Policy: L5 Patients Leave Policy (non Broadmoor) Version: L5/01 Ratified by: Policy Review Group Date ratified: 8 th August 2012 Title of originator/author: Consultation Psychiatrist Title of responsible Director Director of Nursing & Patient Experience Date issued: 11 th July 2013 Review date: September 2014 Target audience: All staff Trust wide EIA / Sustainability Implementation Plan Monitoring Plan Other Related Procedure or Documents: L5 Leave Policy EIA L5 implementation L5 Patients Leave West London Mental Health NHS Trust Page 1 of 19
Equality and Diversity statement The Trust strives to ensure its policies are accessible, appropriate and inclusive for all. Therefore all policies will be required to undergo an Equality Impact Assessment and will only be approved once this process has been completed Sustainable Development Statement The Trust aims to ensure its policies consider and minimise the sustainable development impacts of its activities. All policies are therefore required to undergo a Sustainable Development Impact Assessment to ensure that the financial, environmental and social implications have been considered. Policies will only be approved once this process has been completed. West London Mental Health NHS Trust Page 2 of 19
L5 Patients Leave Policy Version Control Version Date Title of Author Status Comment L5/01 Sept 11 Consultant Psychiatrist New Policy Under Consultation. Ratified at August 2012 TMT. 17 th July 2013 Re-issued to reflect Organisation and Department name changes. No changes to content. West London Mental Health NHS Trust Page 3 of 19
CONTENTS Page 1 Introduction 5 2 Scope of Policy and Objectives 5 3 Definitions 5 4 Responsibilities 6 5 Key Themes 8 6 Procedure 9 6.1 PART 1 - Informal patients 9 6.2 PART 2 - Detained patients 10 6.3 Missing Persons and Patients Absent Without Leave (AWOL) 11 6.4 Mental Capacity Act & Deprivation of Liberty Safeguards 14 7 Implementation 16 8 Audit 16 9 Training 16 10 Related Documents/References 16 11 Glossary / Acronyms 17 Appendix 1 Section 17 Leave Form Appendix 2 Inpatient Leave Checklist 18 19 West London Mental Health NHS Trust Page 4 of 19
1 INTRODUCTION 1.1 This policy is to ensure that all clinical staff are aware of their responsibilities prior to the granting (under Section 17 Mental Health Act 1983) or agreeing of an in-patient s leave, during periods of leave and on return from leave. 1.2 Leave is described as any agreed or authorised period of absence from the ward and is an essential part of an individual patient s treatment plan. Whilst on leave patients remain under the care of West London Mental Health Trust. As such, all leave should be planned by the clinical team (except in emergency situations) in conjunction with the patient, relatives and carers. The benefits of leave must be weighed up against the risks in each individual case prior to any decision. 1.3 All patients leave will be fully operated in accordance with the Trust CPA Policy (C2). 1.4 Leave arranged for detained patients will be authorised in accordance with Section 17 Mental Health Act 1983 and will reflect guidance in the Code of Practice to the Mental Health Act 1983. Please refer to Chapter 21 -Leave of Absence. 2 SCOPE OF POLICY AND OBJECTIVES 2.1 The policy provides for leave in relation to both informal patients and those patients who are subject to compulsion under the Mental Health Act 1983 and intends: To ensure the proper provision of leave for each individual patient. To provide staff with a framework for the use of leave. To clarify the role and responsibilities of clinical staff (inpatient and community). 2.2 This Policy does not cover leave arrangements for Broadmoor Hospital. These are detailed in the Leave of Absence for Patients at Broadmoor Policy L2. 3 DEFINITIONS 3.1 Leave The act of a patient leaving the physical structure of the ward/unit, either escorted or unescorted. For informal patients leave is used to mean time off the ward as agreed in the care plan. 3.2 Section 17 Leave Section 17 is the provision within the Mental Health Act 1983 (MHA 1983) for a Responsible Clinician (RC) to grant a detained patient leave of absence from the hospital. It is the only lawful way that a detained patient can be absent from the hospital even for a very short period of time. West London Mental Health NHS Trust Page 5 of 19
3.3 Hospital Grounds The Code of Practice notes 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 and supervising leave within the hospital grounds. For restricted patients, the hospital grounds are limited to the secure garden of their unit unless express Ministry of justice permission has been granted for wider ground leave. 3.4 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. 3.5 Care Programme Approach (CPA) A framework for multi-agency working in mental health services. 3.6 Approved Clinician (AC) A mental health professional approved by the Secretary of State to act as an approved clinician for the purposes of the Mental Health Act (1983). Some decisions under the Act can only be taken by people who are approved clinicians. 