"Subject to and in accordance with the provisions of this Part of this Act, a local authority may with the approval of the Secretary of State, and to such extent as he may direct shall, make arrangements for providing - (a) residential accommodation for persons aged eighteen or over who by reason of age, illness, disability or any other circumstances are in need of care and attention which is not otherwise available to them."
"32. ... The 'care and attention' which is needed under section 21(1)(a) is a wider concept than 'nursing or personal care'. Section 21 accommodation may be provided for the purpose of preventing illness as well as caring for those who are ill. 33. But 'care and attention' must mean something more than 'accommodation'. Section 21(1)(a) is not a general power to provide housing. ... I remain of the view which I expressed in R (Wahid) v Tower Hamlets London Borough Council[2002] LGR 545 para 32, that the natural and ordinary meaning of the words 'care and attention' in this context is 'looking after'. Looking after means doing something for the person being cared for which he cannot or should not be expected to do for himself: it might be household tasks which an old person can no longer perform or can only perform with great difficulty; it might be protection from risks which a mentally disabled person cannot perceive; it might be personal care, such as feeding, washing or toileting. This is not an exhaustive list. The provision of medical care is expressly excluded..."
"... nothing in this section shall authorise or require a local authority to make any provision authorised or required to be made (whether by that or by any other authority) by or under any enactment not contained in this Part of this Act or authorised or required to be provided under theNational Health Service Act 2006 or theNational Health Service (Wales) Act 2006 ."
"Dr Hugh Jones saw Mohammed on 2/11/11 [it is common ground that that should be 2/9/11] at the community health team who has given a diagnosis of - personality disorder with PTSD."
"Mohammed's main concern is that he wants medication, in particular Diazepam and Clonazepam. This is demonstrated with Mohammed's reaction to defacing his drugs card when presented with it by me. He states that these will help him to get better along with other support. Mohammed's issues are related to his immigration situation in that he does not want to be deported back to Algeria and the thought of this does cause him some distress. The Home Office have made several attempts to deport Mohammed after fully considering his asylum application and appear to be in discussions with Algeria to remove him. He would like to be granted indefinite leave to remain in the UK and would like permanent accommodation and to remain living in London to be near an Algerian community and to be able to attend the mosque. I feel Mohammed could benefit from therapy for his PTSD and he states he would interested in this and it is something that can be considered once a decision is made by the Home Office about his immigration status."
"Reports he feels suicidal when he is angry. These thoughts may occur 1-2 times a week when he thinks about what happened to him in Algeria and the way he was treated in the detention centre. He states that if he has to return to Algeria he will attempt to harm himself again or kill himself."
"He is praying 5 times a day, attends the mosque to pray or he will pray wherever he may be at the time. He reports because he is not eating until sunset he feels tired and is sleeping a lot. Mohammed has explained that the Algerian community and his community at the Mosque have previously supported him to a large extent. He has been provided accommodation, food and other supports throughout his time in the UK."
"Mohammed reports he was offered support from National Asylum Seekers but he refused to accept this as the Home Office informed him that they would move him 6 hours outside of London. He says he does not want to live somewhere eg Leeds as his friends are in London and there are Mosques in London that he attends but if NASS find him somewhere to live in London he will accept their support. This is evidence that there are current supports for Mohammed in the London area and he is not destitute and contrary to Mohammed's report that he has had no support in the past 18 months. Dr Hugh Jones does not support the view of Dr Chairman Gold that Mohammed has a severe and enduring mental illness and he does not present with psychotic symptoms or have a diagnosis of schizophrenia. Dr Jones also does not support Professor Katona's view that Mohammed has a diagnosis of severe depression. Dr Jones has diagnosed Mohammed with a personality disorder, with PTSD and a co-dependency on Valium (tranquilisers). Dr Jones has included a letter to support his views and this is attached to the assessment. On 5th September this matter was considered by the Local Authority and it was decided that Mohammed does not fit the criteria to be watched over and looked after in that he does not have a severe and enduring mental illness. Mohammed has indicated that he has a support network who is able to support his living needs whilst this request to have his asylum claim reviewed is considered. His solicitor has made further representations to the UKBA regarding the asylum application. However there is no evidence that this is being treated as a new application. The solicitors have not provided any response from the UKBA. Without a current application the Local Authority is prohibited from providing public funds as he is an 'ineligible' person. I have assessed that there is community support available for Mohammed to avoid him becoming homeless. It is accepted that to remain in the UK homeless may breach Mohammed's article 3 rights; However this breach can be avoided with his return to Algeria. The UKBA and the Local Authority are satisfied that to do so would not breach Mohammed's human rights. Indeed, Mohammed's failure to comply with the reporting conditions confirms that there are no such article 3 grounds as in the Authority's opinion a person with a potentially valid claim would bring it to the attention of officials at the earliest opportunity. If the referral has been accepted as an application by the UKBA Mohammed is able to apply to NASS for support, including accommodation. There can be a recommendation to place Mohammed in London so he can be near a large Algerian community, although there are likely to be Algerian communities around the country."
