ABSENT WITHOUT LEAVE (AWOL) AND MISSING PATIENT POLICY (Inpatient and Community Patients)

Transcription

1 ABSENT WITHOUT LEAVE (AWOL) AND MISSING PATIENT POLICY (Inpatient and Community Patients) Authors Sponsor Responsible committee Ratified by General Manager - Adults North General Manager - Adults South Director of Nursing and Quality Patient Safety & Risk Management Subcommittee Quality & Healthcare Governance Committee Date ratified November 2010 Date issued November 2010 Review date November 2013 Version 3.1 If developed in partnership with another agency, ratification details of the relevant agency: Cambridgeshire Constabulary, Detective Superintendent 968 Ridgway Signed on behalf of the Trust:..... Karen Bell, Chief Executive Elizabeth House, Fulbourn Hospital, Fulbourn, Cambs. CB21 5EF Telephone:

2 Version Control Sheet Version Date Author/s Comments Mick Simpson and Nephat Chege. Policy ratified by Healthcare Governance Committee Mick Simpson and Neil Winstone Orna Clark, Patient Services Manager. Policy revised to incorporate learning from a Serious Untoward Incident, and also to reflect NHSLA and CQC requirements. Ratified by Quality & Healthcare Governance Committee. Policy revised and updated to include the following:- Assurance statement; Addition to Duties and responsibilities (MHA Admin, Patient Services Manager/ Patient Safety and Risk Assurance Manager; Care Quality Commission Statutory AWOL Notification/ The role of the Mental Health Act Administrator; Patients who leave the country whilst AWOL; Dealing with media enquiries; Trust s AWOL outcome form appendix; CQC AWOL notification form appendix; AWOL notification/reporting process appendix Mick Simpson. Policy reviewed jointly with Cambridgeshire Police to take into account Police amendments to their response to MH issues following Police national guidance. Revised version approved by Patient Safety & Risk management Subcommittee in October Revised version ratified by the Quality & Healthcare Governance Committee In November Page 2 of 30

3 Section CONTENTS Page 1 Introduction 4 2 Scope 4 3 Definitions of Terms Unauthorised Absence 6 5 Duties and Responsibilities Risk Categories AWOL Procedure When a Patient Returns from Missing/AWOL When a Patient Fails to Return from a Period of Leave Guardianship Missing Patients in the Community Access to Patient s Homes Assisting Patients to Absent Themselves Care Quality Commission Statutory AWOL Notification/ The Role of the Mental Health Act Administrator Patients Who Leave the Country Whilst AWOL Dealing with Media Enquiries Review Arrangements and Learning from AWOL Incidents Policy Awareness Monitoring Compliance Links to Other Documents References 16 Appendices Appendix 1 CPFT AWOL/Missing Patients Form Appendix 2 CPFT Return of AWOL/Missing Patients Form 19 Appendix 3 CPFT Missing Patient & AWOL Policy Flow Diagram 20 Appendix 4 CQC AWOL of Detained Patients Notification Form Appendix 5 CPFT AWOL Notification Process Flow Chart 24 Appendix 6 Cambridgeshire Protocol for Police Assistance Where Patients from Mental Health Establishments Are Absent Without Leave AWOL (under the Mental Health Act 1983, as amended 2007) or missing Page 3 of 30

4 ASSURANCE STATEMENT The objective of this policy and procedures is to ensure that the key agencies involved when patients go missing from hospital, particularly the police and Cambridgeshire and Peterborough NHS Foundation Trust, have an agreed policy to provide a co-ordinated response. The need is to be effective in reporting and finding missing patients, whilst at the same time, minimising unnecessary reporting and instances of patients repeatedly going missing. The police response is attached at appendix 6 Cambridgeshire Constabulary protocol for police assistance where patients from Mental Health Establishments are Absent without Leave (in accordance with the Mental Health Act 1983, as amended 2007) or are missing. 1. INTRODUCTION 1.1 Cambridgeshire & Peterborough NHS Foundation Trust (referred to thereafter in this document as the Trust ) recognises that appropriate observation and supervision of patients is paramount to their care 1. However, despite these arrangements patients do sometimes go missing or AWOL (Absent without Leave), and it is important that there is no delay in implementing the following procedure to minimise any risks to the patient and others. A copy of this policy is to be readily available at all Mental Health Establishments. 1.2 This policy provides guidance and procedures to be followed when patients absent themselves or fail to return from a period of leave of absence. 2. SCOPE 2.1 This policy applies to all Trust staff responsible for providing clinical care and requires all staff to ensure that they are familiar and comply with the Trust policy on observation and intensive supervision of patients. 2.2 For the remainder of this policy, the terms patient or service users refer to individuals receiving care and treatment from the Trust. 3. DEFINITION OF TERMS 3.1 Terminology The term AWOL is sometimes used to apply to any patients missing from an inpatient unit. However the term does have specific meaning for patients detained under Section of the Mental Health Act 1983 (see Section 3.2) It is recommended that staff use the term AWOL where this applies to a detained patient, otherwise the term Missing Patient should be used. 1 See Cambridgeshire and Peterborough NHS Foundation Trust s Observation and Intensive Supervision Policy Page 4 of 30

