awol - missing or absent without official leave

Version 2.1 October 2019

AWOL - Missing or Absent without Official Leave

Target Audience

Who Should Read This Policy

All Clinical staff

AWOL - Missing or Absent without Official Leave Policy


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Ref. Contents Page

1.0 Introduction 5

2.0 Purpose 5

3.0 Objectives 5

4.0 Process 5

4.1 When is a Patient Deemed to be Absent without Leave (AWOL)? 6

4.2 Procedure for When a Patient Absents Themselves 6

4.3 Community Treatment Order Patients Absent Without Official Leave 11

4.4 Procedure for when a Patient does not Return from Leave 11

4.5 Refusal to Return by a Patient 12

4.6 Actions in the Event of Prolonged Absence 13

4.7 Who has the Power for Returning the Patient to Hospital? 14

4.8 Section 135(2) Warrant 14

4.9 Time Limits for Returning a Patient who has Gone AWOL 15

4.10 Media 16

4.11 Debriefing and Learning Lessons from Incidents of Absence 17

5.0 Procedures connected to this Policy 17

6.0 Links to Relevant Legislation 17

6.1 Links to Relevant National Standards 19

6.2 Links to other Key Policies 20

6.3 References 21

7.0 Roles and Responsibilities for this Policy 22

8.0 Training 24

9.0 Equality Impact Assessment 24

10.0 Data Protection and Freedom of Information 24

11.0 Monitoring this Policy is Working in Practice 25

Appendices

1.0 Strategies to Reduce Incidents of Missing Patients 27

2.0 Gerry Simon Procedures for Restricted Patients 29

3.0 Patient AWOL Flowchart 31

4.0 Informal Patients- Missing Person Flowchart 32

5.0 Missing Patient Reporting Form 33



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6.0 Local Search Guidelines 35

7.0 Degree of Harm - When to Inform Agencies/ Individuals 38

8.0 Attending Court for a Warrant Section 135(2) 39

9.0 Execution of the Warrant 40

10.0 Form CTO3 Regulation 6(3) (a) - Mental Health Act 1983 42



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Explanation of terms used in this policy Absent Without Official Leave (AWOL) - A detained inpatient subject to the provisions of the Mental Health Act 1983 who has deliberately or unthinkingly absented themselves from the ward/unit

or who fails to return on time from authorised leave

Detained Patient - Inpatients that are subject to lawful detention under the Mental Health Act 1983

Informal patient - Any inpatient who is not detained under the Mental Health Act 1983, or any

other relevant legislation

Leave - The term leave includes escorted excursions outside of the hospital accompanied by staff,

relatives or other authorised persons. A detained inpatient absconding from such an excursion will be recorded as absent without leave

Ministry of Justice - One of the largest government departments, its duties include protecting the

public and to reduce re-offending by mentally disordered offenders They achieve this by carefully

monitoring restricted patients detained in hospital or the community

Missing Patient - A generic term for informal patients who absent themselves from the ward/unit or who fail to return on time and whose unknown whereabouts and continued absence arouses concern.

Judgement must be used by the ward/unit team to decide when a patient is classed as ‘missing’ e.g. a patient who is an hour late returning from leave may not yet be classed as missing; the same patient

three hours later who has not responded to phone calls and who is not at home may be. Alternatively high-risk patients must be classified as missing the moment their whereabouts are not known

Restricted Patient - Restricted patients are mentally disordered offenders who are detained in

hospital for treatment and who are subject to special controls by the Justice Secretary due to the level

of risk they pose. They are usually treated in secure hospitals, and will be given gradual access to the community as part of their rehabilitation only when it is safe to do so

Risk Assessment - All inpatients are subject to continual risk assessment in accordance with the

Clinical Risk Management Policy and as such, the decision regarding risk in relation to leave and the

patients subsequent failure to return should be assessed and documented prior to leave being granted. The assessment should include:

- Risk to self (neglect, self-harm, suicide) - Child protection

- Risk of harm to others - Risk to property

Supervised Community Treatment - When a Responsible Clinician considers with the rest of the care team that a detained patient is well enough to leave hospital but is concerned they may not

continue with their treatment, or may need to be admitted to hospital again at short notice for more treatment or for some other reasons

Adult at Risk - A person over 18 years of age who is or may be unable to take care of him or herself, or is unable to protect him or herself from significant harm or exploitation

Absconding - A detained inpatient who absents him or herself from hospital

Absent - An inpatient that is not subject to the provisions of the Mental Health Act 1983, otherwise

defined as “informal” can be absent but not absent without official leave



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1.0 Introduction Mental Health Act 1983 Code of Practice requires that hospitals have a clear written policy detailing the action to be taken when a detained patient, or a patient subject to supervised community treatment, goes missing. There are a number of factors which contribute to the incidence of absconding: boredom through lack of therapeutic activity; ward environment; patient mix; potential for bullying or harassment; drug and alcohol misuse. Lack of regular access to fresh air and to a peaceful environment may also contribute to disengagement from care and absconding. Episodes of unexplained or unauthorised absence from care and treatment may serve to disrupt recovery and prevention of such episodes is considered an integral component of risk management plans for all patients. Section 18 of the Mental Health Act 1983 allows for the return of detained patients who are absent without official leave. Every effort must be made to ensure that all patients (and where appropriate carers) understand their rights under the MHA 1983 and the processes involved within Section 18. This can be achieved using the following resources: approved translation services; advocacy; leaflets; large print forms; visual aids; family/carer assistance (where appropriate) and support from the equality and diversity team. It is the responsibility of the healthcare professionals involved within the process of Section 18 MHA 1983 to ensure that the patients’ right to equality, diversity, respect, confidentiality and advocacy is maintained throughout.

2.0 Purpose The purpose of this policy is to define the responsibilities and provide guidelines for staff in relation to the appropriate identification, searching for, reporting of and subsequent requirements for dealing with patients who go missing or absent without official leave (AWOL).

3.0 Objectives

Enable staff to act appropriately according to the legal status of the patient

Enable staff to respond appropriately to the level of current risk

Enable staff to provide appropriate services in the least restrictive manner

Promote a collaborative approach with other organisations who may become involved e.g. Police

Highlight the need for staff to consider the cultural, spiritual and special needs of the absent without leave patient or missing person

Enable staff to adhere to the rights and principles outlined in the Mental Health Act and the Police and Criminal Evidence Act

4.0 Process Multidisciplinary Teams caring for inpatients with absconding histories or risk assessed as at risk of absconding, are recommended to refer to Appendix 1 when developing and implementing care plans in order to try and reduce incidents of patients missing or absconding. Appendix 1 outlines good practice strategies that can be adopted in clinical settings with patients presenting risk issues of absconding.



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4.1 When is a Patient Deemed to be Absent without Leave (AWOL)?

Patients are deemed to be AWOL if they:

Are absent from hospital without official leave granted under Section 17 with the RC’s authorisation

Fail to return to hospital at the end of an authorised leave of absence

If the patient is refusing to return from leave and has no intention to return after the Responsible Consultant (RC) or out of hours on call RC has revoked the leave and recalled [Community Treatment Order (CTO) patients] the patient to hospital, the patient will be AWOL. CTO patient is not officially AWOL until they have been given notice by the RC in writing of this (Appendix 2)

Are absent without permission from the address where they have been given leave

Supervised Community Treatment (SCT) patients that have been recalled to hospital and then abscond

SCT patients that do not return to hospital when recalled When the patient is subject to detention under the requirements of The Mental

Health Act 1983 (Amended 2007) or Deprivation of Liberty safeguards and has left without explicit and written permission of the Responsible Clinician

4.1.1 A patient who is not detained under the Mental Health Act who leaves hospital without permission is classed as a missing patient Patients will be considered missing in the following circumstances:

If an informal patient considered to be vulnerable by the clinical team leaves the ward area without the staff being aware or has not returned from leave

If an informal patient who has been identified as posing a significant risk to themselves or others absents themselves whilst being escorted or transported in the community.

If an informal patient, with capacity whereabouts are known, but they are refusing to return to the ward and there is no immediate risk to themselves or other they are not missing. In these circumstances staff should arrange a Multi-Disciplinary Team (MDT) review to agree if discharge is appropriate. It’s important that community staff, and/or friends and family are informed (where appropriate)

For an informal patient whose whereabouts are known but the patient lacks capacity an urgent best interest meeting is to be convened to agree if discharge is appropriate.

4.2 Procedure for When a Patient Absents Themselves Any member of staff, who becomes aware that a patient has gone absent without official leave or is otherwise unaccounted for, should immediately inform the Nurse in Charge of the patient’s ward. The Nurse in Charge implements the following procedure (see Appendix 3 and Appendix 4). 4.2.1 Stage 1- Initial Search The Nurse in Charge will instigate a log to provide a record of the searches to be carried out. This will include details of the immediate area to be searched and by whom as well as where the search is extended to other areas and to whom it has been delegated. The log will provide a readymade record for the Nurse in Charge’s subsequent report.



