SECTION: 8.0 - MENTAL HEALTH LEGISLATION POLICY AND PROCEDURE NO: 8.03 NATURE AND SCOPE: SUBJECT: POLICY - TRUSTWIDE SECTION 17 LEAVE OF ABSENCE FOR PATIENTS DETAINED UNDER THE MENTAL HEALTH ACT 1983 This policy details the requirements relating to patients detained under the MHA 1983 who are granted leave of absence. DATE OF LATEST RATIFICATION: SEPTEMBER 2016 RATIFIED BY: EXECUTIVE LEADERSHIP TEAM IMPLEMENTATION DATE: OCTOBER 2018 REVIEW DATE: AUGUST 2019 ASSOCIATED TRUST POLICIES & PROCEDURES: Section 18 of the MHA Absence without Leave - 8.04 ISSUE 8 OCTOBER 2018
NOTTINGHAMSHIRE HEALTHCARE NHS FOUNDATION TRUST SECTION 17 LEAVE OF ABSENCE FOR PATIENTS DETAINED UNDER THE MENTAL HEALTH ACT 1983 POLICY 1.0 Introduction 2.0 Policy Principles CONTENTS 2.1 Sections of the MHA under which Section 17 Leave of Absence is applicable 2.2 Who can grant Leave of Absence under Section 17? 2.3 Granting of leave under Section 17 2.4 What needs to be done prior to leave being granted? 2.5 Recording of Section 17 Leave 2.6 Section 17 leave for patients requiring a stay in another hospital. 2.7 Care and treatment whilst on leave 2.8 Action to be taken if the patient fails to return from leave at the agreed time. 2.9 Who can revoke a period of leave? 2.10 Action to be taken if Section 17 Leave is revoked 2.11 Duration of Leave/ Renewal of Authority to Detain 2.12 Human Rights Issues with regard to Section 17 Leave of Absence 3.0 Definitions 4.0 Source Documents 5.0 Responsibilities 6.0 Training 7.0 Target Audience 8.0 Review Date 9.0 Consultation 10.0 Legislation Compliance 11.0 Equality Impact Assessment 12.0 Champion and Expert Writer Appendix 1 Appendix 2 Equality Impact Assessment (EIA) Screening Tool Record of Changes ISSUE 8 OCTOBER 2018 2
NOTTINGHAMSHIRE HEALTHCARE NHS FOUNDATION TRUST SECTION 17 LEAVE OF ABSENCE FOR PATIENTS DETAINED UNDER THE MENTAL HEALTH ACT 1983 POLICY POLICY STATEMENT This policy should be read in conjunction with Chapter 27 of the Mental Health Act Code of Practice (2015) and associated Trust Divisional and Directorate procedures. 1.0 INTRODUCTION 1.1 For patients receiving care and treatment within Mental Health Services, periods of leave from the ward area play an important part in their treatment plan, particularly in relation to discharge planning. 1.2 For patients who are detained under the Mental Health Act 1983, the only way they may be allowed, lawfully, to go outside the hospital grounds is if the responsible clinician (RC) has granted leave of absence to an unrestricted patient or, in the case of a restricted patient, with the approval of the Secretary of State for Justice. 1.3 It is immaterial if the patient is escorted by hospital staff, whether the excursion is part of a specified treatment plan or even as a result of an emergency, without the consent of the RC, or with the authority of the Secretary of State for Justice if the patient is subject to restrictions, the leave is invalid and a breach of the law. 1.4 Section 17 concerns leave of absence from hospital. This is the hospital which is named in the application or order which provides authority for the patient s detention. This includes a hospital where the patient has been transferred under section 19. 1.5 A hospital is that managed by one set of managers e.g. Nottinghamshire Healthcare Trust. Leave of absence under s 17 is therefore not a legal requirement if a patient is not going to leave the grounds of the hospital. Those patients subject to restriction orders can have ground leave within the hospital unless they are subject to an order under s47 Crime (Sentences) Act 1997 to be detained in a named hospital unit. 1.6 Each directorate must have a local section 17 procedure which defines what constitutes the particular hospital and where the boundaries of that hospital lie. 2.0 POLICY PRINCIPLES 2.1 Sections of the MHA under which Section 17 Leave of Absence is applicable: 2.1.1 Leave of absence can be granted to any patient detained under sections 2, 3, and 37 of the Mental Health Act 1983. It is not legally possible to do so where a patient is subject to sections 4, 5(2), 5(4), 135 and 136. 2.1.2 Patients detained under Sections 35, 36 and 38 cannot be granted leave of absence. 2.1.3 Patients who are subject to a restriction order under Sections 41 or 49 cannot be granted leave of absence without the permission of the Secretary of State for Justice. ISSUE 8 OCTOBER 2018 3