3.7 Responsible Clinician (RC) Under the terms of the Mental Health Act 1983 this means the Approved Clinician in charge of a patient s treatment. The role of the RC pertains only to patients who are formally detained under the Act. The term Responsible Consultant should be used in respect of informal patients, meaning a clinician with statutory responsibility for the patient s day-to-day care or a Deputy acting in their place. 3.8 Supervised Community Treatment (SCT) Arrangements under which patients can be discharged from detention in Hospital under the Act, but remain subject to the Act in the community. 3.9 RiO The electronic patient record system used by West London Mental Health Trust. 4 RESPONSIBILITIES 4.1 Chief Executive The Chief Executive has overall responsibility to ensure that policies and procedures are in place for the processes associated with the Mental Health Act. West London Mental Health NHS Trust Page 6 of 19
4.2 Executive Directors Executive Directors have responsibility to ensure that Clinical and Support Services are suitably established to provide the processes associated with the Mental Health Act and to ensure that clinical staff understand and comply with the service provision. 4.3 All WLMHT staff All WLMHT staff (both clinical and non clinical) have a general responsibility to act on information they receive regarding potential risk in leave arrangements and to liaise with the relevant mental health practitioner. This is an individual responsibility of every staff member. In cases of doubt a staff member who becomes aware of such information should discuss this with their line manager in a timely fashion. 4.4 Mental Health Practitioners All mental health practitioners are accountable for ensuring that appropriate management practices are used in the care of those service users for whom they are responsible. 4.5 In Patient Team Members All members of the multidisciplinary team involved with the service user (including Doctors, Nurses, Allied Health Professionals) are responsible for reviewing leave arrangements and risk assessments as part of an optimally informed care plan. 4.6 Care Coordinators Care Coordinators are responsible for being the community member of the in patient multidisciplinary review team. They are responsible for liaising with the inpatient team to inform leave arrangements and risk assessments as part of an optimally informed care plan. 4.7 Consultant Psychiatrists Consultant Psychiatrists are responsible for the proper care of all service users admitted under their care. This includes negotiating off ward activities and home leave with patients in consultation with the multidisciplinary team. 5 KEY THEMES 5.1 Within this policy a clear distinction is drawn between patients who are formal i.e. detained under the provisions of the Mental Health Act 1983 and those who are in hospital on an informal basis. 5.2 It is acknowledged that informal patients are free autonomous individuals who have a right to make their own decisions about whether to leave or remain in hospital. This includes decisions about day-to-day activities which may involve periods away from the ward base. West London Mental Health NHS Trust Page 7 of 19
5.3 For informal patients, the period of stay in hospital should be negotiated with them as part of a jointly agreed plan of care. The relative/carer s view should be sought where appropriate and with the patient s consent. 5.4 Activities outside of the ward base and periods of leave at home are crucial to the psychosocial management and recovery of those patients who have needed hospital admission under mental health services. 5.5 Leave under Section 17 MHA 1983 for detained patients can be granted: Indefinitely: i.e. without limit of time, up to the maximum allowed in law*. For specific occasions: e.g. weddings, out-patient appointments For specified periods: e.g. may have one week s home leave or may have two hours weekly for shopping. This leave can be extended in the patient s absence. *The length of leave cannot exceed the expiry of the order for detention which was current when the leave was granted - maximum of one year. If the patient has not been recalled from leave at the end of the period of detention, then he/she ceases to be detained. West London Mental Health NHS Trust Page 8 of 19
6 PROCEDURE 6.1 PART 1 - Informal Patients 6.1.1 On admission, the admitting Doctor and Primary Nurse should carry out a comprehensive risk assessment as per the Clinical Risk Policy (C27). 6.1.2 The risk assessment should be documented and should inform the care plan with respect to the appropriateness of off-ward activities/leave. The Primary Nurse/clinical team should negotiate this agreed plan with the patient in the context of the therapeutic aims of the admission. 6.1.3 The risk management and care plan, including the provisions for leave, should be reviewed and revised at the first multi-disciplinary team (MDT) meeting and at each multi-disciplinary team meeting thereafter. Changes to the plan should be negotiated with the patient, and where appropriate relatives and other professionals. The outcome of these reviews should be clearly documented and regularly updated. 