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The objective of an initial search is to confirm or otherwise that the patient is physically missing from the confines of the building/ premises/ grounds. Prior to commencing the local search staff must ensure that the safety of other patients is maintained. They must also ensure that they maintain their own safety. A search area may be specifically denoted as being unsuitable to be searched by a lone member of staff. However, for all search areas due care and consideration should be given to the time, weather, knowledge of the patient, to determine the level of staff required to conduct a safe search. All completed searches must be documented in the patients nursing notes on the day of the search and on the Missing Person form if required by the police (see Appendix 5). If the patient is not located, the Nurse in Charge must then contact other wards, departments or services on the same site and asking for any sightings, times of sightings and request that a similar, thorough search is undertaken within their buildings/ areas in negotiations with other agencies. As indicated above the Nurse in Charge will document all this in her log. Please see Appendix 6 for Local Search Guidelines for Trust sites. The guides ensure that the Nurse in Charge organises and delegates a thorough search of the ward and other areas within the building, including any adjacent rooms, corridors, cupboards, stairwells, pathways or roadways. 4.2.1.1 Action to be taken if the Patient is confirmed as Missing Once the patient is confirmed as missing or unaccounted for; the Nurse in Charge notifies the patient’s Consultant Psychiatrist/ Responsible Clinician or Medical Team, (duty RC out of hours) whichever is most relevant, as soon as possible within working hours. Out of hours the Manager on Call would be informed and the medical team the next working day. 4.2.2 Stage 2 - Determine the Level of Risk The Nurse in Charge undertakes a risk assessment of the situation. Risk assessments inform and support any further decision-making. The risk status of patients will vary in line with a number of factors and may alter over time. It is therefore imperative that regular entries relating to the patient’s current risk status are clearly documented within the patient’s risk assessment and associated care planning records. Risk factors are taken into account at all stages of a patient’s assessment and are considered when admission to hospital or detention under the Act is proposed. Other issues, such as impairment of memory or an inability to appreciate danger may be factors to be included in on-going risk assessment. For the purpose of determining what/ when to notify internal and external agencies within these procedures the person in charge must ensure a clinical risk assessment is completed at all times and documented within the patient’s case records. NB: A missing patient’s risk category (High, Medium or Low) can alter whilst the patient is absent without leave and all agencies must be informed of any decision to alter their Risk Category.



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4.2.2.1 Engage with Key Stakeholders If a patient goes missing or absent without official leave, the impact can be lessened with good engagement with the main stakeholders in securing return, this can be achieved by:

Police / Ambulance / relatives (conveyance) depending on the level need/ risk.

Ensuring informative protocols for absent without leave/ missing persons are in place

Ensuring relatives and carers are fully involved in the care team and the process of their relative’s care needs at this time

Ensuring a good working relationship with carers and relatives and ensuring contact people and phone numbers are communicated

Ensuring regular discussion and shared understandings of this policy translated into practice with key staff for all relevant areas

Ensuring all patients are offered access to an Occupational Therapy (OT) assessment within three days of admission and repeated weekly if they initially refuse

Patients who are subject to The Deprivation of Liberty Safeguards. (DOLS) If a patient subject to the Deprivation of Liberty Safeguards leaves the Hospital without the agreement of the Consultant Psychiatrist and/or Nurse, a request should be made to the Police that as they are a “vulnerable adult” they are located and returned to the hospital. 4.2.2.2 Notifications If appropriate, Attempts should be made to make contact with the patient via any known contact details including friends and relatives (where appropriate) to establish 1) their location, 2) current risk factors, and wherever possible 3) organise arrangements for the patients safe return to hospital. The nearest relatives or next of kin should be informed immediately, unless there are clear reasons for not doing so. If the relatives are not informed the reasons for this decision should be clearly documented in the patient’s clinical records. They must be kept up to date with any developments as well as offering reassurances where required. Meanwhile the following formal notifications, by the person in charge, to both internal and external agencies must be followed if the patient cannot be located: Police - Where the risk assessment shows the patient to be a high risk or a medium risk, as agreed by the Ward Team (which includes the Responsible Clinician or consultant psychiatrist and the patient’s representative where relevant) the AWOL/ missing person should be reported to West Midlands police on 101 or 999 if urgent (see Appendix 7). They should be reported either as ‘missing’ or ‘absent without authorisation’ depending on the level of risk posed. All information should be entered into the patients nursing notes and when required, onto the Missing Persons form (Appendix 5) which the police may request a copy of. The police will implement the West Midlands Police Management, Recording and Investigation of Missing Persons (April 2012) for all AWOL/missing patients reported to them as soon as they are notified. The police will want to know the time limit to take or re-take patients to a hospital or particular place. On receipt of the notification of a missing patient, the police (at their discretion) direct an officer to attend the ward or unit from where the patient has been reported as

http://foi.west-midlands.police.uk/wp-content/uploads/2016/05/MISSING-PERSONS-POLICY-V1.1_-REDACTED.pdf

http://foi.west-midlands.police.uk/wp-content/uploads/2016/05/MISSING-PERSONS-POLICY-V1.1_-REDACTED.pdf



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missing. It needs to be noted that a missing person for the NHS may not be a missing person for the police. They will bring a Missing Person record sheet with them to complete with Trust staffs assistance and an incident number will be provided. The officer may wish to gain further details, including evidence that the patient is formally detained under the Act. The Nurse in Charge must ensure that they are able to provide full and detailed information relating to the AWOL/ missing patient to the officer attending, and that the Nurse has access to the patient’s case files to assist in the provision of this information. The Nurse must ensure this information is ready prior to police arrival to save time using Appendix 5 if required. Appendix 5.a details the risk based questions the police may ask the caller. The police will undertake their own risk assessment of the AWOL/ missing patient and will act according to their internal procedures. The police risk assessment will be based on the information provided by Trust staff and it is imperative that detailed information is provided accurately and swiftly. If the police locate the patient, they may either return the patient to hospital or inform the appropriate Trust Manager of the patient’s whereabouts. Where a patient who is liable to be detained is believed to be on premises to which access has been refused, then an officer of the hospital can be authorised by the Service Manager to apply to a justice of the peace for a warrant under 135(2). The authorised member of staff will attend court (see Appendix 8). The warrant will authorise any police constable to enter the premises, if need be by force, and remove the patient. The constable may be accompanied by an officer of the hospital in the execution of the warrant (see Appendix 9). Relatives - The patient’s nearest relative (if detained or liable to be detained) must be informed immediately that the patient is known to be absent without leave. A telephone call may be the most appropriate method of contact for the nearest relative, but alternative methods of contact, as preferred by the relative, must be recorded in care plans/ CPA documentation and used by staff accordingly. There may be times when it is impractical to notify the nearest relative immediately, but all efforts must be made to inform the nearest relative within one hour after the patient’s absence is known, in line with Appendix 7 guidance. Contact details for the nearest relative and carer if appropriate should be established on or shortly after the patient’s admission to hospital and a telephone number should be recorded in the patient’s case records and be easily accessible. For informal or voluntary patients, the next of kin and/ or a friend/ carer/ relative previously identified by the patient should be notified immediately unless there are sound reasons for not doing so. An example where it may not be appropriate to notify the next of kin or others is where a voluntary patient has expressly stated that they do not want their relatives to know their whereabouts and there are no assessed risks.



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Contact details for the next of kin or others should be established as soon as possible after the patient’s admission to hospital. Telephone number(s), or other contact details, should be recorded in the patient’s case records and be easily accessible. Contact preferences, outlined above should also be recorded and easily accessible in the patient’s case records. Responsible Clinician or Consultant Psychiatrist - The patients Responsible Clinician or Consultant Psychiatrist should be informed immediately. This will also ensure the home office is informed depending on the category of the detained patient. Governance Assurance - All AWOL’s /Missing persons have to be reported on DATIX. Where the risk is classed as high or medium, this should be rated as an amber/red incident and reported to the Governance Assurance Unit as soon as possible. Mental Health Act Office (detained patients) - Contact the Mental Health Act Officer for all unauthorised absences (if you are using Datix, this will be done automatically once you click submit). Care Quality Commission - Care Quality Commission must be notified of all AWOLs (detained patients) if they are resident in a PICU or secure ward within 24hrs and if on a general psychiatric ward if they have been AWOL after midnight on the day the AWOL commenced. The person in charge/ Ward Manager/ Team Leader will be contacted to enable completion of the CQC form by the risk administrator who will submit it to the Care Quality Commission on the Manager's behalf. Ministry of Justice - The Ministry of Justice should be informed in relation to any patients detained under restraining orders who go absent without official leave.. If the patient is deemed through assessment to be high-risk, consideration must be given to alerting other Mental Health/Acute Trusts, this decision would be made by the Multidisciplinary Team. On-going contact with all of the above persons must be maintained whist the patient is AWOL, if required continue to hold Care Programme Approach reviews to ensure all involved are kept informed. 4.2.2.3 Out of Area When a patient, who is liable to be detained, is located outside of the West Midlands, the Service Manager or Manager on Call if out of hours, is delegated to act on behalf of the Hospital Managers to authorise the detention of the patient at a local hospital in writing. Such authority can be provided by fax. The Manager should also ensure that the relevant clinical details are provided to the host hospital. Where a detained patient is taken to another hospital, the Service Manager may make arrangements for the return of the patient or delegate responsibility for organising the patient’s return to the Nurse in Charge of the ward. The person organising the return should ensure that the appropriate transport and escorts are organised to collect the patient, usually within 3 days of receiving notification of their whereabouts.

https://www.justice.gov.uk/contacts/noms/mental-health-unit



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The person in charge of the ward area at the time of absence is fully responsible for ensuring that:

The process for managing the risk associated with patients who are absent without leave is correctly and efficiently implemented

Notifications are completed with timescales

Actions, decisions made/ taken and outcomes are clearly, succinctly documented in healthcare records

The Manager on Call's responsibility is to ensure attempts to locate the patient have been fully exhausted and that notifications, record keeping and police working have been conducted correctly. Furthermore the Manager on Call has the authority to move staff between wards and community teams to ensure that the most appropriate staffs are released to ensure early location and speedy, effective and safe return of the patient.

4.3 Community Treatment Order Patients Absent Without Official Leave If the patient, having received a Community Treatment Order (CTO3) recalling them to hospital, does not go to hospital or leaves hospital while on recall, they will be Absent Without Leave or AWOL and the AWOL procedure must be followed. While AWOL they can be taken into custody and returned to the hospital by any approved mental health professional, by any constable, or by any person authorised in writing by the Responsible Clinician or the Managers of the hospital. This can only be done if it is before the time at which the CTO would have expired or 6 months before the first day of AWOL. Unless patients CTO has been extended twice or more (for a year) the last day will always be 6 months after patient went AWOL. If the police are involved in the recall they will require a copy of the CT03 (see Appendix 10) paperwork so they have documented proof of recall.