2.2 Who can grant Leave of Absence under Section 17? 2.2.1 Only a patient s RC has the authority to grant leave of absence under Section 17. 2.2.2 In the case of restricted patients leave can only be granted with the approval of the Secretary of State for Justice. 2.2.3 The authority for granting Section 17 leave cannot be delegated, so RC cannot delegate the task to a junior. Where the RC is on annual leave or otherwise unavailable (such as off sick), permission can only be granted by the approved clinician who is for the time being in charge of the patient s treatment and who is, therefore, temporarily acting as the patient s RC. 2.2.4 Where trial leave is granted - for example to a rehabilitation unit within the Trust - it is usual practice for the in-patient consultant to maintain their RC status for the patient until it is clear that the patient will successfully rehabilitate outside the ward environment. The RC status will then be formally transferred to the community consultant. As such, the in-patient consultant maintains the role and responsibilities of the RC until the transfer takes place. 2.3 Granting of leave under Section 17 2.3.1 Wherever possible, any period of leave should be planned in advance and agreed in consultation with all relevant persons included in the patient s care and treatment. The responsible clinician can also make the leave subject to any condition, which he/she considers necessary in the interests of the patient or for the protection of other people. 2.3.2 Any proposal to grant leave to a restricted patient has to be approved by the Secretary of State for Justice who should be given as much notice as possible, together with full details of the proposed leave. 2.3.3 Leave of absence can be granted by the responsible clinician for specific occasions or for longer indefinite or specific periods of time. The period of leave may be extended in the patient s absence. The granting of leave should not be used as an alternative to discharging the patient or as an alternative to a Community Treatment Order. 2.3.4 Whenever considering whether to grant leave of over seven consecutive days, the responsible clinician must first consider whether the patient should instead go onto a Community Treatment Order (CTO) and show that both options have been considered. This does not apply to restricted patients or patients subject to section 2. 2.4 What needs to be done prior to leave being granted? 2.4.1 Once the responsible clinician has determined that s 17 leave, rather than a CTO is the appropriate option for the patient the leave should be properly planned, if possible, well in advance. Leave may be used to assess an unrestricted patient s suitability for discharge from detention. There should be: Consultation with the people involved in the patient s care and treatment about the proposed leave. ISSUE 8 OCTOBER 2018 4
Agreement with the patient about the period of leave and any restrictions imposed on them. Subject to the patient s consent detailed consultation with any appropriate carers, relatives, friends or other persons (especially where the patient is to reside with them) and with community services who are to be involved in his/her care. If patients do not consent to carers or other people who would normally be involved in their care being consulted about their leave, responsible clinicians should reconsider whether or not it is safe and appropriate to grant leave (MHA Code 2015 (27.19)) A review and updating of the patient s risk assessment to take into account the plans for leave from the ward. An up to date care plan completed in conjunction with the patient which reflects the planned period of leave and ensures that the patient and significant others are aware of what to do if problems arise. 2.4.2 In the case of patients who are seen by the responsible clinician and leave is agreed in advance, the nurse in charge of the ward at the time the patient is to commence leave, has a responsibility to assess the patient s mental state. If there are any concerns, the nurse in charge of the ward should not facilitate the leave and request the responsible clinician to assess the patient. For patients at high security hospitals, The High Security Psychiatric Services (Arrangements for Safety and Security in Ashworth, Broadmoor and Rampton Hospitals) Directions 2011 (Paragraph 40) impose strict requirements relating to the provision of a risk assessment management plan and security director approval before granting leave of absence. 2.5 Recording of Section 17 Leave 2.5.1 The granting of leave under Section 17 and any specific conditions attached to it should be recorded in both the patient s nursing and medical notes as well as on the Section 17 Leave Form As electronic patient records have recently been introduced across the Local Partnerships Division, a Section 17 Form can be found within the RiO system. This enables the RC to complete the form remotely if necessary. The RiO form will still have to be printed out in order for it to be given to the patient and others who may need to have it. A paper form is accessible should IT problems prevent access to the RiO system. http://connect/mental-health-act-section-forms Within Rampton High Secure Hospital, the Section 17 Leave Form is embedded into the Leave of Absence Planning and Authority Form (LAPA), with the Responsible Clinicians signature reflecting authority for the Section 17 Leave to commence located within the Record of Authorising Signatories page of the same document. The granting of leave within Arnold Lodge, Wathwood and the Wells Road Centre will be documented using a local template and recorded within the patient s nursing and medical notes. Authorisation has to be completed by the responsible clinician, dated and signed, with copies going to: The patient (signed by the patient if possible) ISSUE 8 OCTOBER 2018 5
