leave of absence under s17 mha 1983 and time away from the ... · leave of absence under s17 mha...

Leave of absence under s17 MHA 1983 and time away from the hospital

MHA-0003-001-v1.3

Status: Ratified Document Type: Policy

Ref: MHA-0003-001-v1.3 of 22 Ratified Date: 07 September 2016

Leave of absence under s17 MHA 1983 and time away from the hospital Last amended: 24 March 2020

Table of Contents 1 Introduction ............................................................................................ 3

2 Why we need this policy ........................................................................ 3 2.1 Purpose ............................................................................................................................ 3 2.2 Objectives ......................................................................................................................... 3

3 Scope ...................................................................................................... 4 3.1 Who this policy applies to ................................................................................................. 4 3.2 Roles and responsibilities ................................................................................................. 4

4 Policy ...................................................................................................... 5 4.1 Urgent medical treatment .................................................................................................. 5 4.2 Patients who are not detained ........................................................................................... 5

4.2.1 Planning .................................................................................................................... 5 4.2.2 Preparing for time away from the hospital .................................................................. 6 4.2.3 Frequent / intermittent / short term time away from the ward...................................... 8 4.2.4 Overnight and longer time away from the ward .......................................................... 8 4.2.5 On return ................................................................................................................... 8

4.3 Detained patients .............................................................................................................. 8 4.3.1 Restricted patients ..................................................................................................... 8 4.3.2 Leave within the hospital grounds .............................................................................. 9 4.3.3 Leave outside the hospital grounds............................................................................ 9 4.3.4 Accompanied leave ................................................................................................. 11 4.3.5 Overnight leave........................................................................................................ 12 4.3.6 Choosing between leave and CTO .......................................................................... 12 4.3.7 Care and treatment on leave.................................................................................... 13 4.3.8 Escorted leave and custody in other hospitals ......................................................... 14 4.3.9 If difficulties develop during leave - recall to hospital ................................................ 14

5 Definitions ............................................................................................ 15

6 Related documents .............................................................................. 16

7 How this policy will be implemented .................................................. 16

8 How this policy will be audited ........................................................... 17

9 Document control ................................................................................ 18

Appendix 1 Leave / time off ward flowchart .......................................... 20

Appendix 2 Example leave monitoring form ......................................... 21

Appendix 3 Section 17 leave authorisation form .................................. 22



1 Introduction

Patients who are not legally detained in hospital have the right to leave at any time. They cannot be required to ask permission to do so, but may be asked to inform staff when they wish to leave the ward.

27.38 MHA 1983 Code of Practice, 2015.

The term ‘leave’ is often used to describe two different things:

1. Where a patient who is not legally detained is to spend a period of time away from the hospital, and is expected to return. This is referred to as “Time away from the ward” and is covered in section 4.2 below.

2. Where a patient who is detained under the MHA 1983 is formally granted leave of absence under s17 MHA 1983. This is covered in section 4.3 below.

A review of serious incidents relating to patients on leave in TEWV noted that this distinction is not always made.

North of England Mental Health Development Unit, 2017, p. 28

2 Why we need this policy

2.1 Purpose

Following this document will assist the Trust to ensure:

• the proper provision of leave or time away from the ward for each patient;

• that staff have a framework for the use of leave and time away from the ward; and

• the roles and responsibilities of clinical staff are clearly defined

2.2 Objectives

This document is published to ensure that all staff are aware of their responsibilities:

• before granting leave under section 17 Mental Health Act 1983 (MHA); or

• before agreeing time away from the ward with ‘informal’ patients; and

• during periods of leave and time away from the ward; and

• on a patient’s return.



Leave for detained patients must be authorised in accordance with section 17 MHA and must follow the guidance in the Code of Practice to the Mental Health Act 1983 (MHA CoP).

Chapter 27 gives detailed information on Leave of Absence.