4.4 Procedure for when a Patient does not Return from Leave

Information needs to be included on the Missing Persons form (Appendix 5) if required by the police and in the medical and nursing notes when a patient does not return from a period of authorised absence. It is the Trust’s responsibility to organise the return of an AWOL/ missing patient dependant on risk assessment and location but assistance from the police, ambulance service or social services may be negotiated if required. The police should be asked to assist in returning a patient to hospital only if necessary, this is to assist with police powers e.g. prevent crime, Breach of the Peace, risk of violence, significant self-harm. They should be given as much notice and information as possible when a request for police assistance is made in these circumstances. Clear guidance needs to be given to the Police as to what the Trust expects from them in these situations. When the AWOL/ missing patient is located, the Service Manager/ Manager on Call is responsible for taking the decisions as to what staff and resources are to be utilised in organising the return of the patient.



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The Manager responsible for organising the return of the patient will make a decision as to the mode of transport used as well as the number and skill mix of staff required to ensure the patients safe return. Section 18 of the Mental Health Act provides powers for the return of patients who are absent without leave and liable to be detained in hospital. The police powers in these situations are limited and if the patient is arrested under section 18 when AWOL the authority afforded to the officer is to return the patient to the hospital from which they are missing or to which they have been recalled. Legal advice to the police service is that detention in police cells pending re-assessment or identification of a new bed would not necessarily be legal. Therefore a contingency plan will be required by the hospital to manage this situation as the Police cannot detain the patient in Police cells. The return to hospital of the patient can be by an Approved Mental Health Practitioner (AMHP), any officer on the staff of the hospital, any police officer or any person authorised in writing by the Hospital Managers. More than one agency may be involved in returning the patient, so co-operation between agencies is vital. Should any disputes occur throughout the process - report immediately to the Service Manager. If the matter remains unresolved notify the Director of the service.

4.5 Refusal to Return by a Patient 4.5.1 Refusal to Return by a Detained Patient (Section 17 Leave) For detained patients located off hospital grounds staff must make every effort possible to persuade/ negotiate the patients return. Staff should consider the family / carer, who the patient responds to best when trying to get the patient to return to the ward, also consider safe/ preferred transport arrangements. If all attempts at persuasion fail to achieve a detained patient’s return, and there are enough staff present to safely affect a forced return, then force may be used providing that it is safe to do so and it is deemed ‘reasonable’. In these circumstances, ‘reasonable’ means the minimum force. “A person may use such force as is reasonable in the circumstances in the prevention of crime, or in effecting or assisting in the lawful arrest of offenders or suspected offenders or of persons unlawfully at large” Consideration needs to be given as to whether a forced return could create a public incident (breach of the peace) or public uncertainty as to what is taking place. Proportionate actions must also be considered when measuring reasonableness. Therefore force must be:

Necessary and proportionate

Conducted by appropriately trained and competent staff

Combined with strategies to continuously de-escalate

The least restrictive possible

For the minimum amount of time

Continually monitored for signs of medical/physical distress in the patient

Formally recorded as soon as possible after the event



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If all else fails, and every reasonable effort has been made to return the patient but the patient presents as a low risk to himself or others, staff will return to the ward and inform Ward Manager/ Nurse in Charge who will review the situation and determine the most appropriate outcome. However, where the patient refuses to return and remains a risk to himself or others then the police will need to be contacted to assist in the return. Application for a warrant under 135(2) may be required – see point 4.8 Section 135(2) Warrant below. However, it must be clear the Manager responsible for the area may only request police assistance if they think this is necessary. Attendance of the police is to prevent risk of crime, breech of the peace, threat to life/ damage to property and public safety and not to assist in the management of the patient. 4.5.2 Refusal to Return by an Informal Patient If a voluntary patient has left the ward, and is found in the hospital grounds, then a Nurse of the prescribed class should consider whether there are grounds for the implementation of the Nurse’s holding power under section 5(4) of the Act. Where an informal patient leaves the ward and is located within the hospital grounds, or in close proximity to the hospital, the patient, if willing, should be persuaded to return and be seen by the doctor. If all attempts at persuasion fail, i.e. the patient is unwilling to return to the ward, then an informal patient may be detained under the Nurse’s holding power, section 5(4), whilst within the hospital grounds but usually only under certain conditions e.g. someone who lacks capacity. This is usually the same rationale for any detention, i.e. ‘the patient is suffering with a mental disorder to such a degree that it is necessary for the patient to be immediately prevented from leaving the hospital either for the patients’ health or safety or the protection of others’. If the person lacks capacity it may be appropriate to consider the Mental Capacity Act, which would cover return under best interests and then a DoLs application made. If Police have been informed of an informal patient’s absence because the risk has been assessed as medium/ high information needs to be provided to the Police as to what the Trust is seeking from them i.e. safe and well check etc. If the patient is found in a private place police powers for non-detained patients are nil without a section 135(2) warrant unless there is a ‘life or limb’ scenario. If a section 135(2) warrant is thought necessary then the Manger on Call will need to be informed and the situation managed in liaison with the police taking into account the risk the patient poses to themselves, staff and the wider public. See Appendix 8 for Attending Court for a Warrant Section 135(2) and Appendix 9 for Execution of the Warrant.

4.6 Actions in the Event of Prolonged Absence Should a patient remain absent for a prolonged period then regular Multi-Disciplinary Team (MDT) reviews of the patient’s absence and risk must be undertaken. A representative from the police should be invited if there is sufficient concern over the patient’s absence (all levels of risk) with weekly updates to the Mental Health Act (MHA) office as additional information becomes available.



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4.7 Who has the Power for Returning the Patient to Hospital? The following persons have the power to return the patient to hospital:

Any member of hospital staff, where the patient is detained

Any person authorised in writing by the Hospital Managers of the hospital where the patient is detained

Any approved mental health practitioner

Any police officer, if it is necessary for them to assist

If the patient is on leave at another hospital under Section 17 of the Mental Health Act 1983, in addition to the above, the staff and any person authorised in writing by the Hospital Managers of the hospital from where the patient is on leave can return the patient to the hospital he/ she is required to be. If it is necessary for the patient to be returned to another hospital, they may do so with the written authorisation of the mangers of the detaining hospital and the patient would be subject to detention at that hospital whilst arrangements are made to return him/ her to where they should be. 4.7.1 Powers under Mental Capacity Act to Return Patient Section 4 and 5 of the Mental Capacity Act provides powers to the police as well as staff to make a Best Interests Decision to return the patient to the ward. Section 6 authorises restraint provided that; the officer or member of staff “reasonably believes that it is necessary to do the act in order to prevent harm to Patient.” and that restraint “is a proportionate response to: — (a) The likelihood of Patient's suffering harm (b) The seriousness of that harm.” However the Police powers under section 4 and 5 of the Mental Capacity Act can not to be used to obtain a Mental Health Act assessment as there is provision within the Mental Health Act 1983(Amended 2007) for when these situations arise. 4.8 Section 135(2) Warrant If entry to private residence is necessary and entry is prevented then a warrant under section 135(2) is required (Appendix 8). With respect to patients AWOL from in-patient wards, it should be a qualified Registered Mental Nurse (or other suitably qualified professional) from the hospital site who ideally knows the patient and his or her circumstances that attends court. This may include CTO patients who are AWOL after being returned to the ward and patients who have absconded from a hospital based place of safety. However, community based staff may be available and may often be better placed to assist with these instances. To execute a section 135(2) warrant (Appendix 9) a police constable must be accompanied by either a registered medical practitioner or by any other person authorised by or under this Act as outlined above. In practice, it will often be the same professional who applied for the warrant at court who accompanies the police but this need not be the case. The patient may be taken into custody and returned to the hospital from any other part of the UK, the Channel Islands or the Isle of Man – see Section 88 of the Mental Health Act 1983.

http://www.legislation.gov.uk/ukpga/1983/20/section/88

http://www.legislation.gov.uk/ukpga/1983/20/section/88



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Section 135 (2) warrants pertaining to premises in Wolverhampton must be applied for at Wolverhampton City Magistrates Court. If the premises are not located in Wolverhampton advice will need to be sought as an application would need to be made to the magistrate’s court covering that area. For Sandwell premises Walsall or Dudley Magistrates Court will be used (from September 2016) and a similar process as above.

4.9 Time Limits for Returning a Patient who has Gone AWOL Any patient detained under section 5(4), 5(2), 2, 4 may not be returned to the hospital after the expiration of the section. The only exception to this would be if the Section 2 has been extended by virtue of Section 29 (application to the County Court to displace the nearest relative). Patients detained under Section 3/ 37 can be returned up to 6 months after going AWOL or until the expiry date of the section they are detained on. The later date of the above two will be the relevant date. If at the time the patient goes AWOL, the new period of renewal under Section 20 has not commenced, the renewal is ignored and the 6-month rule applies. For a patient who is returned within 28 days or less – the section continues to run until the expiration of section (unless the patient returns during the last week of the order and the section has less than 7 days to run or if the section has expired) (see 4.9.2). Patients subject to restrictions set out by the Ministry of Justice, who go AWOL, can be returned to hospital at any time. 4.9.1 Action to be Taken when the Patient is Returned to Hospital On return to hospital the Nurse in Charge must assess the patients’ mental state and alter observation levels if required (see Clinical Observation Policy). The nurse in charge of the ward must:

Inform the RC (Out of Hours – On call RC) of the patients’ return to hospital

Inform the police (101), nearest relative, carers (if appropriate) and all other professionals involved at the earliest opportunity of the patients return to hospital

Inform the Mental Health Act Administration office The Nurse in Charge assessment will take into consideration the following aspects of patients care and current presentation:

Current mental state

Time without medication

Current level of risk

Level of observation required

Specific care needs, e.g. PICU services, suspension of leave etc.

