Author and Publication
Author: Ben Slater, Registered Social Worker, Founder and Managing Director of Nellie Supports
Reviewed by: Kerry Slater, Director of Operations
Last reviewed: 20 July 2026
Citation
1. Department of Health and Social Care (2022) National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Available at: https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care
2. Department of Health and Social Care (2022) NHS Continuing Healthcare Decision Support Tool.
3. Mental Health Act 1983, c. 20, section 117. Available at: https://www.legislation.gov.uk/ukpga/1983/20/section/117
4. R v North and East Devon Health Authority, ex parte Coughlan [2000] 2 WLR 622.
Copywright
Copyright © 2026 Nellie Supports Ltd. All rights reserved.
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This article does not constitute legal advice, clinical advice or a substitute for a decision-specific professional assessment. Where legislation, government guidance, court forms or external professional materials are referred to, those materials remain subject to their own copyright, licensing and re-use terms.
Abstract
This guide explains how NHS Continuing Healthcare eligibility is assessed where a person has a severe and enduring mental illness. It covers why section 117 aftercare should be considered before a CHC assessment, the domains engaged, risk and relapse, medication and monitoring, self-neglect, the physical health needs that accompany severe mental illness, and the evidence that supports an accurate assessment.
Severe mental illness and NHS Continuing Healthcare funding
Where there is any history of detention under the Mental Health Act, section 117 aftercare should be considered before an NHS Continuing Healthcare assessment. It cannot be charged for and it avoids a lengthy process.
Check section 117 first
Where the person has been detained under a qualifying section, principally section 3, the NHS and local authority owe a duty to provide aftercare services free of charge. That duty arises from the detention rather than from the level of need. Establishing it first avoids an unnecessary assessment and avoids charges accruing while one runs.
Where the standard route applies
Where there is no qualifying detention history, or where needs extend beyond those arising from the qualifying disorder, the standard NHS Continuing Healthcare route applies. Severe and enduring mental illness can produce substantial needs across several domains, and it is assessed on the same test as any other condition.
The domains engaged
Psychological and emotional needs most obviously, and behaviour where distress or disturbance presents risk. Cognition where there is impairment. Medication where regimes are complex, require monitoring such as blood level checks, or are resisted. Nutrition and skin where self-care has deteriorated. The picture is frequently broader than expected.
Risk and relapse
Relapse patterns, particularly where deterioration occurs rapidly or without warning, engage unpredictability directly. Record the relapse history with dates, what precipitated each episode, how quickly it developed and what intervention was required, including any admission or crisis team involvement.
Medication and monitoring
Antipsychotic and mood stabilising regimes frequently require blood monitoring, physical health checks and careful management of side effects. Depot administration, clozapine monitoring and management of resistance or covert administration are all significant. This engages the medication domain, which can reach priority.
Physical health and self-neglect
People with severe mental illness experience substantially worse physical health outcomes, and physical conditions are frequently under-recognised. Self-neglect affecting nutrition, skin, continence and engagement with treatment produces needs in those domains. Record them as the physical health needs they are rather than absorbing them into the psychiatric picture.
Key takeaway
Establish the section 117 position before pursuing an assessment. Where the standard route applies, record the relapse history with dates, the monitoring the medication regime requires, and the physical health and self-neglect consequences separately.
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Frequently asked questions
Should we check section 117 first?
Yes, where there is any history of detention under a qualifying section such as section 3. Aftercare cannot be charged for and establishing it avoids an unnecessary and lengthy assessment.
Can severe mental illness qualify for CHC?
Yes, on the same test as any other condition, where there is no qualifying detention history or where needs extend beyond those arising from the qualifying disorder.
Which domains are engaged?
Psychological and emotional needs, behaviour where risk is present, cognition where impaired, medication where regimes require monitoring or are resisted, and nutrition and skin where self-care has deteriorated.
Related NHS Continuing Healthcare pages
These links take you to the most relevant Nellie Supports service page and to the supporting guides that explain the surrounding process.
Speak to an independent CHC specialist
Nellie Supports prepares independent needs evidence for NHS Continuing Healthcare assessments, reviews and appeals across England and Wales. Our reports are written by registered social workers on a permanent employed team, with internal peer review before release. Call 0333 987 5118 or send an enquiry and we will talk through where you are in the process.