All patients’ leave must be operated in accordance with Tees, Esk and Wear Valleys NHS Foundation Trust CPA policy

3 Scope

3.1 Who this policy applies to

This document relates to leave for both informal patients (i.e. those not detained under the MHA) and those who are detained under the MHA.

3.2 Roles and responsibilities

Role Responsibility

Head of Mental Health Legislation

• Ensuring that this policy is implemented

Responsible Clinicians • Authorising leave under S17 MHA • Ensuring that required documentation is completed

Trust staff • Ensuring that this policy and any associated procedures are followed

http://flc-intouch:35000/Docs/Documents/Policies/TEWV/Inter-Agency/CPA%20-%20The%20Care%20Programme%20Approach%20and%20Standard%20Care.pdf




4 Policy

4.1 Urgent medical treatment

There may be occasions when a patient needs to receive urgent or emergency treatment. This will include acute medical emergencies such as heart attack, stroke, serious burns or wounds but may also include situations which are not life threatening but still require urgent treatment e.g. fractures. In such circumstances, medical treatment must not be delayed because the patient does not have a signed section 17 form. The first priority is to ensure that the patient receives the medical treatment that they require. Leave can be authorised by the patient’s Responsible Clinician, or the duty consultant if out of hours once the emergency has been dealt with.

4.2 Patients who are not detained

Patients who are not detained have the right to make their own decisions about whether to remain in hospital. This includes decisions about day to day activities which may involve periods away from the ward.

For informal patients, the period of stay in hospital must be negotiated with them (and, where appropriate and with their consent, relatives and carers) as part of a jointly agreed plan of care.

Appropriate information should be shared with carers and relatives involved with leave to ensure risks are managed appropriately.

4.2.1 Planning

On admission, consideration must be given to the potential risks to the patient and/or others of off the ward activities including time off the ward which may be, in the hospital grounds, within the local area or to their home as part of a comprehensive risk assessment. This assessment must consider:

• the clinical presentation of the patient and nature of their illness;

• risk factors;

• information from relevant others (e.g. carers, GP, Care Coordinator); and

• the social circumstances of the patient (condition at home / available support).



The risk assessment must be recorded in the appropriate risk assessment and management documentation specific to each specialist service on Paris and must include clear advice on the appropriateness of off ward activities. The key worker must negotiate this agreed plan with the patient in the context of the therapeutic aims of the admission.

The risk management plan including the provisions for off ward activities and time away from the ward must be reviewed and revised at the first multi-disciplinary team (MDT) meeting and at each further meeting with changes to the plan being negotiated with the patient (and where appropriate relatives, with the consent of the patient, and other professionals).

The outcome of these reviews must be clearly documented in the case notes on Paris and regularly updated

Before any decision is made about time away from the ward, discuss with the patient; their relatives and carers (where appropriate and with the patient’s consent) to find out their views. The key worker (or other relevant clinician) must inform the MDT to assist the decision making process where the patient is not present themselves.

The responsible consultant has a statutory responsibility for the proper care of all informal patients admitted under their care. This includes negotiating off ward activities and time away from the ward with informal patients in consultation with the MDT. This must be considered daily at the report out. In order to allow maximum freedom for the patient when this plan has been agreed and documented, other members of the MDT will be authorised to act within this agreed framework, varying the agreed plan if the patient (or their carers) wishes to. Any change in the plan must trigger a review of the risk management plan and must be documented in Paris.

This ability to vary leave within an agreed framework exists only in relation to informal patients.

4.2.2 Preparing for time away from the hospital

The key worker will, in collaboration with the Care Co-ordinator, the patient, relatives and carers (if appropriate, and with the patient’s consent), discuss the activities and goals that the patient should be aiming to achieve during their period of time away from the hospital. Such goals and activities will form part of the patients planned care and must be recorded in the Paris Care Record.

If the patient is going home the key worker or Care Co-ordinator must ensure that the patient has the necessary practical requirements to provide day-to-day care for themselves and that any necessary support (emotional/practical) has been arranged.