In more serious incidents involving high-risk patients these may be investigated as a Serious Untoward Incident (SUI)

All relevant information obtained from interview will be carefully considered by the clinical team and will formulate the assessment of future risk and any changes needed to the care plan.



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All information must be documented within the patients care records. 4.9.2 Section 21A Special Provisions for Patients AWOL for 28 days or Less The authority for detention simply continues until the expiry of the section for patients who have returned or been brought back to hospital. If the patient is on Section 2, 3/ 37 and returns during the last week of their period of detention and the section has less than 7 days to run or if the authority has expired, then Section 21 extends it by up to seven days beginning with the day of their return to hospital. The RC may examine the patient and if they are on Section 3/ 37, if appropriate, furnish a renewal report (S20 Form H5). If a report is furnished and dated after the expiry of the section, the report is retrospective in that it is treated as if it had been furnished on the final day of section. If the patient is on Section 2 the RC may use the 7 day period to complete their assessment under Section 2 and, if appropriate, make a recommendation for detention under Section 3. A patient absent for more than 28 days is liable to be returned for up to six months beginning from the first day of AWOL. This means that a patient can be taken into custody and brought back to hospital even after the section expires so long as it is within the six month permitted period.

Once returned, the patient remains liable to detention or guardianship for 7 days beginning on the first day of their return. During this period, the RC must examine the patient to determine whether the conditions are met for continued detention. The RC must discuss with other professionals the reasons for continuation of detention and inform the patient of their decision. If the RC does not see the patient within 7 days the section will lapse at midnight on the 7th day and the patient ceases to be liable to be detained even though the original section expiry date may not have been reached. If the patient returns to hospital within the final 2 months of the original detention (excluding the last 7 days of detention) the section can be renewed under Section 21B(7) using a form H6 rather than the form H5, this avoids the need for 2 reports for renewal of authority. Under Section 128 of the Mental Health Act 1983 it is an Offence to Induce or Knowingly Assist a Detained Patient to be AWOL. Section 18 does not give power to return a patient who has left the UK.

4.10 Media

The Police have responsibility for the missing person enquiry and will decide whether media involvement will assist or hamper the enquiry. A decision to use the media will only be made after consultation between the Police, the Chief Executive of the Trust, the Patient’s Responsible Clinician and the patients/ family/ carers. Where media publicity is required, the Trust Head of Communications will coordinate this. Where a person is to be publicised through the media every effort will be made by the person in charge of the process to inform the nearest relative.

http://www.mentalhealthlaw.co.uk/media/Form_H5_section_20_-_renewal_of_authority_for_detention.pdf

http://www.mentalhealthlaw.co.uk/media/Form_H6_section_21B_-_authority_for_detention_after_absence_without_leave_for_more_than_28_days.pdf



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4.11 Debriefing and Learning Lessons from Incidents of Absence

The Trust is expected to learn from incidents of absence and ensure that incidents are reported and investigated. 4.11.1 Debriefing A debriefing with the patient and discussion related to the patient absconding or not returning from leave should take place and the outcome documented in the patients’ notes. This meeting will assist the team to:

Understand as far as possible the patient’s rationale for absconding or not returning within the time frame

Share information as to the whereabouts of the patient whilst absent, contact they may have had with carer/ family/ friends. This will be helpful information for any future episodes

Review practices within the clinical area in analysing how this event could have been avoided

Review inter-agency working procedures between services involved e.g. trust staff, police

Identify lessons learnt in order to minimise or prevent similar events re-occurring and to adjust practice and procedures accordingly

4.11.2 Learning Lessons

All incidents of absconding or AWOL will be reported as incidents via the incident reporting system Datix

Serious incidents arising from absconding or AWOLs will be investigated in line with Incident Reporting - Standard Operational Procedure 2 (SOP 2) Reviewing and Investigating an Incident

Patterns and trends of absconding and AWOL will be analysed and reported through the quarterly Serious Untoward Incident (SUI) report and annual incident report

Group Quality and Safety Groups are responsible for monitoring inpatients who go missing or absent without official leave from inpatient areas within their Group

The results can inform or improve current practice in a variety of ways and below are some examples of the different forms this may take:

- Policy review - Review of training analysis needs

Individual areas are also able to conduct their own monitoring and analysis of these incidents by making requests to the Datix administrator for feedback reports from the Datix system

Trust wide learning from analysis of incident data or from investigation reports will be disseminated in the Report and Lessons Learnt Bulletins

5.0 Procedures connected to this Policy

AWOL - SOP 01 - Identification Checks for Patients returned to the ward by a Third Party

Please see SOP for checks to be completed when patient is returned to the ward by third party

6.0 Links to Relevant Legislation

Mental Health Act 1983 (as amended by the Mental Health Act 2007)



18

The Mental Health Act (2007) amended the Mental Health Act (MHA) of 1983. The main purpose of the legislation is to ensure that ‘people with serious mental disorders, which threaten their health or safety or the safety of other people can be treated irrespective of their consent where it is necessary to prevent them from harming themselves or others’. The amended act introduced:

A new broad definition of ‘mental disorder’ to encompass ‘any disorder or disability of the mind’

An ‘appropriate treatment test’, preventing patients from being compulsorily detained unless appropriate medical treatment is available

Community Treatment Orders to supervise the treatment of certain patients in the community

New safeguards including a provision for Independent Mental Health Advisors to provide information and help people understand and exercise their rights

New roles to replace the roles of approved social worker and responsible medical officer

Provision for powers to reduce the time limits for the automatic referral of some patients to the Mental Health Review Tribunal

Mental Capacity Act 2005 The Mental Capacity Act provides a statutory framework to empower and protect vulnerable people who are unable to make their own decisions. It aims to ensure that people are given the opportunity to participate in decisions about their care and treatment to the best of their capacity. It covers all aspects of health and social care. The Act creates a new statutory service, the Independent Mental Capacity Advocate (IMCA) Service. Its purpose is to help vulnerable people who lack mental capacity who are facing important decisions about serious medical treatment and changes of residence. The Act also created a new criminal offence of Ill treatment or neglect of a vulnerable adult. 1 April 2009 saw the implementation of the Deprivation of Liberty Safeguards under the Mental Capacity Act. These safeguards were created to create legal protection for adults who lack capacity to consent to care or treatment in a hospital or care home and that care or treatment constitutes a deprivation of their liberty. These safeguards are not an alternative to the Mental Health Act but instead provide a legal framework for people who cannot legally be made subject to the Mental Health Act (i.e. they are not eligible for some reason). Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) These regulations introduce the new fundamental standards, which describe requirements that reflect the recommendations made by Sir Robert Francis following his inquiry into care at Mid Staffordshire NHS Foundation Trust. They enable the Care Quality Commission to pinpoint more clearly the fundamental standards below which the provision of regulated activities and the care provided to people must not fall, and to take appropriate enforcement action where we find it does. Part 3 has two sections: Section 1 describes the requirements relating to persons carrying on or managing a regulated activity.



19

Section 2 introduces the fundamental standards below which the provision of regulated activities and the care people receive must never fall. They came into force for all health and adult social care services on 1 April 2015.

Regulation 8: General Regulation 9: Person-centred care Regulation 10: Dignity and respect Regulation 11: Need for consent Regulation 12: Safe care and treatment Regulation 13: Safeguarding service users from abuse and improper treatment Regulation 14: Meeting nutritional and hydration needs Regulation 15: Premises and equipment Regulation 16: Receiving and acting on complaints Regulation 17: Good governance Regulation 18: Staffing Regulation 19: Fit and proper persons employed Regulation 20: Duty of candour Regulation 20A: Requirement as to display of performance assessments Data Protection Act 1998 The Data Protection Act 1998 became law in March 2000. It sets standards that must be satisfied when obtaining, recording, holding, using or disposing of personal data. The law applies to data held on computers or any sort of storage system, including paper records. There are 8 enforceable principles of good practice. Data should be:

Fairly and lawfully processed

Processed for limited purposes

Adequate, relevant and not excessive

Accurate

Not kept longer than necessary

Processed in accordance with the data subject's rights

Secure

Not transferred to countries outside the European Economic Area (EEA), without adequate protection

Freedom of Information Act 2000 The Freedom of Information (FOI) Act gives a general right of access to all types of recorded information held by public authorities, including NHS Trusts. The Act also sets out exemptions to that right and places certain obligations on public authorities. In addition to providing information when asked to do so, FOI also requires public authorities to be proactive in the release of information. Every public authority is required to adopt and maintain a publication scheme setting out how it intends to publish the different classes of information it holds, and whether there is to be a charge for the information disclosed. The Trust’s FOI publication scheme is regularly updated and has been approved by the Information Commissioner

6.1 Links to Relevant National Standards



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CQC Regulation 17: Good Governance The intention of this regulation is to make sure that providers have systems and processes that ensure that they are able to meet other requirements in this part of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Regulations 4 to 20A). To meet this regulation; providers must have effective governance, including assurance and auditing systems or processes. These must assess, monitor and drive improvement in the quality and safety of the services provided, including the quality of the experience for people using the service. The systems and processes must also assess, monitor and mitigate any risks relating the health, safety and welfare of people using services and others. Providers must continually evaluate and seek to improve their governance and auditing practice. In addition, providers must securely maintain accurate, complete and detailed records in respect of each person using the service and records relating the employment of staff and the overall management of the regulated activity. As part of their governance, providers must seek and act on feedback from people using the service, those acting on their behalf, staff and other stakeholders, so that they can continually evaluate the service and drive improvement. When requested, providers must provide a written report to CQC setting out how they assess, monitor, and where required, improve the quality and safety of their services.

