• Awareness without explanation does not meet statutory, ethical, or person-centred standards.
• Failure to explain Section 117 undermines informed involvement, trust, and lawful practice.

Local systems should:

• Proactively explain S117 to individuals and carers, including:
  • What it is
  • What it entitles the person to
  • That it is non-chargeable
  • How long it lasts and how it is reviewed
  • That s117 aftercare can commission or arrange support outside standard local service pathways, not only provide existing services free of charge
• Ensure explanations are:
  • Provided verbally and in accessible written formats
  • Revisited at key points (admission, discharge, review)
  • Clearly recorded as part of statutory compliance

2. Timing of Section 117 Aftercare Planning

Key finding

• Many respondents reported that planning did not start at admission, despite statutory expectations.
• Aftercare was frequently experienced as reactive, crisis-led, or addressed only at the point of discharge.

Lived experience survey statements 

• “There was no plan before I left hospital — everything felt rushed and unclear.”
• “It only became an issue once things started to go wrong.”

Implications

• Delayed planning increases risk of relapse, distress, and avoidable readmission.
• Late or absent planning undermines the preventative purpose of S117.

Local systems should:

• Begin S117 planning at the point of qualifying detention, not at discharge.
• Treat discharge without an agreed Section 117 framework as poor practice and a legal risk.
• Ensure planning is integrated into CPA, care coordination, and discharge pathways.

3. Involvement, Voice and Co-production

Key finding

• A significant proportion of respondents reported:
  • Limited involvement in planning
  • Feeling that their views were not consistently listened to
• Involvement was described as variable and dependent on individual professionals, rather than embedded in system practice.

Lived experience survey statements

• “They didn’t really listen to what I said would help me.”
• “Decisions felt like they were already made.”
• “I wasn’t properly involved in meetings about my own care.”

Implications

• Inconsistent involvement breaches Care Act principles, the Mental Health Act Code of Practice, and CQC expectations.
• Lack of co-production damages trust and weakens outcomes.

Local systems should:

• Embed co-production and shared decision making as a core requirement of S117 planning and review.
• Evidence how a person’s:
  • Views
  • Outcomes
  • Preferences
    have shaped decisions.
• Transparently record and address disagreements rather than defaulting to professional judgement alone.

4. Reviews and ongoing entitlement

Key finding

• Reviews of S117 were inconsistent.
• Some respondents were:
  • Unaware that reviews should happen annually
  • Unclear about their ongoing entitlement
• Reviews were sometimes experienced as a route to reducing or ending support, rather than reassessing need.

Lived experience survey statements

• “I wasn’t told I should have a yearly review.”
• “It felt like the review was about cutting things, not helping me stay well.”

Implications

• Inconsistent reviews create legal risk and undermine the purpose of aftercare.
• People may disengage or deteriorate if reviews are perceived as punitive.

Local systems should:

• Ensure S117 reviews are:
  • Annual as a minimum
  • Joint between NHS and local authority
  • Clearly focused on need, outcomes, and wellbeing
• Only end S117 following:
  • A lawful, documented decision
  • Clear evidence that aftercare is no longer required

5. Nature and Scope of Support Provided

Key finding

• Common forms of support included care coordination and medication management.
• Respondents consistently identified gaps in:
  • Psychological therapies
  • Practical support (housing, benefits, daily living)
  • Continuity of care coordination

Lived experience survey statements

• “I needed therapy but was told it wasn’t available.”
• “Access to practical help like benefits would have made a huge difference.”
• “They said I was too complex and passed me between services.”

Implications

• S117 is often interpreted too narrowly as clinical follow-up.
• This undermines its statutory purpose as holistic aftercare.

Local systems should:

• Apply a broad, lawful interpretation of S117, including:
  • Social care
  • Housing-related support
  • Practical and preventative interventions
• Actively challenge cost-driven or restrictive interpretations.

6. Impact and outcomes

Key finding

• Experiences of impact were mixed:
  • Some respondents reported improved stability
  • Others reported little benefit due to inconsistency and gaps
• What mattered most to people was:
  • Continuity
  • Trusting relationships
  • Feeling safe and not abandoned

Lived experience survey statements

• “Mental health services do not provide timely intervention.”
• “I feel nervous that I will be detained again.”

Implications

• Outcomes should not be measured solely by service inputs or eligibility decisions.
• Emotional safety and prevention are critical indicators of effectiveness.

Local systems should:

• Define success in S117 through:
  • Stability
  • Staff continuity
  • Wellbeing
  • Reduced crisis and detention
• Use lived experience feedback as a core assurance mechanism.

Cross-cutting system issues identified

Across qualitative responses, the following systemic issues were repeatedly identified:

• Poor communication
• Fragmentation between NHS and local authority responsibilities
• Lack of clarity about rights and entitlements
• People being labelled “too complex”
• Anxiety driven by absence of preventative support

These themes underline the need for stronger national expectations and local accountability.