The key worker must ensure that arrangements are clearly understood by the patient and communicated to relatives (with the patient’s consent) and to any other relevant professionals.

Before the patient leaves the ward, the nurse in charge/key worker must be sure that earlier risk assessments remain valid.



The review of serious incidents highlighted inconsistent recording of risk information at the point at which the patient left the ward, particularly in the case of informal patients.

Where there is cause for concern, the nurse in charge/ key worker will act to manage the risk for example, by offering escorted time away from the ward. The concerns and actions must be documented in the case notes on Paris.

If a clinician is concerned that an informal patient would be at significant risk due to their mental disorder if allowed to leave the ward, an attempt must be made to persuade the patient to remain as part of a revised agreed risk management plan.

If this is unsuccessful and the patient wishes to leave consideration must be given to the use of holding powers under Section 5 Mental Health Act 1983. It is not acceptable to use the threat of detention to “persuade” a patient to remain on the ward.

The key worker will discuss risk and coping strategies with the patient and their carers prior to leaving (with the consent of the patient having been obtained). Any support needs will be fully assessed and arrangements put in place and communicated to the patient and relatives. Where the patient is going home, the clinical team must be satisfied:

• that the patients home destination is habitable with all services, i.e. heating, water, power, sanitation;

• that the patient has access to the premises;

• that arrangements have been made for the patient to obtain any groceries etc.

• that the patient has any necessary medication

Where an informal patient declines offered community support or refuses to accept the advice of the MDT to delay until any social problems can be resolved and there are no grounds for compulsory detention on the basis of their mental disorder, the advice given must be documented in the case notes on Paris.

Any medication required by the patient during a period of time away from the ward will be issued immediately prior to the patient departing. The key worker must ensure that the patient understands how and when to take their medication and also explain any “as required” (PRN) medication if issued. The patient must be reminded of the purpose of the medication and of any side effects they might encounter.

The patient, relatives and carers must be informed that if there are any problems they should either contact the ward via telephone or return early from leave to discuss any issues arising with a member of staff. Contact details of the ward and the Care Co-ordinator must be provided to the patient and relatives before leaving.

The ward staff must give a verbal handover to anyone who arrives to accompany the patient, make sure that any standard processes are completed and a record of information shared is made,



including agreement as to whether the patient must be accompanied back to the ward after time away or can come back themselves or remain in reception or cafeteria, for example.

The ward staff must keep an accurate record of all patients away from the ward. An example monitoring form is included at Appendix 2

4.2.3 Frequent / intermittent / short term time away from the ward

Where a patient is taking frequent short term periods of time away from the ward the ward staff must establish that there has not been any change in assessed risks before the patient leaves the ward. These periods of absence must be documented on Paris by the end of the span of duty.

4.2.4 Overnight and longer time away from the ward

When an informal patient is on leave overnight or longer, this must be recorded in the Client Leave section on Paris as “Home Leave (INF)” in addition to an entry in the case notes on Paris.

4.2.5 On return

All professionals must review the mental state of the patient both before and after any period of time away from the ward. Any changes must lead to a review of the risk management plan.

On return, the key worker must discuss with the patient, relatives and carers events during the period of time away in order to assess achievements and/or any incidents that may have occurred.

Where community support services are involved then contact must be made to establish their views of the leave.

The outcomes of these discussions must be recorded in the case notes on Paris and used as part of the ongoing review of care within the MDT.

Time away from the ward must be reviewed regularly within the report out or other MDT discussions with the outcome and decisions arising from this review being clearly recorded in the case notes on Paris.

4.3 Detained patients

4.3.1 Restricted patients

In the case of patients who are restricted, by virtue of being subject to Sections 41 or 49 of the MHA, then leave can only be granted with the agreement of the Secretary of State.

The RC must provide the Ministry of Justice with all the relevant details concerning the proposed leave, i.e. type of leave, destinations, timescales and with full details of the patient’s present condition and the reasons why leave is being proposed.



When leave has been authorised by the Secretary of State the RC may then grant leave under section 17 as below.