5 3.2 Detained patients Detained patients are considered to be AWOL when they 2 : Have left the hospital in which they are detained without their absence being agreed (under Section 17 of the Act) by their responsible clinician; Have failed to return to the hospital at the time required to do so by the condition of leave under Section 17; Are absent without permission from a place where they are required to reside as a condition of leave under Section 17; Have failed to return to the hospital when their leave under Section 17 has been revoked; Are supervised community treatment (SCT) patients who have failed to attend hospital when recalled; Are SCT patients who have absconded from hospital after being recalled there; Are conditionally discharged restricted patients whom the Secretary of State for Justice has recalled to hospital; or Are guardianship patients who are absent without permission from the place where they are required to live by their guardian Please also refer to the Section 17 Policy - Leave of Absence from Hospital, for further guidance. 3.3 Informal Patients Informal patients are not detained under the Mental Health Act, however, Trust staff are accountable for their care and safety at all times. Informal patients may wish to leave an in-patient unit; however the member of staff should explain the rationale for patients remaining on the unit for assessment and treatment and ultimately can consider assessment within the Mental Health Act, if required Decision-making concerning leave with regard to informal patients should always be considered as part of the patient s care plan and clinical risk assessment by the multi-professional team If an informal patient:- cannot be located on the ward and no information is available as to their whereabouts; OR does not return to the ward at either the agreed/accepted time AND/OR within a reasonable time that is deemed acceptable to that individual's mental state; 2 Code of practice Mental Health Act 1983 (2008), chapter 22. Page 5 of 30

6 They should be treated as missing. All patients that have gone missing should be considered against the risk categories in Section 4 and appropriate action taken. 4. UNAUTHORISED ABSENCE 4.1 Professional Judgement The Nurse in Charge should use their professional judgement in relation to the late returning of a patient from authorised leave, and where there are concerns should discuss and agree a response with the responsible clinician (or his/her deputy). If the patient or carer informs the ward of a reasonable delay to returning from leave this may not be viewed as being absent without leave, however a risk assessment of the patient s situation should always be undertaken The Nurse in Charge should evidence in the patient s records that risk factors have been considered, and the actions taken, including discussion and decisions made with the responsible clinician The same principles apply to patients who go missing or refuse to return to the ward whilst on escorted leave It is important that staff make judgements on how to proceed when a patient wishes to leave the ward, or is absent without leave, taking full account of all available risk information. The patient s legal status is only one factor to be considered and a global risk assessment should be made taking all risk factors in to account. 5. DUTIES AND RESPONSIBILITIES 5.1 Chief Executive As the accountable officer, the Chief Executive must ensure that responsibility for the management of missing or AWOL patients is delegated to an appropriate executive lead. 5.2 Executive Lead As nominated executive lead, the Director of Nursing & Quality, working with the Director of Operations, must ensure that appropriate and robust systems, processes and procedures are in place for missing and/or AWOL patients. 5.3 General Managers The Adult Services General Managers are the Trust leads for the development, implementation and monitoring of this policy and for providing advice on measures in place for managing missing and/or AWOL patients. Page 6 of 30

7 5.4 Team Managers All team managers have delegated responsibilities for the correct and consistent implementation and monitoring of this policy. 5.5 Medical Team The medical team includes the Consultant Psychiatrists and Responsible Clinicians, and are responsible for undertaking the necessary assessments of the mental and physical health of the patients and formulating the appropriate treatment plan in consultation with the wider multidisciplinary teams. 5.6 Clinical Staff All Trust staff that provide clinical care to patients are responsible for following the procedures in this policy. In particular, the Nurse/Practitioner in Charge of the ward has specific responsibilities set out throughout this policy. 5.7 Locality Mental Health Act Administrators To maintain the Trust s AWOL/missing patients database, notify the Care Quality Commission (CQC) of all AWOL incidents involving patient detained (or liable to be detained) under the Mental Health Act, provide the Trust s Patient Services Manager with the required AWOL quarterly statistics and liaise with ward staff/clinicians and AMHPs as necessary. 5.8 Patient Services Manager in liaison with the Patient Safety and Risk Assurance Manager. To compile reports on AWOL episodes for the Trust s Mental Health Act Committee and Mental Health Act Liaison Group. To co-ordinate AWOL processes, audit and report outcome to the Divisional Managers and Mental Health Act Committee. 6. RISK CATEGORIES 6.1 General If the Trust staff are aware of the location of a patient who is missing (whether informal or detained) they should make arrangements for his/her safe return The police should be asked to assist in returning a patient to hospital only if necessary. If the patient s location is known, the role of the police should wherever possible, be only to assist a suitably qualified and experienced mental health professional in returning the patient to hospital The Trust uses the same three categories of clinical risk status as Cambridgeshire Constabulary, Low, Medium and High. This helps ensure that there is clarity of roles and expectation between the two organisations Determining the category should be based on risk assessment, and the Nurse in Charge should make use of relevant information, and seek advice and 3 Mental Health Act Code of Practice 2008 Page 7 of 30