"Dear sir/madam, This man is a current client of your practice. He awaits a final decision on his application for asylum from Algeria. Our service was asked to assess him in view of concerns that he may have a severe mental illness and that further detention may be detrimental to his mental health. Previous reports by Dr Charmain Goldwyn give a range of diagnoses not all of which are recognised in standard diagnostic classification schemes. Professor Katona gives a diagnosis of severe depression and possible post traumatic stress disorder. He also states this man is unfit to fly or perhaps even for continued detention. As Professor Katona accepts, assessment of Mr Oukil is difficult. He presents in a highly aroused state and is preoccupied with his concerns about possible deportation to Algeria or more immediately dispersal from London as part of the asylum process. He told me on a number of occasions that were either of these to be attempted he would self harm. He expected me to fully support him in his wish to remain with mental health services and became angry at attempts on my part to more fully assess his mental state. On direct questioning he did say quite openly that the most helpful treatment he could receive would be to be granted fully asylum in the UK. On the basis of my assessment I can state the following. 1. In contrast to the view of Dr Goldwyn I do not believe he has a psychotic illness. He states that previously he experienced voices and was treated with Clonazepam. Clonazepam is not a treatment for psychosis but is rather an acute sedative (similar to valium). 2. He does present with acute distress, but it would be very difficult to form the view he had a severe depressive illness. He made it clear to me that his mood would improve rapidly were he to be granted asylum. 3. He does present with great difficulty in coping with stress and a history that suggests this may be a stable feature of his character. It may be more helpful to view his current distress as reflecting an underlying abnormal personality structure and that as a result of this he is coping very poorly with his admittedly difficult life circumstances. 4. For now there is no useful treatment that our team can offer to this man. The crucial decision that is required is a clear view about his asylum status. This is one that must rest with the UK Government and depends on matters beyond my expertise namely his history of torture and his potential safety if returned to Algeria. It will not be possible to offer any useful treatment for his mental health until that has been settled. Indeed it may be that further contact with our mental health team may only serve to further delay the decision about his asylum status. It may be hoped that treatment by our team may improve his mood to make it easier to decide about his status. It is my view that his mental state will not improve significantly whilst his asylum status is undecided. 5. Once this is decided it may be that treatment could be considered although treatment would be available outside the UK. 6. It is not my view he is unfit to fly. He has stated he will try and self harm if forced to return to Algeria and that is something that needs to be taken seriously by the UK authorities if that decision is taken. However this is really an issue for how his deportation is handled and not a reason of itself to reverse any such decision. It is the case that continued detention is harmful to his mental health. However that again is not a reason to rush the legal process to the point where unsound judgements are made."
"10.45 hours attending NRPFP [I interpose to say that that means the No Recourse to Public Funds Panel] - they do not agree to fund Mohammed as he does not fit the criteria to be watched over or looked after. He is also had NASS before and they feel his solicitor could argue with NASS that he is placed in London to be close to an Algerian community.[sic]"
"The Local Authority has completed its comprehensive care assessment of your client and I enclose this for your information. The assessment concludes that your client is suitable for continuing support from National Asylum Support Services. This is on the basis that your client is claimingArticle 3 ECHR as part of his application. There are no apparent Article 8 claims being made by your client. Furthermore, the assessment concludes there your client has no need which is not otherwise available than by the Local Authority. In light of this, your client has been given 28 days notice of his support being ceased by the Local Authority. This notice period is provided to enable your client to take advice from yourselves and further, to make relevant applications to NASS for support."