A restricted patient may have their leave revoked by the RC or the Secretary of State.

4.3.2 Leave within the hospital grounds

The authorisation of leave to a detained patient is a process governed by legislation as described in section 17 of the Mental Health Act 1983.

Section 17 leave is not required for leave within the hospital grounds, unless the patient is a restricted patient.

Where the Secretary of State, or the courts have decided that the patient is to be detained in a particular unit of a hospital that patient will require the Secretary of State’s permission to go to any other part of that hospital as well as outside the hospital.

For example if a restricted patient is detained specifically to the Ridgeway Unit rather than to Roseberry Park, then an authorisation under Section 17 is required for leave within the grounds of Roseberry Park and must be agreed with the Ministry of Justice before the RC can grant leave.

4.3.3 Leave outside the hospital grounds

Before going on leave

Only the patient’s Responsible Clinician (RC) can authorise leave. The power cannot be delegated to another person. In the absence of the patient’s usual RC (e.g. if they are on leave) permission for leave can only be authorised by the approved clinician who is for the time being acting as the patient’s RC. Out of hours, such as overnight and at weekends, the on-call approved clinician is the patients RC with the authority to authorise leave under Section 17. This should only be necessary in exceptional circumstances, such as emergency medical treatment at another hospital, as all leave should be planned in advance.

The decision to authorise any section 17 leave will be based on a thorough assessment of needs and risk, and will form part of the patient’s overall care plan. Prior to section 17 leave outside of the hospital grounds being considered, review whether the patient meets the criteria for MAPPA notification and refer to the MAPPA guidance.

This must be recorded in the appropriate risk assessment and management documentation on Paris. Any decisions regarding section 17 leave should be planned, whenever possible in advance, and should be the subject of multi-disciplinary discussion and fully involve the patient.

Where relatives, carers, friends or community professionals are involved, they must be provided with clear advice on contacting the ward staff and, if necessary, the RC if they have any concerns during the leave period. Patients must be made aware of how and who to contact if they have concerns during the leave period.



The discussion with the patient and relatives or carers must be documented in the case notes on Paris including who the discussion was with and what specific information was given.

If there is multi-disciplinary agreement, the RC may authorise short-term local leave to be taken at the discretion of the nursing staff. This permits a degree of flexibility in terms of permitting or not permitting leave in response to day to day changes in the patient’s presentation. However, the Act does not permit the delegation of authority for leave under Section 17.

If short term leave is granted for specified periods (e.g. a patient may have one hour of leave, up to three times per week at the discretion of the nursing staff), an accurate record must be kept in the case notes on Paris of:

• when the leave is taken;

• the destination and purpose of the leave;

• the outcome of the leave;

• whether the patient returned on time; and

• if any problems occurred while on leave.

Each time the leave is used the nurse in charge or key worker must check that the leave is within the maximum limit and terms authorised by the RC.

It may be necessary for the nurse in charge to decline leave authorised on this basis if behaviour or mental state indicates that the patient or others may be placed at risk.

Should this occur, the RC must be informed and leave and risk assessment reconsidered. This decision must be recorded in the case notes on Paris.

• An explanation must be given to the patient of the RC’s power of recall to hospital if it becomes necessary, and the circumstances that may necessitate its use.

• The discussion and decision to grant leave must be recorded in the case notes on Paris and the specific details entered on the Section 17 Leave Authorisation Form (Appendix 1).

• All details requested on the form must be fully completed including patient details and those pertaining to the type of leave which has been granted, any conditions which are to be placed on the leave and relevant dates and times.

It must be made absolutely clear as to the maximum period authorised (e.g. up to 3 hours on 3 occasions weekly from 1st January 2010 to 1st February 2010). The RC maintains responsibility for any leave arranged and implemented on this basis.

The form must be signed by the RC and, unless under exceptional circumstances, by the patient (if not signed by the patient, a reason must be recorded on the form).



Under no circumstances must forms ever be signed by the RC and left blank to be subsequently completed by other staff.

