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  • 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 Page 2 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

  • Ref: MHA-0003-001-v1.3 Page 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

    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.

  • Ref: MHA-0003-001-v1.3 Page 4 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

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

  • Ref: MHA-0003-001-v1.3 Page 5 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

    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).

  • Ref: MHA-0003-001-v1.3 Page 6 of 22 Ratified Date: 07 September