6.2 Links to other Key Policies

Clinical Risk Management Policy This policy is intended to guide practitioners who work with service users to manage the risk of harm. It sets out the principles and standards required that should underpin best practice across all health settings, and describes the tools that are used to structure the often complex clinical risk management process. Incident Reporting Policy The purpose of this policy is to make clear the system used for reporting incidents involving patients, staff and others undertaking activities on behalf of the Trust. Clinical Observation Policy The purpose of this policy is to make clear the standards expected of clinical staff for the observation and engagement of patients, and to provide them with direction and guidance for making decisions about observation levels including reviews, carrying out observations, correct completion of documentation and their training requirements. Health Records Policy This policy is intended to be a comprehensive guide to all staff involved in the handling of health records and the associated documentation providing a framework for consistent and effective record management enabling the Trust to ensure that there is a systematic and planned approach to the management of health records, from the moment the record is created until their ultimate disposal.



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Supervision Policy This policy defines and describes four types of supervision in use within the organisation:

Clinical Supervision

Managerial Supervision

Professional Supervision

Safeguarding Children Supervision Through defining and outlining standards and practice within these four types the policy seeks to inform both the delivery of these models and the development of local guidance and procedures for the delivery of all other forms of supervision in use within the Trust and to make clear:

The expectation of the Trust in relation to clinical supervision, managerial supervision, professional supervision and safeguarding children supervision

The roles and responsibilities within all supervision arrangements

The process for monitoring that all staff receive the appropriate supervision for their role

Record Keeping Standards (Clinical) - SOP 01 - Patient Identification The Trust takes the safety of service users seriously. The correct identification of service users is a priority in making sure that clinical and record keeping aspects of the service promote and ensure that mistakes are reduced and even eliminated. This SOP sets out the trusts decision to use photographs as the primary method of identification for people using inpatient services. The trust requires the use of wristbands as a secondary method. This does not replace the requirement to ask the Service User their name and date of birth.

6.3 References

Jones, R. (2015) Mental Health Act Manual (18th Edition) S.18

Department of Health, Code of Practice- Mental Health Act 1983 – 2008, Chapter 28 (2015)

Department of Health, Reference Guide to the Mental Health Act 1983 – Paragraphs 12.57 to 12.89, 15.66 to 15.96

Article 8 of the European Convention on Human Rights ACT 2003

Care Quality Commission (2014) Guidance for providers on meeting the fundamental standards and on CQC’s enforcement powers

NHS Resolution - Trust providing Acute, Community, or Mental Health & Learning Disability Services and Non-NHS providers of NHS Care



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7.0 Roles and Responsibilities for this Policy

Title Role Key Responsibilities

Nursing Staff Adherence - Ensure they are familiar with the policy and be responsible for adhering to the procedures referred to within the policy

- Attend training applicable to their role - Promote the well-being and dignity of the patient at all times

- Implement strategies and innovations to minimise the number of inpatients going absent, absent without leave or missing

in accordance with the procedures referred to in this policy - Inform the Nurse in Charge or Ward Manager of any circumstances that they become aware of which might contribute to

an inpatient potentially going missing or absent without official leave

Governance Assurance

Unit

Governance - Ensure investigations of serious incidents arising from absconding or AWOLs are investigated in line with Incident Reporting

- Standard Operational Procedure 2 (SOP 2) Reviewing and Investigating an Incident

- Maintain the Trust’s Datix (Trust’s reporting system) of detained in-patients who go absent without official leave - Analyse and report patterns and trends of absconding and AWOL through the quarterly Serious Untoward Incident (SUI)

report and annual incident report - Notify the Care Quality Commission of all AWOLs (detained patients) if they are resident in a PICU or secure ward within

24hrs and if on a general psychiatric ward if they have been AWOL after midnight on the day the AWOL commenced

- Contact the person in charge/ Ward Manager/ Team Leader to enable completion of the CQC form - Liaise with ward staff/clinicians and Approved Mental Health Practitioners as necessary

- Provide guidance to clinical staff of action necessary to ensure compliance with appropriate legislation in relation to missing service users

- Facilitate and disseminate any learning identified from AWOL incidents through the quarterly Lessons Learnt bulletin

Nurse in Charge Operational - Decide when inpatients should be classified as missing or absent without official leave in accordance with the procedures referred to in this policy

- Co-ordinate searches for any inpatients going missing or absent without official leave in accordance with the procedures referred to in this policy

- Liaise with other agencies e.g. police as necessary

- Notify Senior Managers, directors as appropriate - Report all incidents of inpatients going missing or absent without official leave in accordance with the procedures referred

to in this policy

Medical Team (Consultant Psychiatrist

and Responsible Clinicians)

Assessment and Treatment

- Undertake the necessary assessments of the mental and physical health of the patients - Formulate the appropriate treatment plan in consultation with the wider multidisciplinary teams

Service Managers and Ward Managers

Implementation - Ensure they are familiar with this policy and be responsible for adhering to the procedures referred to - Ensure staff attend training applicable to their role and for implementing the guidance across their areas of responsibility

- Ensure risk assessments for inpatients with absconding histories or risk assessed as at risk of absconding are carried out and plans are put in place to minimise them

- Ensure all incidents of inpatients going absent, absent without leave or missing are reported



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Title Role Key Responsibilities

Group Directors and

General Managers

Leadership - Ensure that all Managers are aware of the policy and promote good practice

- Provide support and guidance regarding resources to enable this policy to be implemented - Implement strategies to minimise the number of inpatients going missing or absent without official leave are implemented

in accordance with the procedures referred to in this policy

Clinical Directors Leadership - Ensure that appropriate and robust systems, processes and procedures are in place for inpatients who go missing or absent without official leave from inpatient areas within their Group

- Oversee the completion of reports and audits and subsequent action plans in respect of this issue

- Lead discussions on reports, audits and data received at Group Quality and safety Group meetings - Provide updates on inpatients who go missing or absent without official leave from inpatient areas within their Group

Quality and Safety Group meetings

Group Quality and

Safety Groups

Monitoring - Monitor inpatients who go missing or absent without official leave from inpatient areas within their Group

- Ensure all incidents of inpatients who go missing or absent without official leave from inpatient areas are reported via

Datix, the Trust’s incident reporting procedure and monitored on a case by case basis within each Group - Ensure a report of all incidents is discussed at monthly meetings of each Group Quality and safety Group

- Receive the results and recommendations of all related completed clinical audits and be responsible for monitoring action plans to implement changes to current practice until completion

Quality and Safety

Steering Group

Scrutiny and

Performance

- Ensure that appropriate and robust systems, processes and procedures are in place for inpatients who go missing or absent

without official leave from inpatient areas and oversee the implementation of this - Provide exception and progress reports to Quality and Safety Committee

- Ensure processes and procedures are managed efficiently and effectively in accordance with the Board’s Assurance Framework and strategic priorities

Trust Board Strategic - Have a strategic overview and final responsibility for overseeing there are appropriate and robust systems, processes and

procedures are in place for inpatients who go missing or absent without official leave from inpatient areas across the Trust

Executive Director of Nursing, AHPs and

Governance

Executive Lead - Ensure that appropriate and robust systems, processes and procedures are in place for inpatients who go missing or absent without official leave

- Lead on strategies and innovations to reduce the number of inpatients missing or absent without official leave

- Ensure that any serious concerns regarding the implementation of this policy are brought to the attention of the Board

Chief Executive Accountable - Ensure that this policy is implemented within the Trust (operational responsibility has been delegated)



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8.0 Training

What aspect(s) of this policy will

require staff training?

Which staff groups require this

training?

Is this training covered in the Trust’s Mandatory & Specialist Mandatory

Training Needs Analysis document?

If no, how will the training be delivered?

Who will deliver the training?

How often will staff require

training

Who will ensure and monitor that staff have

this training?

Use of Section 17 and Section 18

Mental Health Act

1983

Doctors and Qualified Nursing

Staff

No, staff will receive specific training in relation to this

policy where it is identified in

their individual training needs analysis as part of their

development for their particular role and

responsibilities

Internally Mental Health Act/Capacity Advisors

When required Learning and Development Team

9.0 Equality Impact Assessment Black Country Partnership NHS Foundation Trust is committed to ensuring that the way we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group. The Equality Impact Assessment for this policy has been completed and is readily available on the Intranet. If you require this in a different format e.g. larger print, Braille, different languages or audio tape, please contact the Equality & Diversity Team on Ext. 8067 or email [email protected] 10.0 Data Protection and Freedom of Information

Data Protection Act provides controls for the way information is handled and to gives legal rights to individuals in relation to the use of their data. It sets out strict rules for people who use or store data about individuals and gives rights to those people whose data has been collected. The law applies to all personal data held including electronic and manual records. The Information Commissioner’s Office has powers to enforce the Data Protection Act and can do this through the use of compulsory audits, warrants, notices and monetary penalties which can be up to €20million or 4% of the Trusts annual turnover for serious breaches of the Data Protection Act. In addition to this the Information Commissioner can limit or stop data processing activities where there has been a serious breach of the Act and there remains a risk to the data. The Freedom of Information Act provides public access to information held by public authorities. The main principle behind freedom of information legislation is that people have a right to know about the activities of public authorities; unless there is a good reason for them not to. The Freedom of Information Act applies to corporate data and personal data generally cannot be released under this Act. All staffs have a responsibility to ensure that they do not disclose information about the Trust’s activities; this includes information about service users in its care, staff members and corporate documentation to unauthorised individuals. This responsibility applies whether you are currently employed or after your employment ends and in certain aspects of your personal life e.g. use of social networking sites etc. The Trust seeks to ensure a high level of transparency in all its business activities but reserves the right not to disclose information where relevant legislation applies.

mailto:[email protected]

http://simple.wikipedia.org/wiki/Information

http://simple.wiktionary.org/wiki/right



25

The Information Governance Team provides a central point for release of information under Data Protection and Freedom of Information following formal requests for information; any queries about the disclosure of information can be forwarded to the Information Governance Team. 11.0 Monitoring this Policy is Working in Practice

What key elements will be monitored?