8 guidance from senior staff including the responsible clinical consultant on call. Relevant information can include past history, current mental state and known risks, the views and information friends or carers etc. The category can be revised by the nurse in charge. 6.2 Low Risk Category The patient may be detained or informal status. Situations where a patient is well known to the team and there are no significant risks on assessment, may have had authorised leave, and a known history of going missing/awol but returning without incident Low risk category patients will not be reported to the police but inpatient service staff will contact relatives, attempt to contact the individual, and contacted place of residence, etc. The management of the process will be entirely within the Trust and police will not be informed as this will initiate their missing patient process. The category should be reviewed at least every 24 hours. Trust staff will make reasonable attempts to locate and return the patient to the service, or consider escalation to a higher risk category as required. 6.3 Medium Risk Category The patient may be detained or informal status. There is sufficient concern that we need to know where the patient is and that they are safe, and that they need to be returned to hospital, by Trust staff or by police depending on the circumstances Patients assessed as medium or high risk will be reported to the Police. The police will require as much detail as possible to be made available to them - details of friends, contacts and other relevant information available (e.g. bank account details, photo identification). They will expect a comprehensive ward search to have been done. The police may need to repeat the ward search as this is part of their core process. The incident should be recorded on the Datix incident reporting system. 6.4 High Risk Category The patient may be detained or informal, to be of high risk and is considered in danger of harm to self or others and that there is an immediate need to establish their whereabouts, and return to the ward Details of medication and particularly any potential impact of lack of regular medication will be required. Expectation within the Trust is that the Duty Manager and RC/Duty Consultant will be informed of all high category absences. The incident should be recorded on the Datix incident reporting system. Page 8 of 30

9 7. AWOL PROCEDURE When a patient absents themselves from an inpatient setting and is defined as absent without leave or missing, it is the responsibility of the Nurse in Charge of the ward to take the following actions. A flow chart of this procedure is attached at Appendix Procedure for all Risk Category Missing Patients The following actions should be taken:- Establish risk category (as set out in Section 4), and take appropriate action. Complete the Trust AWOL/Missing Patient Form (see Appendix 1) and retain a copy in patients case notes. Carry out a thorough search of the ward and immediate areas outside of the ward. Inform Duty Nursing Officer (South) or Shift Coordinator (North). The Manager on call can also be contacted at the discretion of the DNO/Shift Coordinator (North). The Duty Manager has discretion to also inform the On call Director/on call consultant Try and establish whereabouts by contacting the following addresses/telephone numbers: - Carers at home address OR the Hostel from where the patient was admitted. - The next-of-kin/nearest relative as defined by the Mental Health Act - as documented in the case notes. - Any other known address/telephone numbers. - The GP when/if it is deemed appropriate Establish when and where the person was last seen and record a physical description of the person, identifying features, clothes etc. Record the date and time of all events and search processes in the patient s notes, and summarise on the Ward Report. Undertake ward and site searches. Give (or fax) a copy of all Trust AWOL/Missing Patient Forms (of formal and informal patients) to the locality s Mental Health Act Administrator within 24 hours of the AWOL date. 7.2 Procedure for Medium and High Risk Category Missing Patients All of the following actions must be taken: Give copy of the Trust s AWOL/Missing Patient Form to the Police when they attend the ward (or by fax). An Incident report should be completed using the DATIX system. Give (or fax) a copy of all Trust AWOL/Missing Patient Form (for both formal and informal patients) to the locality s Mental Health Act Administrator within 24 hours of the AWOL date. Inform the patients Consultant/Responsible Clinician or nominated deputy. Page 9 of 30

10 The Serious Untoward Incident procedure should be implemented where a detained patient is AWOL and serious harm has occurred or where there is high risk of harm or untoward incident. If further advice is needed the team manger and or senior manager should be contacted. 7.3 Procedure if a patient refuses to return while on escorted leave Attempts should be made to persuade the patient to return. If these have failed, the escort should try to ascertain the patient s state of mind and their intentions. Report to the Nurse in Charge of ward. Individual cases must be discussed with the Responsible Clinician or nominated deputy. It may be appropriate to request police assistance. 7.4 Procedure for patients absconding whilst on escorted leave If a patient absconds whilst on escorted leave the escort must do the following: As soon as possible, inform the ward of the details and circumstances surrounding the absconsion. The ward will then initiate the AWOL policy. Search the immediate area before returning to the ward. 8. WHEN A PATIENT RETURNS FROM MISSING/AWOL 8.1 Inform all parties as soon as possible that the patient has returned from AWOL or missing and complete and record on the ward report and in the patient s case notes. 8.2 Complete Part 2 of the Trust AWOL/Missing Patient Form: Give (or fax) a copy of all Trust AWOL/Missing Patient Forms to the locality s Mental Health Act Administrator within 24 hours of the AWOL date. 8.3 For Medium and High risk categories and where it is felt necessary by the Nurse in Charge, Low category, the SHO/Duty SHO or consultant/responsible clinician should be asked to attend and reassess the mental and physical health of the patient and this should be recorded in the patient s notes. Together the SHO and nurse in charge of the ward should undertake a risk assessment review for that patient and take and record any appropriate action(s), amending the care plan as necessary. 8.4 If required the Responsible Clinician should be contacted for advice regarding the management of the patient. 8.5 The multi-disciplinary team and the care co-ordinator should review the care plan on the next working day. Page 10 of 30