"We still believe that our client is in need of care and attention which cannot be provided without accommodation. We are prepared to challenge the cessation of support by judicial review but hope that this can be avoided. The community care assessment concluded that Mr Okil does not have a need for care and attention which is not otherwise available than being provided by the local authority. The assessment contends that Mr Okil can access accommodation via the National Asylum Support Service ('NASS') and relies on the letter from Dr Jones of the Community Mental Health Team to say that no other services are necessary for Mr Okil as matters currently stand. In our view, it is difficult to reconcile the conclusion of the Southwark assessment with the facts which are recorded in the assessment. It is clear from the assessment that Mr Okil requires regularly monitoring in respect of his medication level. He appears not to have much of an understanding as to what medication is suitable for his mental health difficulties and has an apparent fixation on clonazepam. As is suggested by the assessment, Mr Okil's medication level and mental health require monitoring and review. The only reason it appears not to have been reviewed and monitored is because the assessor has deemed it unsafe for the assessor to carry out reviews and monitoring as Mr Okil is prone to agitated and violent outbursts. Mr Okil's need for monitoring and regular review of his medication because he lacks insight into his mental health difficulties suggests in our view that he may be in need of care and attention. In M v Slough with the recent Court of Appeal judgment in SL v Westminster CC[2011] EWCA Civ 954 where it was held that the regular review and monitoring of a mentally unwell asylum seeker was not only for the purpose of regulating his medication but also for the purpose of monitoring his mental health to prevent a relapse/deterioration in his mental state. To this extent, it was held by the Court of Appeal that what the Appellant in SL required met the test set down by Lady Hale in M v Slough ie that the monitoring of the mental state was something which someone else had to provide for the Appellant in SL. In the present case, the monitoring set out in the assessment appears to be limited to the monitoring of Mr Okil's medication level. However the assessment suggests that Mr Okil lacks insight into his mental health state as evident from his apparent lack of understanding of his medication needs. Furthermore, the assessment appears also to suggest that Mr Okil requires monitoring in respect of his mental health state but that this cannot be done as his violent behaviour puts those who support him at risk. This rather suggest (i) a need for monitoring beyond medication needs; (ii) that he has a high need for such monitoring rather than no need at all for monitoring. If you require further information, please do not hesitate to contact us."
"The Local Authority has sought the view of Dr Jones and his view is set out in the letter enclosed. Dr Jones' view has not altered and he maintains that Mr Oukil has no mental health diagnosis. Professor Katona assessed Mr Oukil in August 2011 and any update of this view could have been completed in view of the papers and the assessment of Dr Jones. Your response has failed to acknowledge Mr Oukil's refusal of NASS support on the grounds that he has friends and support in London available to him. The Local Authority has undertaken its own assessment of your client which has included that assessment by Dr Jones. It would be misdirected to propose that the Local Authority has relied solely on the view of Dr Jones. Mr Oukil has received adequate care and support other than by the Local Authority since the Local Authority assessment was concluded. This is echoed by the comments of Dr Jones'. It is therefore not accepted, as suggested in your letter, that Mr Oukil requires regular monitoring by the Local Authority of his medication level and mental health. On the basis of recent and medical assessment the Local Authority is of the view that Mr Oukil does not have a mental health diagnosis. It is therefore illogical to suggest that the Local Authority is required to regularly review him in order to, in part, monitor his mental health. Mr Oukil is able bodied and has recently proven capable of regulating his medication through prescription from his GP. This is particularly a medical need. The Local Authority has fully assessed Mr Oukil ensuring that he was fully involved. Mr Oukil has presented to professional social workers and the assessment was rationally concluded. Mr Oukil has been provided with a copy of the assessment setting out the basis for the Local Authority decision. The Local Authority reliance on its assessment remains following a reconsideration of the case."