(measurable policy objectives)

Where described in

policy?

How will they be monitored?

(method + sample size)

Who will undertake this

monitoring?

How Frequently?

Group/Committee that will receive and

review results

Group/Committee to ensure actions

are completed

Evidence this has

happened

Clinical Directors, Quality and

Safety Groups, Service Managers and Ward

Managers are discharging

their responsibilities in respect of AWOL/missing

persons

7.0 Roles and

Responsibilities for this Policy

Monitoring of all incidents

of AWOL/ missing persons through Group

Annual Audit Programmes

and action plans to completion

Ward Managers Monthly Quality and Safety

Steering Group

Quality and Safety

Steering Group

Minutes of

meetings/ monitoring

templates/

action plans signed off

What should be done when a patient absents themselves

from an inpatient setting

4.2 Procedure for When a

Patient Absents Themselves

A report of all incidents relating to AWOL/ missing

persons reported via Datix - AWOL/ missing persons

monitored on a case by case basis within

each Group

Governance Assurance Unit

Monthly Quality and Safety Steering Group

Quality and Safety Steering Group

Minutes of meetings/

Datix incident resolved

7.0 Roles and

Responsibilities for this Policy

Detailed review of

practice will be audited to review whether

procedures and roles and responsibilities have been

adhered to in accordance with the policy

Ward Managers Monthly Group Quality and

Safety Steering Groups

Group Quality and

Safety Steering Groups

Minutes of

meetings/ monitoring

templates/ action plans

signed off



26

What key elements will be monitored?

(measurable policy objectives)

Where described in

policy?

How will they be monitored?

(method + sample size)

Who will undertake this

monitoring?

How Frequently?

Group/Committee that will receive and

review results

Group/Committee to ensure actions

are completed

Evidence this has

happened

What should be done when a

patient fails to return from a period of leave of absence

4.4 Procedure

for when a Patient does not

Return from

Leave

A report of all incidents

relating to AWOL/ missing persons reported via Datix

- AWOL/ missing persons

monitored on a case by case basis within

each Group

Governance

Assurance Unit

Monthly Quality and Safety

Steering Group

Quality and Safety

Steering Group

Minutes of

meetings/ Datix incident

resolved

7.0 Roles and Responsibilities

for this Policy

Detailed review of practice will be audited

to review whether procedures and roles and

responsibilities have been

adhered to in accordance with the policy

Ward Managers Monthly Group Quality and Safety Steering

Groups

Group Quality and Safety Steering

Groups

Minutes of meetings/

monitoring templates/

action plans

signed off

How the organisation learns

from AWOL incidents

4.11.2 Learning

Lessons

Patterns and trends of

absconding and AWOL

will be analysed and reported through the

Serious Untoward Incident (SUI) report

Governance

Assurance Unit

Quarterly

Quality and Safety

Steering Group

Quality and Safety

Steering Group

Minutes of

meetings

Incident Report

Governance Assurance Unit

Annually



Minutes of meetings

Lessons Learnt Bulletin Governance

Assurance Unit Quarterly Quality and Safety

Steering Group

Quality and Safety

Steering Group

Minutes of

meetings



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Appendix 1

Strategies to Reduce Incidents of Missing Patients

Strategies involve posing six critical questions:

Who is going missing i.e. same patients repeating or wide spread of patients?

From where are they going missing?

How are they managing to leave unnoticed?

At what times are they leaving?

Are they leaving without staff knowledge?

Can procedures ward routines/ escort arrangements/ occupational activity etc. be improved to reduce the number of inpatients going missing?

Risk Assessments Each service user upon admission should have a comprehensive clinical risk assessment undertaken where consideration is given to the risk of absconding and the arrangements needed to detain. Research shows the main predictors for patients at risk of absconding may be within the first two-three weeks of admission. Risk assessments need to consider these evidence-based predictors as part of the clinical risk assessment as the more predictors presented, the higher the risk of absconding. However, these predictors are not exhaustive and staff will need to be vigilant at all times and be prepared to re-assess the risk of absconding as and when needed. Risk assessments need to be recorded clearly in the clinical records with care planning reflecting assessed needs and clearly stating the arrangements in place for any restrictions on the patient's movements. A patient’s movements must be discussed, fully explained and shared with the patient, as part of the care plans and arrangements put in place with the patient receiving a copy. For degree of harm/ categories of risk and associated actions see Appendix 5. Developing Entry and Exit Procedures Staff teams should identify workable systems that allow for the monitoring of patient’s movements to and from the ward, identify agreed exits and commission recording methods. This should involve: Development of locked door protocols for each site Patients being made aware of why such protocols, policies and checks are

required, including reasons why there are any restrictions on leave (MHA identified risk concerns may necessitate some patients being denied leave)

Follow site policies Involving Patients in their Care Planning Patients should be involved in their care planning and be given as much choice and responsibility as possible in how, what and where they engage in expected interventions, this includes: Ensuring the patient knows why they have been admitted Ensuring regular engagement with their primary nurse Ensure regular 1:1 engagement with patient to ensure concerns, requests are

communicated and that this is evidenced



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Risk assessing mental state prior to leave and document Providing ‘protected time’ for patients to ensure quality engagement In addition, research shows that patients often leave mental health units because they feel trapped and claustrophobic or disinterested and bored whilst on unit. Structured days provide patients with the opportunity to engage in meaningful and therapeutic activity, this can be achieved by:

Positively promoting activities and encouraging patients to take part and staff involvement. Demonstrating that nursing staff value the initiative as well as gaining time to build up a therapeutic alliance with patients

Identifying the patients' interests and needs in order to identify a suitable activity or therapeutic programme (in liaison with MDT professionals)

Regular patient meetings, where patients are encouraged to attend

Ensure that activities outside of normal working hours 9-5 are available (evening and weekends)

Review activity programmes on regular basis utilising patient views

Every detained patient who does not have unescorted leave granted must be offered time each day for recreational purposes such as taking escorted leave outside the building or going to the local shops if such activities are consistent with Multidisciplinary Team plan and Section 17 leave. Restricted movement is the greatest source of frustration for detained, acute inpatients and occupational/ recreational activities can help to offset this

Application of Holding Powers Occasionally, staffs are faced with difficult moral dilemmas when an informal patient assessed as having capacity leaves the ward with clear intentions to harm themselves or to harm others. Unless the nurse believes that the criteria are met for the nurse to prevent the patient from leaving hospital under the nurses holding power [section 5(4)], there are no statutory powers to prevent the patient from leaving, and staff must then rely on their professional judgement and understanding of common law, Human Rights Act and the Mental Health Act. Example The Code of Practice to the Mental Health Act states that: “In an emergency, where it is not possible immediately to apply the provisions of the Act, a patient suffering from a mental disorder which is leading to behaviour that is an immediate serious danger to him or herself or to other people may be given such treatment as represents the minimum necessary response to avert that danger.” This is covered by common law as “urgent treatment” In such circumstances staff would be acting responsibly by returning the patient to the ward, thus alleviating the assessed danger. On the return of the patient to the ward, the nurse in charge should request an urgent assessment under the Mental Health Act.



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Appendix 2

Gerry Simon Procedures for Restricted Patients

All AWOL patients on Restriction Orders should be reported to Governance Assurance Unit for onward reporting to:

Care Quality Act Commission within 24 hours

Specialised Commissioning Team (West Midlands) SCT (WM) for patients missing above 24 Hours

Informing the Ministry of Justice The Ministry of Justice will be contacted via telephone within 24 hours regarding any AWOL of restricted patients by the responsible Clinician in that this will apply to Gerry Simon Clinic patients only. Contacts During Working Hours 9.00 – 5.00 – contact case worker via Dr Vella’s secretary on ext. 8425. Senior Caseworker (SEO) – responsible overall for detained patients

Patient surname

Allocated to Tel. 020 7035

Fax Line Manager

A - GK Alison Gallagher

1493

B

Laura Toze (A – Ch) Bernard Bennet-Diver (Ci–GK)

GI – Nif Greg Nanda 1486 C Sarah Denvir (GI – Ket) Nina Shuttlewood (Keu – Nif)

Nig - Z Andrew Sansom

1450

A

Lindsay McKean (Nig – Smith G) Chris Kemp (Smith H – Z)

Outside Working Hours Telephone Main Switchboard on 020 7035 4848 and leave a message. Only ask to speak to ‘On-Call’ staff if the AWOL involves a ‘High’ profile patient, or if the AWOL will attract media attention. Alternatively/additionally leave a message on the voicemail of the appropriate Senior Caseworker. They will contact the Trust on the next available working day. A written report by the Responsible Clinician, outlining the summary of events, will be required within 48 hours. Details required in telephone call and summary report will be as follows:

Name of patient

Date and Time of AWOL

Detaining Ward/Hospital

Detaining Order (i.e. S37/41)

Whether Conditionally Discharged

Brief details of AWOL (i.e. was patient on ground leave)

Date of Return (if known)

https://www.justice.gov.uk/contacts/noms/mental-health-unit



30

When and how police were informed

If media will be involved

If there are any victim issues (i.e. should any previous victim be informed or

alerted of AWOL)

Should the events lead to a Trust internal enquiry, (Critical Incident Review), then the Ministry of Justice will need to be informed and would require a full report when available. If the patient is detained at the Gerry Simon Clinic the full report would also go to the Specialised Commission Team West Midlands.



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Appendix 3

Patient AWOL Flowchart

AWOL Incident: Is the Patient detained under the MHA?