Any conditions attached to the leave must be clearly specified and all relevant people informed. A copy of the leave arrangements should be given to the patient, professionals involved and, where appropriate, relative and/or carer. There must be a record made in the case notes on Paris of who has been given a copy of the section 17 leave form.

The ward staff must give a verbal handover to anyone who arrives to accompany the patient from the ward on leave, make sure that any standard processes are completed and a record of information shared is made.

• A copy of the current Section 17 leave form may be kept on the ward, e.g. in a leave file

• The original section 17 form must be sent to the Mental Health Legislation Office

• The Mental Health Legislation team will scan the section 17 form within 1 working day of receipt, it will then be available to view on Paris.

• Old copies of forms must be disposed of as confidential waste when they are superseded or when leave is revoked to avoid confusion as to the current leave status. The MHL Office will keep all originals for a leave history if required.

Any extended/indefinite leave will be fully operated in accordance with the Trusts CPA Policy and Procedures.

On return from leave

All leave must be reviewed regularly in MDT discussions with the outcome and decisions arising from this review being clearly recorded in the case notes on Paris.

4.3.4 Accompanied leave

Before going on accompanied leave

Where leave has been agreed with a patient with a condition that the patient is to be accompanied by a relative, carer or friend, as opposed to escorted by a member of staff, it is essential that the accompanying person is fully aware of all relevant details.

The nurse in charge of the ward must inform the accompanying person of:

• The exact details of the agreed length of leave

• The exact details of the agreed destination(s) of leave

• Any restrictions in place

• Any instructions for observation and risk management



This discussion must be fully recorded by the nurse in charge/key worker in the case notes on Paris including who the accompanying person is and exactly what information they have been given.

Any specific details may be recorded in the conditions and instructions section of the s17 leave form.

A copy of the s17 leave form must be given to the accompanying person and the accompanying person must be asked to sign the s17 leave form.

The ward staff must give a verbal handover to anyone who arrives to accompany the patient from the ward on leave, make sure that any standard processes are completed and a record of information shared is made, including whether the patient must be accompanied back to the ward on return from leave or can remain in reception or cafeteria by themselves, for example.

On return from accompanied leave

On return from accompanied leave any standard process must be followed, the nurse in charge/key worker must speak to the accompanying person and the patient and obtain a detailed account of the leave.

This must include:

• Positive elements

• Any problems encountered

• Potential risks or areas of concern

These must be fully documented in the care record, including who the accompanying person is and whom they spoke to.

The appropriate risk assessment and management documentation must be updated.

4.3.5 Overnight leave

When a detained patient is on leave overnight or longer, this must be recorded in the Client Leave section on Paris as “Leave of Absence” in addition to an entry being made in the case notes on Paris.

4.3.6 Choosing between leave and CTO

This section does not apply to restricted patients, or to patients detained under Section 2 of the Act, as they are not eligible for CTOs.

Leave of absence is primarily intended to allow a detained patient to be temporarily absent from hospital where further inpatient treatment is still thought to be necessary.



Longer term leave of absence (more than 7 consecutive days) may be used to assess a patient’s suitability for discharge from detention where the clinical team wish to see how the patient manages outside hospital before making a decision to discharge.

Leave for a longer period should be for a specific purpose or a fixed period, and not normally for more than one month. MHA CoP 31.5

A community treatment order must be considered if leave is granted for more than 7 days (or extended so that the total period of leave is more than 7 days).

Any decision to authorise section 17 leave for more than 7 days on a second occasion should be fully documented, including why a CTO or discharge is not appropriate. MHA CoP 31.5

Guidance on deciding between leave of absence and a CTO is given in Chapter 31 of the Code of Practice and is summarised in the table below.