"Mr Oukil was first seen by our service in August 2011 and last seen on12th October 2011 . During this time he was assessed by the team, including myself who met him on the 2nd September. We have reviewed this decision on 1st December and maintain a clear view that he does not have a severe mental illness that warrants specialist treatment with specialist mental health services. He presented requested accommodation and for a supply of sedative medication. This medication was prescribed to him in a detention centre. It is not a recognised specific treatment of any mental illness. He was on an inappropriately high dose of this and our service cautiously reduced this in a careful manner. If his social circumstances had not been so unstable we would have reduced this further. We maintain that the assessment of Mr Oukil's diagnosis is clear and have taken account of the view of Professor Katona. Mr Oukil has not presented to emergency services in crisis since being provided accommodation. He has presented both to our service and to primary care making aggressive requests for extra medication. When these have not been met he has resorted to verbal threats, and on one occasion physical violence, towards a member of staff. The physical violence towards one of our team led to us discussing if it was reasonable to discharge him from our team. As there is no clear evidence he has a mental illness it was felt an appropriate clinical decision to do this. We have continued to fund his accommodation although housing support would be available from another agency."
"a. In my view Mr Okil has very severe mental health problems. He is extremely distressed and his behaviour is very disturbed. In my opinion the most disturbing features of his presentation (his episodes of aggression) are themselves strongly supportive of the diagnosis of complex PTSD and indicators of the intensity of his suffering. B. In my opinion Mr Okil needs very long term highly specialised psychotherapy as well as long term medication with antidepressants and antipsychotics. This will only [be] possible if he has stable accommodation with good access for this therapy. C. Mr Okil's disturbed behaviour since his release from detention (episodes of which caused him to be arrested and to be taken off his GP's list) indicated that he is currently not able to live independently and needs close supervision. In my opinion he would benefit from intensive support from a community mental health crisis or home treatment team. D. In the light of this it seems clear that Mr Okil desperately needs to be 'looked after' because of the complexity of his mental health needs as well as his vulnerability and that he is therefore in need of 'care and attention' as well as appropriate accommodation."
"4.1 I would challenge the view presented in Professor Katona's report that Mr Oukil requires immediate specialised treatment. There is ample clinical evidence and experience that such treatment should only be started once the life and social situation of the individual is sufficiently stable. This is clearly not the case at present for Mr Oukil. Indeed were such treatment to be started currently it may only increase his current distress and disturbed behaviour. 4.2 Mr Oukil could agree to have at least a trial of standard antidepressants although there are no grounds to enforce treatment if he does not agree to this. In the absence of any major change in his social situation I would not however expect such treatment to produce a major improvement in his mental condition. This treatment could be started in any environment and does not require ongoing contact with a specialist mental health team. 4.3 I would not agree that Mr Oukil requires intensive community support from a community team of even a crisis home treatment team. Such teams can have a role in helping individuals to manage practical aspects of their daily life or to reduce the risk of inpatient admission. However there is no evidence that he is not managing the practical aspects of his life and there is no evidence that inpatient admission is required for Mr Oukil or that his condition will significantly deteriorate if medication is not started immediately. 4.4 The clear evidence is that his disturbed behaviour occurs in specific situations, notably at times when he perceives that his own needs are not being met promptly This has included physical assault on a team leader at our team, threats to harm made at other medical and support staff, and a recent assault of a resident in a hostel. There is no evidence that community team input would reduce this. These events also provided evidence that Mr Oukil has a low tolerance to frustration when his perceived needs are not met and in the aftermath of each incident he has displayed a clear lack of remorse or guilt over these actions and a marked tendency to blame others for these incidents. These are all typical personality traits for an individual with a cluster B personality subtype. I do not think they can be merely attributed to symptoms in the interpersonal symptom cluster of PTSD. 4.5 It is an open question whether he will even require any treatment if his social situation was more stable. The evidence from his own account was that from 2003-2007 he lived in the UK and functioned at a relatively good level within a social support network and working) and without any contact with mental health services. The reasonable assumption is that he had a relatively low level of symptoms at this time. Such a history is not compatible with the view suggested by Professor Katona that Mr Oukil has a severe and enduring mental illness. Indeed the clear history that he did not require any specialist intervention in 2003 argues strongly against the view he had severe complex PTSD as this is a condition that would not be expected to become less severe in such a straightforward manner. 4.6 I would argue that the failure to arrive at a clear decision about his asylum status is the key factor in accounting for his current mental and behaviour symptoms. It is of course a legal decision as to whether it is appropriate to proceed with deportation. His history is such that he has probably experienced childhood trauma (although there is no independent corroboration of his history of torture). However it has previously been the case that his symptoms have reduced to a low level (between 2003 and 2007) without any specialist treatment. It is thus reasonable to expect that his symptoms may again reduce if his social situation can be made more stable. 4.7 I hope in the interests of his health that his asylum case can be settled as soon as possible. It is very sad to witness the behaviour disturbance shown by Mr Oukil that the delay in resolving this matter is directly contributing towards."