11 8.6 All instances of AWOL or missing patients should be considered at the ward round both to inform clinical decision making in regard to the individual patient and to inform general practice on the ward. 9. WHEN A PATIENT FAILS TO RETURN FROM A PERIOD OF LEAVE 9.1 Arrangements should be made for daily liaison by a nominated member of the ward team with the family/carer, as required. 9.2 Should the individual s whereabouts be unknown, implementation of the procedure for missing patients (Section 7) should be considered in consultation with carers/relatives. 9.3 A daily update report should be given to the Team Manager and consultant/responsible Clinician). 10. GUARDIANSHIP 10.1 Where a patient, who is for the time being subject to guardianship, absents himself without the permission of the guardian from the place at which he/she is required to reside, he/she may be taken into custody and returned to that place by:- Any officer on the staff of a local social services authority, A Police constable, or Any other person authorised in writing by the guardian or a local social services authority Where a patient subject to guardianship goes absent without leave, the care co-ordinator and the Guardian must be informed as soon as possible. 11. MISSING PATIENTS IN THE COMMUNITY 11.1 Where a community mental health team worker becomes concerned about the unknown whereabouts of a patient in the community or considers them to be missing, they should discuss their concerns with their Team Leader/Manager and psychiatrist in the first instance, unless immediate action is required Significant events and the current risk assessment of the individual s mental state will influence the urgency of the response Key individuals involved in the patient s care and wellbeing or with whom the individual has significant social contact, should be identified through the Care Programme/Risk Assessment for that patient and through team discussion. The Care Coordinator should discuss with their Line Manager which of these individuals will be contacted regarding the whereabouts of the individual patient. Page 11 of 30

12 11.4 Should the patient s whereabouts remain unknown and concerns for their wellbeing and safety remain high, the Care Coordinator should discuss with their Line Manager whether or not to report the individual as missing to the Police In the event that a decision is taken to report the individual as missing to the Police, an incident form should be completed to record the event. This would be at Medium or High category The Line Manager will support the Care Co-ordinator throughout the process and will ensure that there is a clear understanding of what action will be taken following involvement of the police The Care Coordinator will stay in contact with key informants identified previously to offer support as necessary The Line Manager will ensure that the situation is reviewed as required It is the patient s Care Co-ordinator s responsibility to report to the Mental Health Act Administrator of AWOL incidents of patients who are detained under S17a (Community Treatment Order) 12. ACCESS TO PATIENT S HOMES In situations where there are concerns about the well-being and safety of a community patient and it is considered necessary to gain access to a patient s home, the care co-ordinator should liaise with the Approved Mental Health Professional (AMHP), the Responsible Clinician and the Police. (Policy / Guidance re Sec 135) 13. ASSISTING PATIENTS TO ABSENT THEMSELVES 13.1 Where a person induces or knowingly assists a patient liable to be detained in a hospital, who is subject to guardianship, is a community patient, to absent himself without leave he/she shall be guilty of an offence Where any person induces or knowingly assists another person who is in legal custody by virtue of Section 137 to escape from such custody he/she shall be guilty of an offence Where a person knowingly harbours a patient who is absent without leave or is otherwise at large and liable to be taken under the Mental Health Act or gives him any assistance with intent to prevent, hinder or interfere with his being taken into custody or returned to the hospital he/she shall be guilty of an offence. Page 12 of 30

