Under section 23 of the Mental Health Act 1983 hospital managers (NHS Trusts, Health Boards, and independent hospitals) have a power to discharge people detained in hospital, or subject to Community Treatment Orders. The power is separate to that held by the patient’s Responsible Clinician and Nearest Relative. This power is normally delegated to a specially appointed group of people – often called Associate Hospital Managers (AHMs) – who sit as a quasi-judicial panel to consider whether to exercise the power of discharge. Very little is known about who sits as an AHM, the scale of the operation underpinning the process (e.g. how many hearings are held annually, how many discharges are made), or what policies govern the operation of s.23 at a local level (there is only limited, centrally issued guidance).

In this paper I discuss some initial findings resulting from responses to requests sent to NHS Trusts and Health Boards in England and Wales (n=74), as well as some of the practical challenges faced.