Factors suggesting longer term leave Factors suggesting a CTO

• Discharge from hospital is for a specific purpose or a fixed period

• There is confidence that the patient is ready for discharge from hospital on an indefinite basis

• The patient’s discharge from hospital is deliberately on a ‘trial’ basis

• There are good reasons to expect that the patient will not need to be detained for the treatment they need to be given

• The patient is likely to need further inpatient treatment without their consent or compliance

• The patient appears prepared to consent or comply with the treatment they need – but risks as below mean that recall may be necessary

• There is a serious risk of arrangements in the community breaking down or being unsatisfactory – more so than for a CTO

• The risk of arrangements in the community breaking down, or of the patient needing to be recalled to hospital for treatment, is sufficiently serious to justify a CTO, but not to the extent that it is very likely to happen

4.3.7 Care and treatment on leave

The responsibilities of the RC and other professionals involved in the patient’s care remain the same while they are on leave although they are exercised in a different way. The duty to provide aftercare under Section 117 includes patients who are on leave of absence.

A patient granted leave under Section 17 remains liable to be detained and the provisions of Part IV of the Act continue to apply.

If it becomes necessary to administer treatment in the absence of the patient’s consent under Part IV, consideration should be given to revoking leave and recalling the patient to hospital. See section 4.3.9 below.



The refusal of treatment would not on its own be sufficient grounds for recall.

If a patient is to be recalled to hospital then this must be done in writing (see section 4.3.9 below).

4.3.8 Escorted leave and custody in other hospitals

The RC may direct that the patient remain in custody whilst on leave, i.e. escorted, either in the patient’s own interests or for the protection of other people.

They may be kept in the custody of any officer on the staff of the hospital or any person authorised in writing by the Hospital Managers.

Patients may also be given leave with a condition that they are resident within another hospital.

These terms would allow detained patients to have escorted leave for outings, to attend other hospitals for treatment, or possibly an in-patient stay, or to have home visits on compassionate grounds.

4.3.9 If difficulties develop during leave - recall to hospital

The RC may revoke a patient’s leave and recall them to hospital at any time if they consider it to be necessary:

• In the interests of the patient; or

• For the protection of other people.

The RC must arrange for a notice in writing revoking the leave to be served on the patient or the person for the time being in charge of the patient.

The reasons for recall must be fully explained to the patient and a record of such explanation made in the case notes on Paris.

In an emergency situation where the patient has deteriorated rapidly, the staff returning the patient may have to deliver the letter at the time of taking the patient into custody.

It is not necessary to issue a notice if the patient returns to the hospital of their own volition or if they indicate that they would comply with a request to return without delay. A notice should only be issued if the patient fails to comply with the request to return.

If the patient refuses to return to the detaining hospital following the issuing of the notice, they become absent without leave. See TEWV Missing persons procedure for guidance

http://flc-intouch:35000/Docs/Documents/Policies/TEWV/Clinical/Missing%20Persons%20Procedure.pdf



5 Definitions

Term Definition

Approved clinician (AC) A mental health professional approved by the Secretary of State or a person or body exercising the approval function of the Secretary of State, or by the Welsh Ministers to act as an approved clinician for the purposes of the Act. Some decisions under the Act can only be taken by people who are approved clinicians. All responsible clinicians must be approved clinicians.

Care Programme Approach (CPA)

A system of care and support for individuals with complex needs which includes an assessment, a care plan and a care coordinator. It is used mainly for adults in England who receive specialist mental healthcare and in some CAMHS services. There are similar systems for supporting other groups of individuals including, children and young people (children’s assessment framework), older adults (single assessment process) and people with learning disabilities (person centred planning).

Community treatment order (CTO)

The legal authority for the discharge of a patient from detention in hospital, subject to the possibility of recall to hospital for further medical treatment if necessary. Community patients are expected to comply with the conditions specified in the community treatment order.

Hospital grounds Paragraph 27.7 of the MHA Code of Practice states that: “What constitutes a particular hospital for the purpose of leave is a matter of fact which can only be determined in the light of the particular case. Where one building, or set of buildings, includes accommodation under the management of different bodies (e.g. two different NHS Trusts), the accommodation used by each body should be treated as forming separate hospitals. Facilities and grounds shared by both can be regarded as part of both hospitals.”