13 14. CARE QUALITY COMMISSION STATUTORY AWOL NOTIFICATION/ THE ROLE OF THE MENTAL HEALTH ACT ADMINISTRATOR 14.1 Since April 2010, the Trust has a statutory obligation to notify CQC of any absence without leave of a person detained or liable to be detained under the Mental Health Act 1983 (e.g. on s.17 leave of absence from hospital, or held under short-term powers of s.5, 135 or 136) Copies of all Trust AWOL/Missing Patients Forms must be given/faxed to the locality Mental Health Act Administrator within 24 hours of the AWOL incident The Mental Health Act Administrator will notify the CQC of all AWOL incidents of patients detained/liable to be detained under the Mental Health Act (when absence occurs over midnight) by completing and faxing the CQC AWOL notification form (Appendix 4) The Mental Health Act Administrator will a copy of the CQC AWOL notification form to the Trust s Patient Safety and Risk Assurance Manager for quality assurance and monitoring purposes The Mental Health Act Administrator will report to the CQC of the outcome of AWOL incidents involving patients detained and liable to be detained under the Mental Health Act by completing part 2 of the CQC AWOL notification form (Appendix 4) The Mental Health Act Administrator will submit to the Patient Services Manager monthly figures of both formal and informal AWOL incidents, the outcome and the number of AWOL incidents that have been reported to the CQC It is the responsibility of the locality Mental Health Act Administrator to maintain the Trust s AWOL/Missing Patients database and notify the Patient Services Manager of non compliance with the Trust AWOL reporting process. 15. PATIENTS WHO LEAVE THE COUNTRY WHILST AWOL 15.1 Detained patients who are AWOL and are found in Scotland, Wales, Northern Ireland, the Channel Islands and the Isle of Man can be retaken, held in custody and returned to this Trust by virtue of Section 88 and Section 138 of the Mental Health Act The issue of arranging transport for the patient s safe return, and bearing the cost, should be negotiated with the body that holds the patient. In the case of a NHS hospital, it is usually the returning hospital that has the responsibility for arranging and funding transport In the case of hospitals and other bodies overseas, it is reasonable to expect them to act as CPFT would; that is escort the patient to an airport where the patient can be met and a handover take place to CPFT staff, however, this is Page 13 of 30

14 very much subject to individual negotiation and there are no protocols binding on overseas countries Patients who go out of the UK cease to be subject to English Law and are not therefore detained under the MHA whilst abroad. It follows that there is no power to return them under the MHA. It may be that such patients will be detained under Mental Health legislation in another country, in which case arrangements may be made for their return When AWOL patients go abroad, the police should be notified in order that they can update their records and so that they can consider the need to advise the local foreign police force if the risk is considered high. 16. DEALING WITH MEDIA ENQUIRIES 16.1 Media enquiries relating to a Trust s patient or service user who is AWOL or missing are to be immediately referred to the Division s General Manager or the Manager on-call. Staff must not answer any enquiries themselves In the event that staff become aware that the patient/service user s family or friends have, or may contact the media, they are to notify the Divisions General Manager, or Manager on-call If necessary a press statement will be issued by the Trust. 17. REVIEW ARRANGEMENTS AND LEARNING FROM AWOL INCIDENTS 17.1 All planned leave from an in-patient unit should be reviewed with the patient on their return to the unit and the outcome recorded in the clinical record All absence from the unit, planned or unplanned, by an individual patient should be reviewed at the next ward round. In particular, factors leading to AWOL incidents should be identified to inform future practice. Where significant, this learning should be shared with other services and directorates via discussion at the Divisional Management Team (DMT) meetings and/or Trust-wide Learning the Lessons events and bulletin The SUI process should be implemented for absconded detained patients as appropriate, in accordance with the Incident Reporting and Serious Untoward Incident Policy The Acute Care Forum should consider a report from the DATIX web incident reporting system bi-annually concerning incidents of AWOL to inform best practice. Page 14 of 30

15 18. POLICY AWARENESS It is expected that this policy will form part of the induction of all medical staff, registered and unregistered in-patient staff and community team leaders/managers. It is the responsibility of Team manager/team leaders and individual qualified staff to ensure familiarity with the policy. 19. MONITORING COMPLIANCE 19.1 Compliance with this policy will be monitored through quarterly team-based monitoring as part of the monitoring arrangements for Observations and Intensive Supervision of Inpatients Guidelines. The outcome of the teambased monitoring will be reported to the Divisional Management Team meetings with exception reports provided to the Patient Safety and Risk Management Subcommittee, as part of the quarterly Patient Safety and Risk Management Report In addition, AWOL and missing persons incidents are captured on the DATIXweb incident reporting system, and reported to Patient Safety and Risk Management Subcommittee on a quarterly basis An annual audit of Missing Persons incidents will be undertaken, to monitor staff compliance with the duties identified in this policy and identify learning. The findings of this audit and any recommendations and required actions will be presented to the Divisional Management Team and the Patient Safety and Risk Management Subcommittee Patient Services Manager will submit to the Trust s Mental Health Act Committee and the Mental Health Act Liaison meetings a quarterly report of AWOL incidents/outcome of patients detained (or liable to be detained) under the Mental Health Act. 20. LINKS TO OTHER DOCUMENTS Guidelines for the Observation and Intensive Supervision of Inpatients Incident & Near Miss Reporting Policy and Serious Untoward Incident Procedure Care Programme Approach Policy Clinical Risk Assessment Policy Section 17 Policy (Leave of Absence from Hospital) Page 15 of 30

16 21. REFERENCES Supervised Community Treatment Order (MHA 1983) Mental Health Act Code of Practice (2008). Mental Health Act 2007 Page 16 of 30