The patient s carer/relative/friend or other person The Mental Health Act Administrators (other than where completed on RiO) The patient s running records (which may be by completion on RiO) The patient s community worker (as appropriate). 2.5.2 The information that has to be recorded is: Date that leave has been granted. Expiry date and time. If it is for recurring leave, a review date. Where the leave is to be taken. Who, and how many persons (if anyone), is to escort the patient whilst on leave. Any restrictions imposed whilst the patient is on leave. Who has received copies of the leave form. If the Section 17 Leave Form or LAPA has not been authorised by the responsible clinician, the leave cannot go ahead. 2.5.3 The outcome of leave should be recorded. Patients should be encouraged to give their own views about their leave, which will be recorded in the running records. 2.6 Section 17 leave for patients requiring a stay in another hospital 2.6.1 There may be instances where a detained patient has to stay on a medical or surgical ward for treatment. 2.6.2 A Section 17 leave form must be completed when detained patients leave the hospital that is managed by the detaining Trust. 2.6.3 Where a hospital comprises of a number of buildings which are not on the same site, leave of absence will be required for any period of absence involved in moving between those buildings. 2.6.4 Each directorate must have a local procedure which defines procedures to follow in an emergency (e.g. physical treatment). 2.7 Care and treatment whilst on leave 2.7.1 A patient granted leave under Section 17 remains liable to be detained under the Act and is, therefore, subject to the same consent to treatment provision as if they were still in hospital. 2.7.2 The responsible clinician s responsibilities for the patient s care remain the same while he/she is on leave although they are exercised in a different way. The duty to provide after-care under section 117 includes patients who are on leave of absence (provided they would otherwise qualify). 2.8 Action to be taken if the patient fails to return from leave at the agreed time ISSUE 8 OCTOBER 2018 6
2.8.1 If a patient fails to return to the ward at the agreed time they are classed as absent without leave (AWOL) and can be returned under Section 18 of the Mental Health Act 1983. 2.8.2 Patients who are AWOL and who are liable to be detained may be retaken by a police officer, an officer on the staff of the hospital, or an AMHP. If the patient is in private premises and entry is barred, a warrant for entry must be obtained under Section 135(2) of the Act. 2.9 Who can revoke a period of leave? 2.9.1 The patient s responsible clinician can revoke leave at any time if he/she considers it necessary, in the interests of the patient s health or safety or for the protection of other people. 2.9.2 Any concerns from relatives or carers about how the leave is progressing and any other concerns they may have should be taken seriously. 2.9.3 If it is the case that the patient is actually on leave at the time Section 17 is revoked, serious consideration must be given to the reasons for recalling the patient and the effect the recall would have on them, as well as how best to return the patient to the ward. Refusal to take medication would not on its own be a reason for revocation. The responsible clinician would have to be satisfied that the likely consequences of the refusal were such as to make it necessary in the patient s interests or for the safety of others for the patient to be recalled. 2.10 Action to be taken if Section 17 Leave is revoked 2.10.1 In all cases the reasons for revoking the leave are to be explained to the patient, and the discussions should be recorded in the patient s running records. 2.10.2 All other relevant persons should also be notified of the patient s leave being revoked. 2.10.3 In circumstances where the patient is recalled to hospital, a separate Notice of Recall, Section 17 (4), must be completed by the responsible clinician (available on the Trust intranet). 2.10.4 The MHA Code 2015 (27.33) requires that the responsible clinician arranges for notice in writing to be served to the patient or the person who is for the time being in charge of the patient. 