6.1.4 Prior to any decision for leave, consultation will take place with the patient, their relatives and carers (with the patient s consent) to ascertain their views. The Primary Nurse (or other relevant clinician) should ensure that these views are communicated to the MDT to inform the decision making process. 6.1.5 The Responsible Consultant has a statutory responsibility for the proper care of all informal patients admitted under his/her care. This should include negotiating off ward activities and home leave with informal patients in consultation with the MDT. 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 leave plan if the patient (or their carers) wishes to. It is stressed that the ability to delegate this power exists only in relation to informal patients. 6.1.6 Preparation for Leave The Primary Nurse will, in collaboration with the Care Coordinator, 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 leave. Such goals and activities will form part of the patient s care plan. 6.1.7 In the case of home leave the Primary Nurse or Care Coordinator should 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 Primary Nurse should ensure that leave arrangements are clearly understood by the patient and communicated to relatives (with consent) and to any other relevant professionals. 6.1.8 Prior to the patient going on leave, the nurse in charge / Primary Nurse should satisfy themselves that earlier assessments remain valid. Where there is cause for concern, the nurse in charge / Primary Nurse should discuss their concerns with the ward Doctor and / or Responsible Consultant. If they are unavailable the West London Mental Health NHS Trust Page 9 of 19
Duty Doctor should be involved. The concerns and outcome of the discussion should be documented. 6.1.9 If any Clinician becomes concerned that an informal patient would be at significant risk due to their mental disorder if allowed to leave the ward, an attempt should be made to persuade the patient to remain as part of a revised agreed risk management plan. If this is unsuccessful the relevant Consultant (or Deputy) should be contacted to carry out an assessment as to whether the provisions of the Mental Health Act 1983 should be invoked. Consideration should be given to the use of holding powers under Section 5 of the Mental Health Act 1983. 6.1.10 The Primary Nurse, in consultation with the community Care Coordinator (if allocated), will discuss risk and coping strategies with the patient and their carers prior to leave (with the consent of the patient having been obtained). Any support needs will be assessed prior to leave and arrangements put in place and discussed with the patient and carers. Where the patient is going on home leave, the clinical team should be satisfied: that the patient has access to the premises that the patient s home destination is habitable with all services e.g. heating, water, power, sanitation that the patient is able to practically manage the leave period e.g. obtain any groceries etc 6.1.11 Any medication required by the patient during leave will be issued immediately prior to the patient going on leave. The Primary Nurse should ensure that the patient understands how and when to take their medication and also explain any as required (PRN) medication if issued. The patient should be reminded of the purpose of the medication and of any side effects they might encounter. 6.1.12 The patient, relatives and carers, should be informed that if there are any problems, they can 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 (if allocated) will be issued to the patient and relatives prior to commencement of leave. 6.1.13 An accurate record of all patients on leave from the ward should be maintained at all times. 6.1.14 Action following a patients leave Adequate feedback of progress when on leave is crucial for informing further recovery oriented care planning, timing of discharge and in reviewing risk. The Primary Nurse should ensure that structured feedback from the patient is always obtained and where possible gathered from all other relevant individuals. 6.1.15 All professionals need to be aware of the need for regular review of the mental state of the patient both before and after leave. Any changes should lead to a review of the risk management plan pertaining to leave. West London Mental Health NHS Trust Page 10 of 19
6.1.16 On return from leave, the Primary Nurse will discuss with the patient, relatives and carers events during the leave in order to assess achievements and/or any incidents that may have occurred. Where community support services are involved, contact must be made to establish their views of the leave. The outcomes of these discussions should be recorded. 6.1.17 All leave will be reviewed regularly in multi-disciplinary team discussions with the outcome and decisions arising from this review being clearly recorded. 6.2 PART 2 Detained Patients 6.2.1 Section 17 leave is not generally required for leave within the hospital grounds. In the case of restricted patients, where the Secretary of State or the courts have decided that the patient should be detained in a particular unit of a hospital, leave within the grounds of the hospital must be authorised under Section 17. 