17 APPENDIX 1 REPORT OF MISSING/AWOL PATIENT (PAGE -1-) Missing Nurse In Charge Ward: Since: Reporting: Surname: Forenames: Hospital M no: DOB: Nationality: Age: Sex: Married / Single / Separated / Divorced / Widowed White European Dark European: Afro-Caribbean: Asian Oriental Arab Complexion: Height: Build: Weight: Hair colour / length / beard / wig Eyes colour / shape: Glasses type: Marks / scars / tattoos, etc: Any distinguishing peculiarities: Clothing (description): Finance (DSS Benefit / Bank Account / Credit Card etc): Vehicle Make: Type: Colour: Reg No: Care / Hospital Order Act: To include power of detention and time limits Section: Expiry Date: Circumstances of disappearance (e.g. following domestic dispute, argument with girl/boy friends etc). Include whether there is any CCTV footage available. Medical History / Treatment / Drugs / Doctor: Last Seen: Time: Date: Location: Date of Report: Informant: Time: Address: Day: Tel No: Address from which person missing: Risk Category* Home Address: Low Medium High See over for details Page 17 of 30

18 APPENDIX 1 ACTION Ward Search: YES NO Local Search YES NO Photograph Obtained Subject of previous missing report Photograph returned (if yes details of date/place found) Details of relatives / associates to be checked (include name, address, telephone no and relationship) Time/Date Checked by Name and Address of School / Employer: RISK INDICATORS YES NO YES NO 1. Suffering from mental disorder 11. Subject of Care Order 2. Informal mental patient 12. Likely to suffer significant harm 13. Weather conditions cause concern 4. Impaired mental age 14. Unemployed 5. Suicidal tendencies 15. Previously missing 6. Physical disability 16. Persistently missing 7. In possession of controlled drug 17. In possession of change of clothing 8. In possession of prescribed 18. In possession of sufficient cash drug 9. Missing for considerable time 19. Note left no cause for concern 10.May be subject of child abuse 20. Believed to be with boy / girl friend 21. Female believed at Women s Refuge This document will inform the Police risk assessment and ultimately their response, and must therefore be completed as fully as possible and handed to Police staff on their attendance. DETERMINE THE RISK CATEGORY (n.b. category determined by clinical Risk) Low Risk Not to be reported to the police but initiates the process for inpatient staff. Expectation is that staff will have contacted relatives, attempted to contact the individual, have contacted their place of residence, etc. The category will be reviewed on a daily basis. The management of the process will be entirely within the Trust and police will not be informed as this will initiate their missing patients process. The category should be reviewed at least every 24 hours. Medium Risk All reports of a missing person to the police will be within the medium risk category as a minimum and will be treated as such by the police within their categorisation. The expectation is that there should be response from the police within one hour. The police will expect to have details of friends, contacts and bank accounts. They will expect a comprehensive ward search to have been done. The police may need to repeat the ward search as this is part of their core process. Ideally photo identification of the missing person should be available. High Risk This category will involve a detective inspector if the individual is not found within 24 hours. Details of medication and particularly any potential impact of lack of regular medication will be required. Expectation within the Trust is that the Duty Manager will be informed of all high category absences. The patient may be detained or informal, felt to be of high risk and that there is an immediate need to establish their whereabouts, and return to the ward. Page 18 of 30

19 APPENDIX 2 RETURN OF AWOL/MISSING PATIENTS FORM (To be completed within 24 of patient s return) Surname: Forenames: Hospital M no: Date Found: Circumstances Found: Time Found: Location found: Police Notified: (include date, time and name of officer advised to ensure Police do not continue searches) Relative/Carer Notified (Date and time) Outcome updated on Datix (Date) Completed by (Name): Profession: Signature: Date: Ward: Tel number: FILE A COPY OF THIS FORM IN THE PATIENT S CASE NOTE AND SEND GIVE/FAX THIS ORIGINAL FORM TO YOUR LOCALITY MENTAL HEALTH ACT ADMINISTRATOR Page 19 of 30

20 APPENDIX 3 Trust Missing Patient & AWOL Policy Flow Diagram Patient is found to be missing or AWOL Nurse in Charge establish risk category (Low, Medium or High). Category can be revised at any point For all categories use Trust missing/awol patient form, and keep record of events in Patients notes. Any reasons not to take any of the following actions must be recorded in the notes. The Ward report should also be completed. A copy of the Missing/AWOL patient form must be sent/faxed to the locality MHA Administrator Low Risk category: Carry out thorough search of ward and immediate area outside ward. Inform duty manager Contact next of kin, any other known contacts Establish when last seen and what clothing worn/identifying features Keep relevant parties briefed on progress Medium and High Risk categories. As Low category plus: Contact Police Give Police copy of Missing person/awol form Police may choose to search ward area Complete DATIX incident form. Inform patient s consultant or duty consultant Report as SUI where appropriate (see SUI Policy). Record details of search and progress in patients notes Whilst patient remains Missing/AWOL The team must review progress on the patient and a nominated person keep in contact with relevant parties at least on a daily basis Patient returns from Missing/AWOL All categories: Inform all relevant parties. Review Risk and level of observation, complete the outcome part of the Missing/AWOL patient form and send/fax a copy to the locality Mental Health Act Administrator. The original form should be filed in the patient s case-notes. Low Category: Contact On call doctor to review if judged necessary by the Nurse in Charge Medium and High: Contact doctor to review.