Initiate ward / unit / ground search

Inform Police Duty Desk and let them know:

Patients risks

That the patient is detained under MHA and is AWOL

Provide a name and contact number for the ward/unit for the police to obtain more information

Location of patient if known or suspected

Complete Risk Assessment and Datix Incident

Complete the AWOL monitoring form

Discuss and review options with M.D.T, Responsible Clinician to arrange return to hospital/ domiciliary visit

If agreed by RC; start procedure of obtaining a S.135(2) warrant

Nursing staff /police have no legal power to enter property and remove a person unless the nurse has section 135(2) warrant

When a detained patient has not returned from leave, has been recalled from leave (or CTO) or leaves the ward without permission, the patient is

AWOL

Inform: RC (duty RC out of hours) Senior/ On Call Manager

Governance Assurance Unit All other involved professionals

Document all actions and rationale within patient records

YES Mental Health Act Section 18 Absent Without Official

Leave

NO Informal Patients- Missing Person Flowchart

(Appendix 4)

Attempt to contact Patient via known contact details (if appropriate) to establish current location and if possible

organise arrangements for their safe return (consider previous AWOL destinations)

Inform nearest relative unless there are clear reasons for

not doing so



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Appendix 4

Informal Patients- Missing Person Flowchart

Informal patient missing

Conduct immediate search of hospital

Contact other clinical areas with patient description and contact number to call if patient seen. Complete

Missing person form Appendix 6 if required

Attempt to contact patient first.

If no response contact known numbers e.g. family, friends

Patient known to be safe/ sheltered

YES NO

Complete Risk Assessment

Establish degree of harm (Appendix 5)

Follow degree of Harm and Notification procedure

(Appendix 5)

Identify any known risks

Treat as Missing Person



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Appendix 5

Missing Patient Reporting Form

PATIENT REPORTED MISSING Name ……….…………………………………………………………… DOB ……………………… Address ……………………………………………………………………… Post Code ..…………….. Ward …….. …………………………………………………………………MHA Section …………… Date Missing………………………………………………..Time Missing ……………………………… Local search Completed Yes No If no reasons why ............................ ......................................................................................................................................... RISK CATEGORY: HIGH MEDIUM LOW RATIONALE Detention under the Mental Health Act 1983 Risk to self and others

Individual is AT risk form others Other (specify) …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… PATIENT KNOWN FOR REPEATED MISSING STATUS ? No Yes Please give details

…………………………………………………………………………………………………………… …………………………………………………………………………………………………………… PATIENT CHARACTERISTICS (Including height, weight, build, distinguishing features, etc.) …………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………….. NOTIFICATION OF PERSON MISSING BY NAME ………………………………………Designation …………………………………… SIGNED …………………………………… Time / Date …………………………………… PATIENT FOUND AND RETURNED CIRCUMSTANCES OF RETURN FOUND BY ………………………………… ………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… NAME …………………………… DESIGNATION …………………………………… SIGNED ……………………………………… Time / Date ……………………………………….



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Appendix 5.a 12 risk based questions that the initial Police call taker may ask. 1) Is this significantly out of character; have they done this before? If yes, when was the last time? 2) Have you been in contact with this person, do you know their whereabouts and is there a time you expect them to return? 3) Do you know their intended actions when last seen and have you done anything to locate them? 4) Do you know who are they with? 5) Is this person a danger to themselves or others? 6) Does this person have any specific medical needs; do you have a list of their medication? Is there a care plan in place? 7) Is this person likely to self-harm or attempt suicide? 8) Is this person likely to be subjected to harm or a crime? 9) Is this person a victim of abuse and/or at risk of sexual exploitation? 10) Is this person being looked after or supported by any Children’s or Adult Services? 11) Prior to this report was the person displaying any behaviours or actions you consider out of the ordinary or cause for concern? E.g. Increased use of technology, unexplained gifts/money. 12) Are there any other specific concerns or can you offer any other significant information at all?

Please note that these questions do not always apply / are necessary and the person making the report must not think that they need to answer these questions prior to phoning the police, especially when it is clearly evident that the person is in danger. What is also useful, is whether the missing person has a mobile phone (and the telephone number), any telephone numbers for family/friends, whether the person is in possession/has access to any money and if they have a bus pass.



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Appendix 6

Local Search Guidelines

Prior to commencing the local searches staff must ensure that the safety of other service users is maintained. They must also ensure that they maintain their own safety and that of other staff by informing all areas on site. A search area may be specifically denoted as being unsuitable to be searched by a lone member of staff. However, for all search areas due care and consideration should be given to the time, weather, knowledge of service user, to determine the level of staff required to conduct a safe search.

Pond Lane Before the commencement of a local search, the Senior Inpatient Nurse (Nurse in Charge), will ensure the safety of all service users is fully maintained. The safety of staff will also be maintained at all times. The level of care needed by inpatient service users will be the determining factor in identifying the number of staff allocated to the search. The local search of Pond Lane should include:

All internal unit areas including all bedrooms, all living and communal areas plus other accessible rooms (e.g. office, staff toilet)

Community reception and non-key activated office area

Main reception area

The immediate grounds and external rear garden

Car Park and outside space (near to Bungalow A, B, HealthTech site and Renal Unit)

Renal Unit reception area

Pond Lane and Pond Grove In addition, it may be appropriate to contact sites that the patient is known to Attend. Penn Hospital The local search of Penn Hospital should include:


Main car park

Garden and bushes to the side and rear of Jasmine

Garden and bushes to the side and rear of Juniper

Garden and bushes to the side of The Beeches adjacent to Penn Road

Car park near The Beeches

Rear gravel car park and fenced skip area

Rear of main building

The section of road that runs adjacent to the front of Penn hospital (bus stop) NOTE: It is impractical to search the wooden area to the rear of the hospital bordering The Avenue In addition, it may be appropriate to contact sites that the Service User is known to attend, e.g. local pubs.



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Hallam Street Hospital The local search of Hallam St. Hospital should include:

All internal unit areas including all bedrooms, all living and communal areas plus

other accessible rooms (e.g. office, staff toilet)

Main car park

Garden and bushes in front of main car park bordering Dagger Lane

The front garden area of Abbey, Friar and Charlemont, Larches and Pines

Alley way leading to Dagger Lane

Bin area to the side of the Resource Centre

Car park at rear of Resource Centre

Bus stop on Hallam St

Vegetable garden (without entering garden)

A telephone call to Sandwell A&E reception in case patient has turned up there MacArthur - Psychiatric Intensive Care The local search of MacArthur PICU should include:

The immediate grounds and perimeter fences

Car Park and main car park and outside space (this includes areas around Scott House, Tredgold, Cabin and Penrose)

Both entrance and exit to Heath Lane Hospital

Adjacent road to MacArthur (Heath lane) Penrose Unit The local search of MacArthur PICU should include: • The immediate grounds and perimeter fences • Car Park and main car park and outside space (this includes areas around Scott House, Tredgold, Cabin and Penrose) • Both entrance and exit to Heath Lane Hospital • Adjacent road to MacArthur (Heath lane) Gerry Simon Clinic Before the commencement of a local search, the Senior Inpatient Nurse (Nurse in charge), will ensure the safety of all service users is fully maintained. The safety of staff will also be maintained at all times. The level of care needed by inpatient service users will be the determining factor in identifying the number of staff allocated to the search. The local search of Gerry Simon Clinic and Heath Lane site should include:


The immediate grounds and external rear garden and perimeter fences

Car Park and main car park and outside space (this includes areas around Scott House, Tregold, Cabin and Penrose)

Heath Lane NOTE: It may impractical to search the out perimeter area of the hospital In addition, it may be appropriate to contact sites that the patient is known to attend.



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Edward Street Hospital The local search of Edward Street Hospital should include:


Other wards (via contacting the relevant ward managers / Nurse In Charge)

All communal areas, corridors and offices

Main reception area

The immediate grounds around the hospital site

Car park opposite Edward Street Hospital, if practical to do so



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Appendix 7

Degree of Harm - When to Inform Agencies/ Individuals

Degree of harm/ Risk categories - Responsibility Nurse in Charge

HIGH RISK MEDIUM RISK LOW RISK

If Applicable May be subject to detention under the MHA

Not subject to detention

RISK FACTORS Risk to self / others

No risk to self / others

Vulnerable from others

Not vulnerable from others

Agency HIGH RISK MEDIUM RISK LOW RISK

Duty Senior Nurse/ Ward Manager/ Nurse In Charge

Inform immediately

Inform immediately

Inform immediately

Police Inform Immediately and search

Inform after 4 Hours following search

Inform after 12 hours or 9 am next morning following search

Medical Staff Inform immediately: RC or On-call Consultant

Office Hours RC or Consultant ASAP Out of Hours: On call- Junior Doctor Immediately

Office Hours RC or Consultant ASAP Out of Hours: On call- Junior Doctor Immediately

Service Manager On Call Manager

Inform immediately Inform immediately Senior Nurse discretion as to when on call Manager is informed

Nearest Relative/ Next of kin

ASAP within 1 hour of patient missing



Social services (If applicable)

If involved inform at 9 am the next day



GP Inform at 9 am the next day

Inform at 9 am the next day


Care co-ordinator Inform immediately Within 1 hour of patient missing

Within 1 hour of patient missing

Communication Lead (If applicable)

Inform immediately Inform at 9 am the next day

Inform after 48 hours

Clinical Commissioning Group




Datix Incident Form

To be completed within 24 hours

To be completed as soon as practicable

To be completed as soon as practicable



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Appendix 8

Attending Court for a Warrant Section 135(2)

Prior to attending court, the Nurse in Charge will contact the Admin Management Support office staff who will contact the Magistrates court and purchase a S.135 (2) warrant via the Trust purchase card. An authorisation code will be provided by the court and given to the Nurse in charge for quoting when attending the court for the warrant. Those attending the magistrates court to apply for a S.135 (2) must take a completed S.135 (2) magistrates form, copies of which should be kept on each in-patient ward or community team base (copies can also be obtained from the Mental Health Act Administrators). Supporting evidence in written form must also be taken. This should document the legal basis of why the patient is liable to be detained and is to be taken/ retaken (e.g. under S.18). It should also outline why issuing a S.135 (2) warrant would be proportionate in terms of article 8 of the Human Rights Act and detail what attempts have been made to re-take the patient without the use of a warrant. If no attempts have been made, the rationale for seeking a warrant must be clearly documented. Also please note that when the applicant is a staff member based in a community based mental health team, he or she will also need to take a completed authorisation form as this may be requested by the court.