2.11 Duration of Leave/ Renewal of Authority to Detain 2.11.1 Any period of leave cannot last longer than the duration of the authority to detain which was current when the leave was granted. 2.11.2 A patient who remains on extended leave of absence from hospital upon expiry of the current detention period ceases to be liable to be detained. 2.11.3 It is not a legal requirement for the patient to be resident in hospital, rather than on leave, prior to the expiry of the current period of detention, but in order for the detention to be renewed there must be a significant component of the care package which involves treatment at a hospital (which could be at outpatients). ISSUE 8 OCTOBER 2018 7
2.11.4 The renewal of leave provides a further opportunity to consider if it would be more appropriate for the patient to be placed on to a Community Treatment Order instead. 2.12 Human Rights Issues with regard to Section 17 Leave of Absence 2.12.1 When dealing with occasions which do require formal leave under Section 17, it is important to ensure that there are no unnecessary delays in the granting of leave. 2.12.2 It is important that the responsible clinician ensures that the conditions attached to Section 17 leave are reasonable and proportionate and the patient is informed of the nature of the conditions and consequences of breach.. 2.12.3 Where Section 17 leave is revoked, there must be adequate grounds to do so. 3.0 DEFINITIONS 3.1 Section 17 Leave is any leave of absence that is authorised by the Responsible Clinician which enables a detained patient to go outside the hospital grounds for any period of time. 4.0 SOURCE DOCUMENTS 4.1 Mental Health Act Code of Practice 2015 Chapter 27. The High Security Psychiatric Services (Arrangements for Safety and Security in Ashworth, Broadmoor and Rampton Hospitals) Directions 2011 5.0 RESPONSIBILITIES 5.1 Executive Directors, Clinical Directors and General Managers will be responsible for ensuring that local procedures are agreed for each Care Group they manage and that these are updated periodically. 6.0 TRAINING 6.1 Mental Health Act Training is available face to face and on line. Section 17 leave is discussed. 7.0 TARGET AUDIENCE 7.1 All staff who care for patients liable to be detained under the Mental Health Act 1983. 8.0 REVIEW DATE 8.1 This policy will be reviewed in 3 or in light of organisational or legislative changes. 9.0 CONSULTATION 9.1 Executive Leadership Council 10.0 LEGISLATION COMPLIANCE 10.1 This policy must be read in conjunction with Chapter 27 of the Mental Health Act Code of Practice 2015 and the appropriate divisional and directorate procedures. 11.0 EQUALITY IMPACT ASSESSMENT ISSUE 8 OCTOBER 2018 8
11.1 This policy has been screened to identify its relevance to equality and diversity. In particular, the policy has been screened in order to identify whether the policy may (1) have a differential and adverse impact on any identified minority groups (2) provide an opportunity to promote equality. 12.0 CHAMPION AND EXPERT WRITER 12.1 The Champion of this policy is Dr Julie Hankin, Executive Medical Director. The Expert Writer is Michael Sergeant MHA/MCA Lead (Local Partnerships Division). ISSUE 8 OCTOBER 2018 9
APPENDIX 1 EQUALITY IMPACT ASSESSMENT (EIA) SCREENING TOOL (Towards an Equality and Recovery Focused Organisation) A. Name of policy/procedure/strategy/plan/function etc. being assessed: 8.03 SECTION 17 LEAVE OF ABSENCE FOR PATIENTS DETAINED UNDER THE MENTAL HEALTH ACT 1983 B. Brief description of policy/procedure/strategy/ plan/function etc. and reason for EIA: This policy details the requirements relating to patients detained under the MHA 1983 who are granted leave of absence. C. Names and designations of EIA group members: Michael Sergeant MHA/MCA Lead Local Services Division Jaswinder Basi CPA & MHA Manager. Julie Harris MHA Team Leader D. List of key groups/organisations consulted: Executive Leadership Council E. Data, Intelligence and Evidence used to conduct the screening exercise: Mental Health Act 1983 Code of Practice Mental Capacity Act 2005 Code of Practice ISSUE 8 OCTOBER 2018 10