21 APPENDIX 4 TO BE COMPLETED BY LOCALITY MENTAL HEALTH ACT ADMINISTRATOR AWOL Notification reference: Statutory notification about the unauthorised absence of a person detained or liable to be detained under the Mental Health Act 1983 Care Quality Commission (Registration) Regulations 2009 Regulation 17 Guidance on completion of this form This form is designed to notify CQC of any absence without leave of a person detained or liable to be detained under the Mental Health Act 1983 (e.g. on s.17 leave of absence from hospital, or held under short-term powers of s.5, 135 or 136). The form requires you to state the security level of your service (at Part A below): Services that are designated as low, medium or high security, or Psychiatric Intensive Care Units (PICUs), should use the form to notify CQC of all incidences of absence without leave (AWOL). Services should complete this form as soon as possible after the incident is noted, but not to the detriment of taking necessary actions to deal with the incident on a practical level. Services designated as general security level (i.e. all services other than those listed above) should use the form to notify CQC of any incidence of AWOL when that absence occurs over midnight on any day. It is acceptable to submit forms reporting AWOL incidents relating to general security services on a weekly basis, if this is administratively more convenient than notifying CQC of each incident as it happens. You should complete a separate form for each AWOL episode, but only one form is required to report an AWOL incident that extends over more than one day. You must provide information in the mandatory sections (marked*). Please also provide all other requested information. It is acceptable to return part 2 of the form separately from part 1. Please type all entries where possible and enter dates in the format dd/mm/yyyy. Further guidance on the completion of this form is available at Under AWOL_Notification To be forwarded to the Commission by fax or secure . This form can be ed VIA NHS.NET ONLY by arrangement with the Mental Health Operations Team by calling number below. Any failure to ensure that its transmission meets current standards for secure delivery of confidential patient identifiable material will be the responsibility of the sender. It is the responsibility of the detaining/responsible authority to ensure this form is completed and sent. Tel: Fax:

22 PART 1 A. Detaining or responsible authority* Name/Address of provider organisation Name of ward Security level (tick ONE appropriate box) General Psychiatric Intensive Care Unit (PICU) Low Secure Medium Secure High Security Hospital (i.e. Ashworth, Broadmoor or Rampton Hospital) B. Details of absent patient Name Date of Birth Gender Date of Admission Section of the Mental Health Act* Date of Section C. Details of absence without leave* Date and Time absence began (tick ONE appropriate box) failed to return from authorised leave absented him or herself from hospital absented him or herself during escorted leave Has the patient a history of going absent without authorised leave? Yes No D. Contact information Contact Details (Please provide the name and professional status of the person who can be contacted about the content of this form if required): Contact Telephone Number: Date: Page 22 of 30

23 PART 2 E. Details of return from absence without authorised leave Name of Patient Date and time absence ended How the patient returned to the ward (tick ONE appropriate box) Returned of own volition Returned by family members Returned by police Returned by hospital or other staff Other (please specify below) F. Contact information Contact Details (Please provide the name and professional status of the person who can be contacted about the content of this form if different from Part 1): Contact Telephone Number: Date: Page 23 of 30

24 APPENDIX 5

25 CAMBRIDGESHIRE PROTOCOL FOR POLICE ASSISTANCE WHERE PATIENTS FROM MENTAL HEALTH ESTABLISHMENTS ARE ABSENT WITHOUT LEAVE - AWOL (under the MENTAL HEALTH ACT 1983, as amended 2007) OR MISSING.

26 Memorandum of Understanding between: Cambridgeshire and Peterborough NHS Foundation Trust Cambridgeshire Constabulary Page 26 of 30