"The claimant's circumstances are not such as to warrant monitoring or care coordination. This is usually provided to those who cannot manage without it in the community, ie for those with a lower ability to function than the Claimant. Furthermore, the Claimant does not want treatment other than tranquillisers, which he has specifically requested. When the Claimant was trailed on the anti depressants in August 2011 he voluntarily chose not to use them stating that he did not wish to take them."
"The Claimant's fundamental problems with related to his lack of immigration status and the threat that he may be deported."
"The Claimant's behaviour is characterised as impulsive and indicates a low tolerance to frustrations that he experiences. This has become his habitual way of relating to others. His errant behaviour is not randomly directed: it is goal directed and used as a way of seeking outcomes that he wants. The Claimant's bad behaviour is directed at particular people and for particular reasons. This behaviour is more akin to anti-social behaviour than to something that has a mental health cause or root. This behaviour has been characteristic of the Claimant since he was first referred to our services in August 2011, which seems to have been in response to the fact that he was going to be dispersed by the government out of London. For example: A. In my letter to the Claimant's solicitors of13 September 2011 I noted how the Claimant was 'preoccupied with his concerns about possible deportation to Algeria or more immediately dispersal from London as part of the asylum process. He told me on a number of occasions that were either of these to be attempted he would self harm. He expected me to fully support him in his wish to remain with mental health services and became angry at attempts on my part to more fully assess his mental state. B. In his letter of31 January 2012 (exhibit HJ1) Dr Johns notes how the Claimant said he was refusing to eat in response to being refused medication in liquid as opposed to tablet form. C. Between these two examples are numerous examples of the Claimant engaging in violent and anti-social behaviour that have been prompted by his inability to get what he wants. Self-harming behaviour 14. Individuals may self-harm for a number of reasons. In the Claimants' case it is my opinion that he does it for two reasons. First, he probably self-harms as a means of controlling stress, rather than with an intent to commit suicide. His scars, for example, are not in places that would suggest an intention to commit suicide. Indeed he has never damaged himself in a serious way and his scars are superficial. Secondly, he probably self-harms, or at least threatens to self-harm, as part of his goal directed behaviour. The accounts of how the Claimant has actually swallowed razor blades, on one occasion he says he swallowed seven, all come from the Claimant and although he says that he was once x-rayed in hospital it is doubtful that he actually swallowed razor blades because of the absence of medical records supporting such a conclusion."
"i) failure to carry out a lawful and rational community care assessment; Ii) refusal to provide accommodation and support pursuant to s21 NAA 1948; Iii) refusal to provide community care services in accordance with the Claimant's needs associated with his mental health difficulties and depression,"
"As [counsel for claimant] submitted, Mr Wyman [that is the social worker in question] is doing something for the appellant which he cannot do for himself: he is monitoring his mental state so as to avoid if possible a relapse or deterioration. He is doing it, no doubt, principally through their weekly meetings; but also by means of the arrangements for contact (or the renewal of contact) with the two counselling groups, and with the 'befriender'. It is to be noted that care and attention within the subsection is not limited to acts done by the local authority's employees or agents. And I have already made it clear that the subsection does not envisage any particular intensity of support in order to constitute care and attention."