Before entering the court, the applicant should seek out the usher and inform him/ her that they wish to provide evidence to apply for a S.135 (2) warrant under the Mental Health Act. The usher will usually be found in or around the actual court. The usher will inform the court of the intended application and hopefully provide an indication of the likely waiting time. Applications will often be dealt with during the intervals between known cases or at the beginning of each court session. Sessions commence at 10am and 2pm and it can often be time efficient to attend for the start of sessions. However, it is advisable to arrive at least 15 minutes prior to the beginning of a court session. The court reception will be able to direct Nurse/ AHP staff to the court usher who should be available 15 minutes prior to the start of the morning and afternoon court sessions.

Applicants will need to swear on oath or affirm to the court before discussing the application with the magistrates. They are also usually asked to produce a work based identification badge. Generally, applicants are requested to give an overview of the circumstances of the case and a rationale as to why use of a S.135 (2) is necessary. Reference can be made to the written supporting evidence so it is advisable to take at least two copies of this as the magistrates will also need to see this. The magistrates may then ask questions aimed at satisfying whether a warrant appears necessary.

If the magistrates are in agreement with the application, the official S.135 (2) warrant will then be signed off. It can then be executed once during the 3 month period from the date of issue.



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Appendix 9

Execution of the Warrant

Under S.135, it is the police constable that has the authority to enter the premises if need be by force and remove the patient. However, it is the role of the accompanying mental health professional to use their skills and expertise to support the process in the following areas. As it will be a mental health professional rather than a police constable who usually applies for the warrant, it will be he/ she who usually phones West Midlands Police (WMP) on 101 to notify them that a S.135 (2) warrant has been granted and that the police are needed to execute the warrant. During this contact, the police will need to be supplied with the necessary details including what section the patient is subject to and where they will need to be returned. Importantly, they must be given details in relation to potential risks to self and others to inform a risk assessment of what arrangements, in terms of resources (e.g. number of police officers), will need to be made. Every effort should be made to give WMP as much advance notice as possible. The accompanying mental health professional will need to carefully consider what is the most appropriate way of gaining access to the premises when access is not given. Consideration should be given to using keys when these are provided by a relative or private landlord, however, any possible negative consequences of this will need to be weighed in the balance as this is not always the best option. If it is likely that force will be required to open a front door, the Nurse in Charge should contact the Trust estates department to attend with respect to private tenancies or privately owned properties for maintenance staff to initially make secure the damage to the door and at a later date repair the damage. For social housing, contact the organisation as they will often assist by providing their own locksmith (N.B. sometimes they will seek reimbursement for this service). Before attempting to gain access, the involved mental health professional should again provide necessary details to the attending police officers in terms of risk and also discuss potential conveyance arrangements. When there are risks to others, refusal or when the situation cannot wait for an attending ambulance, or Secure Hospital Transport (ERS 03332 404077), conveyance via police transport may be the safest option. However, the least restrictive and safest option should always be elected and this will often result in the police delegating their responsibilities for conveyance to the ambulance service. The situation can also be changeable so what is initially planned in terms of conveyance may not end up being deemed the most appropriate option after the patient has been seen. The accompanying mental health professional will assist the police in encouraging the patient to give access in order to avoid the need to gain access without their consent. When there is no response, they will also assist the police in deciding whether to execute the warrant and open the door without the patient’s consent. There may be indications or sources of information suggesting the patient is inside the premises. However, sometimes it may be concluded their presence seems unlikely and decided to try again at a later time. Due to such potential difficulties, it is advisable to schedule the visit at a time the patient is most likely to be at the



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premises. Wherever possible, execution of a S.135 (2) should take place at a reasonable hour, though when a patient is difficult to locate, there may be a strong rationale to execute a warrant at other times. The accompanying mental health professional also has an important role to perform when the patient is seen at the premises. He/ she should utilise their professional skills to reassure the patient where appropriate and promote the least restrictive but also safe level of intervention. Efforts should be made to avoid interventions such as physical restraint though at times this will be necessary. When this is indicated, the potential impact of restraint upon any physical health conditions will also need to be weighed in the balance and medical advice may need to be sought. Please also note that part 4 or 4a treatment can potentially be administered in exceptional circumstances to facilitate the safe conveyance of patients who are liable to be detained under the Mental Health Act but not for AWOL/ missing S.4, S.5, S.35, S.135, S.136 patients, patients temporarily detained under S.37 or 45a or restricted patients who have been conditionally discharged [see S.56 (3)]. For these patients, any such medical treatment (in exceptional circumstances) would need to be given with consent or under S.5/6 of the Mental Capacity Act (2005). The S.135 (2) Warrant is a triplicate form. The attending mental health professionals should take two copies of the S.135 (2) warrant to the premises. They should give one copy to the police and one copy to the patient. When entry is gained but the patient is not present, a copy should be left in a prominent place ideally with an accompanying note giving some explanation. When locks are changed a note should also be left for the returning patient to advise where the new keys have been left (e.g. with a family member). In choosing where seems appropriate, attending professionals will need to consider issues of confidentiality and consider where the patient may be able to pick up the keys out of hours if need be. Please note that once a S.135 (2) warrant has been executed it cannot be used again and a new application to the court would need to be made. The top copy of the s.136 (2) form should be returned to the court irrespective of whether it is used or not. If there are pets at the property which no family or friends can look after, please contact a locally based boarding Kennels/ Cattery for temporary kennelling prior to attending the property. Depending on the circumstances, there may be a need for accompanying mental health professionals to travel with the patient while he/ she is being conveyed to hospital, however, the value of this will need to be weighed against issues of safety. Otherwise it will normally be the case that accompanying mental health professionals travel back to the hospital in their own transport at the same time as those conveying and aim to be involved in accompanying the patient back on to the hospital site.



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Appendix 10

Form CTO3 Regulation 6(3) (a) - Mental Health Act 1983 (amended 2007)

I notify you, (PRINT name of community patient), That you are recalled to (PRINT full name and address of the hospital) Under section 17E of the Mental Health Act 1983 (amended in 2007). Complete either (a) or (b) below and delete the one which does not apply. (a) In my opinion,

(i) You require treatment in hospital for mental disorder,

AND (ii) There would be a risk of harm to your health or safety or to other persons

if you were not recalled to hospital for that purpose

This opinion is founded on the following grounds: (If you need to continue on a separate sheet please indicate here ( ) and attach that sheet to this form)



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:

(b) You have failed to comply with the condition imposed under section 17B

of the Mental Health Act 1983 (amended 2007) that you make yourself

available for examination for the purpose of:

(Delete as appropriate)

(i) Consideration of extension of the community treatment period under

section 20A

(ii) Enabling a Part 4A certificate to be given.

Signed Responsible clinician PRINT NAME Date / / Time A COPY OF THIS NOTICE IS TO BE FORWARDED TO THE MANAGERS OF THE HOSPITAL TO WHICH THE PATIENT IS RECALLED AS SOON AS POSSIBLE AFTER IT IS SERVED ON THE PATIENT. IF THAT HOSPITAL IS NOT THE RESPONSIBLE HOSPITAL, YOU SHOULD INFORM THE HOSPITAL MANAGERS OF THE NAME AND ADDRESS OF THE RESPONSIBLE HOSPITAL. This notice is sufficient authority for the managers of the named hospital to detain the patient there in accordance with the provisions of section 17E of the Mental Health Act 1983.



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Policy Details

* For more information on the consultation process, implementation plan, equality impact assessment,

or archiving arrangements, please contact Corporate Governance

Review and Amendment History

Version Date Details of Change

2.1 Oct 2019

Policy fully Reviewed with amendments below;

addition of SOP regarding return of patients by third party and Patient are referenced

removal of protocols for local searches for LD services ridge hill, orchard hills/ daisy bank as these areas have been closed

Title of Policy AWOL - Missing or Absent without Official Leave Policy

Unique Identifier for this policy BCPFT-CB-POL-02

State if policy is New or Revised Revised

Previous Policy Title where applicable Management of Inpatients Missing or Absent Without Official Leave (AWOL)

Policy Category Clinical, HR, H&S, Infection Control etc.

Challenging Behaviour

Executive Director whose portfolio this policy comes under

Executive Director of Nursing, AHPs and Governance

Policy Lead/Author Job titles only

Mental Health Matron

Committee/Group responsible for the approval of this policy


Month/year consultation process completed *

n/a

Month/year policy approved November 2019

Month/year policy ratified and issued December 2019

Next review date October 2022

Implementation Plan completed * Yes

Equality Impact Assessment completed * Yes

Previous version(s) archived * Yes

Disclosure status ‘B’ can be disclosed to patients and the public

Key Words for this policy

Section 135(2) warrant, prolonged absence, power for return, responsible clinician, community treatment order patients, section 21A , media, refusal to return, section 17 leave, informal patient, confirmed missing, time limits, debriefing, learning lessons, detained patient, missing patient, supervised community treatment, absconding, initial search



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addition of local search protocol for Penrose heath lane added

2.0 Oct 2016 Full policy review and new policy format

1.1 Nov 2012 Minor amendments due to NHSLA

1.0 Aug 2012 New policy for BCPFT; alignment of policies following TCS

awol - missing or absent without official leave

Documents