27 1. Introduction This document has been developed following consultation with the Police service and the Department of Health; and takes account of key principles within the Mental Health Code of Practice (MHA CoP 2008). The protocol provides a framework that will support improved service delivery and the appropriate use of resources, and must be read in conjunction with the Cambridgeshire & Peterborough NHS Foundation Trust policy Absent without leave (AWOL) and Missing Patient policy (Inpatient and Community Patients) and Cambridgeshire Constabulary Missing Persons Policy. 2. Auditing and Monitoring of the Document All parties to this agreement will ensure that it is implemented in accordance with local procedures that will include provision for auditing the maintenance and the management of compliance with the terms of this document. Senior managers from signatory organisations will meet regularly to review compliance and to monitor any difficulties encountered 4. Each Mental Health Locality (Peterborough, Huntingdon, & Cambridge) will establish a regular liaison meeting with a local police officer of at least Inspector rank and the Cambridgeshire Constabulary Strategic Lead for Mental Health (Superintendent level) will review progress with senior Mental Health colleagues quarterly. 3. General Responsibilities 3.1 AWOL Patients If a patient detained under the Mental Health Act is Absent without Leave (AWOL), the police will assist in returning a patient to hospital if necessary under circumstances outlined below 5. When the police are requested to assist, information must be provided with regards to expiry time/date of power of detention If requested, the police will wherever possible assist a suitably qualified and experienced mental health professional in returning a patient who is AWOL to a hospital or other similar establishment. However, Police will normally only assist in returning AWOL patients who display violent behaviour or threats of violence. A failure to comply with a request to return will not in itself be considered sufficient grounds to involve the Police and clinical staff will consider using powers under s.135 MHA. 4 MHA CoP para 10.16: Local policies on the use of police powers and places of safety; the parties to the local policy should meet regularly to discuss its effectiveness in the light of experience. 5 If the person is; considered to be particularly vulnerable; considered to be dangerous; or subject to restrictions under Part 3 of the Act. There may also be other cases where, although the help of the police is not needed, a patient s history makes it is desirable to inform the police that they are AWOL in the area (MHA CoP para 20.14). 6 MHA Cop para Local policies: Wherever the police are asked for help in returning a patient, they must be informed of the time limit for taking them into custody Page 27 of 30

28 3.1.3 If a patient who is AWOL returns or is found, the police will be informed immediately by the agency who identified the patient was missing 7. There will be no need for Police to carry out an alive and well debrief of a patient in these circumstances providing the patient has been seen by a Mental Health professional who has carried out a debrief and recorded any relevant information on the patients records. The importance of a debrief cannot be underestimated, particularly as it informs the risk assessment and search response should the patient go missing again in the future Should an AWOL patient display behaviours that result in them not being suitable to be returned to the MH ward from which they absconded ( because of violence or threats of violence), then the AWOL patient should be lodged in a Police custody suite as a temporary place of safety until appropriate arrangements can be made. The guiding principle is that the patient s needs are paramount, that Police custody suites must always be a last resort for such patients and that all parties should treat the finding of alternative accommodation as a priority. 3.2 Missing Patients If a patient is missing (i.e. not AWOL in accordance with legislation), the Police will carry out a proportionate response taking into account the bespoke risks associated with the missing person and Cambridgeshire Constabulary Missing Persons policy Once missing patients are found safe and well, the Police will take appropriate action, i.e. inform the establishment from where the patient is missing, or refer to an AMPH for an assessment on private premises. The guiding principle is to act in the patients best interests and therefore Police officers may seek to negotiate with the patient and facilitate their return to the establishment. This must, however, be the decision of the officers dealing with the incident and officers are required to apply their professional judgement in light of the circumstances they face. Should the patient be found in circumstances that require Police to use powers under the Mental Health Act then they will do so. 4. Searches of Mental Health Establishments In all cases, staff at the establishment from which the patient is missing or AWOL must ensure that a thorough search of the designated search area has been completed prior to making a request for police assistance. 8 The designated search area will be agreed through local liaison between the local police liaison officer and the appropriate manager of the mental health establishment and displayed in a prominent location within the establishment. 7 MHA CoP para 22.16: Local policies: Where the police have been informed about a missing patient, they will be told immediately if the patient is found or returns. 8 MHA CoP para Local policies: In relation to detained and SCT patients circumstances in which a search of hospital and grounds should be made. Page 28 of 30

29 5. Documentation and Risk Assessment The Mental Health establishment who has reported a patient as either AWOL or missing will supply the Police on attendance a Report of Missing/AWOL Patient form (appendix 1). This form will be used to inform the Police risk assessment process and will be completed in as much details as possible. When a patient returns to the establishment, the Return of AWOL/Missing Patients form (Appendix 2) will be completed. It is not necessary to provide Police with a copy of this form but the form must be available for later scrutiny by Police if requested. It is particularly important to record who in the Constabulary was advised of the patients return. Appendix 3 is the flow chart used by MH professionals when a patient is either missing or AWOL and is attached for the information of Police. 6. Conveyance In cases where a person is AWOL, it is envisaged that the relevant ambulance trust will be responsible for conveying that person to the designated mental unit, if detained under the MHA 9. Currently, there is significant variety of local practice and until such time as the ambulance trust signs up to this protocol, the conveyance of an AWOL patient may be subject to local discussion on a case by case basis. This protocol recognises that this is not an ideal situation for local managers to resolve. In exceptional circumstances a police officer may decide to expedite conveyance themselves, this should ideally only be in cases of urgency where it is necessary to safely manage a risk of violence or to prevent escape MHA CoP para 11.6: Local protocols; It is for primary care trusts (PCTs) to commission ambulance and patient transport services to meet the needs of their areas. This includes services for transporting patients to and from hospital (and other places) under the Act. 10 MHA CoP para 11.20: Local protocol; When conveying it may be necessary to use a police vehicle because of the risk involved. Page 29 of 30

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