The extent of the hospital grounds should be clearly understood by those staff responsible for authorising leave within the hospital grounds.

Key worker The qualified professional responsible for coordinating a patient’s care on a day to day basis.

Leave of absence (S17) Permission for a patient who is detained in hospital to be absent from the hospital for short periods e.g. to go to the shops or spend a weekend at home, or for much longer periods. Patients remain under the powers of the Act when they are on leave and can be recalled to hospital if necessary in the interest of the patient’s health or safety or for the protection of other people.



Leave from hospital The act of a patient leaving the hospital and its grounds, either escorted or unescorted.

Responsible clinician (RC) The approved clinician with overall responsibility for a patient’s case. Certain decisions (such as renewing a patient’s detention or placing a patient on a community treatment order) can only be taken by the responsible clinician.

Restricted patient A patient detained under part 3 of the MHA who, following criminal proceedings, is made subject to a restriction order under section 41 of the Act, a limitation direction under section 45A or a restriction direction under section 49. The order or direction will be imposed on an offender where it appears that it is necessary to protect the public from serious harm. One of the effects of the restrictions imposed by these sections is that restricted patients cannot be given leave of absence or be transferred to another hospital without the consent of the Secretary of State for Justice, and only the Tribunal can discharge them without the Secretary of State’s agreement.

Risk assessment The systematic collection of information to determine the degree to which risk is present, or is likely to pose problems at some point in the future for the patient, relative(s), carer(s) or the public.

6 Related documents

• Code of Practice Mental Health Act 1983, TSO, 2015

• Reference guide to the Mental Health Act 1983, TSO, 2015

• Missing patients procedure

• CPA Policy

• National Offender Management Service, Mental Health Casework Section, Section 17 – Leave of Absence, 2015

• National Offender Management Service, Mental Health Casework Section, Transfers Between Hospitals in England and Wales

• Tees, Esk and Wear Valleys NHS Foundation Trust, Thematic review of 15 serious incidents relating to patients on leave during the period February 2015 – October 2016

7 How this policy will be implemented

• This policy will be published on the Trust’s intranet and external website.

• Line managers will disseminate this policy to all Trust employees through a line

http://intouch/Services/ClinicalSupportServices/MentalHealthAct/Documents/Guidance/2015%20Code_of_Practice.pdf

http://intouch/Services/ClinicalSupportServices/MentalHealthAct/Documents/Guidance/Reference_Guide%202015.pdf

http://flc-intouch:35000/Docs/Documents/Policies/TEWV/Clinical/Missing%20Persons%20Procedure.pdf


https://www.justice.gov.uk/downloads/offenders/mentally-disordered-offenders/mhcs-guidance-s17-leave.pdf

https://www.justice.gov.uk/downloads/offenders/mentally-disordered-offenders/mhcs-guidance-s17-leave.pdf

https://www.justice.gov.uk/downloads/offenders/mentally-disordered-offenders/mental-health-casework-guidance.doc

https://www.justice.gov.uk/downloads/offenders/mentally-disordered-offenders/mental-health-casework-guidance.doc



management briefing.

• Section 17 MHA is included in the Trust’s rolling programme of Mental Health Legislation training

8 How this policy will be audited

• Ward / team managers are responsible for monitoring compliance with this policy.

• All MHA documentation is checked by members of the Mental Health Legislation team and routinely audited by senior MHL personnel on an ad hoc basis.