F. Equality Strand Does the proposed policy/procedure/ strategy/ plan/ function etc. have a positive or negative (adverse) impact on people from these key equality groups? Please describe Race Gender Including. Transgender and Pregnancy & Maternity Disability This policy aims to have a positive impact on any member of the wider community. Consequently the Trust as a public authority must, in the exercise of its functions, have due regard to the need to a) eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Equality Act 2010 in regard to the nine protected characteristics in the Equality Act 2010 (age, disability gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex, sexual orientation). Are there any changes which could be made to the proposals which would minimise any adverse impact identified? What changes can be made to the proposals to ensure that a positive impact is achieved? Please describe Have any mitigating circumstances been identified? Please describe Areas for Review/Actions Taken (with timescales and name of responsible officer) As Race As Race Expert Writer to review in 3 As Race As Race As Race Expert Writer to review in 3 As Race. However, as mental health is classified as a disability under the Disability Discrimination Act this policy promotes consistency of mental health issues. As Race As Race Expert Writer to review in 3 Religion/Belief As Race As Race As Race Expert Writer to review in 3 ISSUE 8 OCTOBER 2018 11
Sexual Orientation Incl. Marriage & Civil Partnership As Race As Race As Race Expert Writer to review in 3 Age As Race As Race As Race Expert Writer to review in 3 Social Inclusion* 1 As Race As Race As Race Expert Writer to review in 3 Community As Race As Race As Race Expert Writer to review in 3 Cohesion* 2 Human Rights* 3 - As Race As Race As Race Expert Writer to review in 3 Including Compliance with Article 8 Safeguarding ECHR * 1 for Social Inclusion please consider any issues which contribute to or act as barriers, resulting in people being excluded from society e.g. homelessness, unemployment, poor educational outcomes, health inequalities, poverty etc. * 2 Community Cohesion essentially means ensuring that people from different groups and communities interact with each other and do not exclusively live parallel lives. Actions which you may consider, where appropriate, could include ensuring that people with disabilities and non-disabled people interact, or that people from different areas of the City or County have the chance to meet, discuss issues and are given the opportunity to learn from and understand each other. * 3 The Human Rights Act 1998 prevents discrimination in the enjoyment of a set of fundamental human rights including: The Right to a Fair Trial; Freedom of Thought, Conscience and Religion; Freedom of Expression; Freedom of Assembly and Association; the Right to Education; the Right Not to be Subjected to Torture, Degrading or Inhumane Treatment; and the Right to Enjoy Private, Family and Home Life Without Unjustified Interference from Public Authorities. G. Conclusions and Further Action (including This policy has been assessed using the Equality Impact Assessment Screening Tool. The whether a full EIA is deemed necessary and agreed assessment concluded that the policy, properly followed, would have no adverse impact on any of date for completion) the nine protected characteristics in the Equality Act 2010 (age, disability gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex, sexual orientation). H. Screening Tool Consultation End Date 27 th August 2013 (EIA reviewed February 2018 no amendments required) I. Name and Contact Details of Person Responsible for EIA (tel. e-mail, postal) J. Name of Group Approving EIA (i.e. Directorate E&D Group; Divisional Workforce, Equality & Diversity Group; Trustwide E&D Subcommittee; or Divisional Policy & Procedures Group) Michael Sergeant Mental Health Act/Mental Capacity Act Lead (Local Services) e-mail: michael.sergeant@nottshc.nhs.uk Postal: Mental Health Act Department, Duncan Macmillan House, Porchester Road, Mapperley, Nottingham NG3 6AA Equality and Diversity Subcommittee of the Board of Directors ISSUE 8 OCTOBER 2018 12
APPENDIX 2 Policy/Procedure: Section 17 Leave of Absence for Patients Detained Under the Mental Health Act 1983 Issue: 08 Status: Author Name and Title: APPROVED Michael Sergeant MHA/MCA Lead (Local Services Division) Issue Date: OCTOBER 2018 Review Date: AUGUST 2019 Approved by: EXECUTIVE LEADERSHIP TEAM (SEPT 2016) Distribution /Access: Normal RECORD OF CHANGES DATE AUTHOR POLICY DETAILS OF CHANGE Aug 10 J Harris 8.03 Minor changes to terminology throughout July 2013 M Sergeant 8.03 Changes and revisions throughout 02/15 M Sergeant 09/2016 M Sergeant 02/2018 M Sergeant 11/2018 M Sergeant 8.03 (Issue 4) 8.03 (Issue 5) 8.03 (Issue 6) 8.03 (Issue 7) References to 2015 MHA Code No amendments required to Policy content. Minor formatting amendments and change to Trust name and logo. Minor amendments only. Additions to 2.5.1 References to LAPA (Rampton) included As electronic patient records have recently been introduced across the Local Partnerships Division, a Section 17 Form can be found within the RiO system. This enables the RC to complete the form remotely if necessary. The RiO form will still have to be printed out in order for it to be given to the patient and others who may need to have it. The granting of leave within Wathwood, Arnold Lodge and Wells Road will be documented locally. ISSUE 8 OCTOBER 2018 13