9 Document control

Date of approval: 07 September 2016

Next review date: 01 June 2020

This document replaces: Policy for leave from hospital and leave of absence under section 17 MHA 1983

Lead: Name Title

Mel Wilkinson Mental Health Legislation Lead

Members of working party: Name Title

Simon Marriott Training and Policy Manager (Mental Health Legislation)

This document has been agreed and accepted by: (Director)

Name Title

Elizabeth Moody Director of Nursing and Governance

This document was approved by:

Name of committee/group Date

Mental Health Legislation Committee

January 2016

This document was ratified by: Name of committee/group Date

Executive Management Team

01 June 2016

An equality analysis was completed on this document on:

January 2016

Change record

Version Date Amendment details Status

1 1 Jun 2016 Full review Renumbered from CLIN/0025 to be included in the Mental Health Legislation portfolio

Withdrawn

1.1 16 Aug 2016 Title change Withdrawn

1.2 01 Jun 2017 Wording added to 4.3.3 re assessing whether the person meets criteria for MAPPA notification.

Withdrawn



1.3 31 Aug 2018 Minor amendments Published

1.3 12 Aug 2019 Review date extended from 07 September 2019 to new date of 31 December 2019

Published

1.3 27 Nov 2019 Review date extended from 31 December 2019 to new date of 28 February 2020

Published

1.3 24 March 2019 Review date extended from 28 February 2020 to new date of 01 June 2020.

Published



Appendix 1 Leave / time off ward flowchart

Befo

re le

avin

g th

e w

ard

Discussion regarding leave/time off ward and risks identified between MDT, patient, carers. Leave/time off ward agreed and decision documented on Paris. For detained patients the responsible clinician prescribes Section 17 leave completes form and documents on PARIS

Purpose of leave / time off ward identified and Individual intervention plan co-produced with the

patient, discussed with carers and other professionals involved then documented on PARIS

Patient and carers will have ward contact number for advice/support Advice/ knowledge regarding medication will be given

Risk assessment review and update and consider change to legal status

Prior to each point of leave/time off ward, nursing staff will speak to patient to ascertain: • Assessed risk has not changed (Section 17 leave if applicable remains valid) • Current Mental State • Where the patient is going and who with? • What time the patient is expected to return? • If any other support is required?

Notify Crisis Team/Care Coordinator if appropriate

Nursing staff document details on Paris. Frequent/intermittent/short term leave / time off ward to be fully documented on Paris by the end of span of duty.

Whi

le a

way

fro

m w

ard

During leave or time off ward, if contact was agreed, the allocated nurse will contact patient and/or carers to ascertain progress/issues and document in Paris. Allocated nurse to obtain feedback from Crisis Team/Care Coordinator if appropriate and review risks

On

retu

rn

On return to the ward, staff will ask patient/carers for feedback and document on Paris. Obtain feedback from Crisis Team/Care Coordinator if appropriate.

Review / update risk assessment

Appendix 2 Example leave monitoring form

Name: S17 Leave / Time off Ward Monitor

Date Where going / purpose Risk Assessment

Time Left Signature Description Time Return

Signature Record on Paris

Appendix 3 Section 17 leave authorisation form

Patient Name Paris ID Section Ward RC

I, the Responsible Clinician for the above named patient, authorise leave of absence as detailed below

Regular / Specified Leave From To Destination and Reason (please include number of

hours, occasions, weekly or daily if appropriate) Escorted? Yes / No

Accompanied? Yes / No By Whom

Conditions of Leave or Instructions and observations for risk

management if accompanied Date Time Date Time

The conditions of the above leave are: that the patient returns to hospital at the time / date stated, agrees to take medication prescribed, is in contact with his / her care coordinator, attends CPA reviews / ward rounds where appropriate, escorted / unescorted (please specify by whom, i.e. numbers, level of qualification, gender etc.) Long Term Leave (end date cannot exceed expiry date of section)

From To Destination and Reason Conditions of longer term leave eg to remain in the custody of staff of X care home or hospital

For sections 3/37/45A/47/48: I have considered the use of a Community Treatment Order and concluded that it is not appropriate at this time and I have fully recorded my reasons for my decision in the patient’s Care Record

RC Signature Patient Signature (Or reason not signed, e.g. unable, refused)

Accompanying Person Signature (where relevant)

Date Date Date

Please ensure a copy is this form is given to relevant people including the patient, accompanying person, carer, casenotes, community staff – original to MHA Dept