6.2.2 The following is a summary of the relevant rules applicable to this part of the Act. It is by no means exhaustive and is not intended to replace the practitioner s need to be aware of the relevant provisions of the Code of Practice, Reference Guide and the Act together with relevant case law. 6.2.3 All of the above in PART 1 is relevant and applicable when considering the granting of Leave of Absence under Section 17 of the Mental Health Act 1983 with detained patients and should be adhered to. 6.2.4 Detained patients may only be given leave from the hospital with the authority of the Responsible Clinician (RC). The power cannot be delegated to any other. The legal interpretation of the RC is the approved clinician with overall responsibility for a patient s care. Certain decisions can only be taken by the RC. In the absence of the patient s usual RC (e.g. if they are on leave) permission can only be granted by the approved clinician who is, for that period, acting as the patient s RC. 6.2.5 The decision to grant 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. Any decisions regarding Section 17 leave should be properly planned, whenever possible in advance, and should where practicable and appropriate be the subject of multi-disciplinary discussion and fully involve the patient. 6.2.6 It is the responsibility of the RC, subject to the patient s consent, to ensure that appropriately detailed consultation with any relatives, carers, friends (especially where the patient would be residing with them) and community professionals involved, is undertaken as appropriate. 6.2.7 Patients themselves should be made aware of how and who to contact if they have concerns during the leave period. In cases where relatives, carers, friends or community professionals are involved, they should also be provided with clear advice on how and who to contact if they have any concerns during the leave period. West London Mental Health NHS Trust Page 11 of 19
6.2.8 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 allows 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. The RC therefore, remains responsible for any leave granted under a general authorisation. 6.2.9 Where leave is granted on a short term specified period basis (e.g. may have one hours leave three time per week to be implemented at the discretion of the nursing staff), an exact record will be kept of when the leave occurs, the destination/purpose and the outcome of the leave, whether the patient returned on time and what, if any problems were encountered. A check, by the allocated nurse of the patient, will be made each time one of the periods of leave is to be implemented, to ensure that it remains within the maximum limit and terms authorised by the RC. It may be necessary for the Nurse in Charge to decline to allow a patient to utilise 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 should be informed and leave and risk assessment reconsidered. This decision must be recorded. 6.2.10 The discussion and decision to grant leave should be recorded and the specific details entered on the Section 17 Leave Authorisation Form (Appendix) 6.2.11 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. For overnight leave periods, the address where the patient will be staying must be recorded on the leave form. 6.2.12 It must be made absolutely clear as to the maximum period authorised (e.g. up to 3 hours on 3 occasions weekly from 1 January 2011 to 8 February 2011). The RC maintains responsibility for any leave arranged and implemented on this basis. 6.2.13 The form must be signed by the RC and, unless under exceptional circumstances, by the patient (if not signed by the patient, a reason should 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. 6.2.14 Any conditions attached to the leave must be clearly specified and all relevant people informed. A copy of the Section 17 leave form should be given to the patient, professionals involved and, where appropriate, relative and/or carer. 6.2.15 The original current Section 17 leave form should be kept in the patient s paper case notes and an entry made in the RiO electronic patient record. A copy must be sent to the Mental Health Act Office. Old forms must be crossed through and dated when they are superseded or when leave is revoked to avoid confusion as to the current leave status. 6.2.16 Any extended/indefinite leave will be fully operated in accordance with the Trusts CPA Policy and Procedures. West London Mental Health NHS Trust Page 12 of 19
6.2.17 All leave will be reviewed regularly in multi-disciplinary team discussions with the outcome and decisions arising from this review being clearly recorded. 6.2.18 Patients in Custody (with an Escort) or 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 kinds of arrangement would allow detained patients to have escorted leave for outings or to attend other hospitals for assessment and treatment as an outpatient or inpatient. 6.2.19 Consideration of Supervised Community Treatment When considering whether to grant leave of absence for more than seven consecutive days, or extending leave so that the total period is more than seven consecutive days, RCs must first consider whether the patient should be under supervised community treatment (SCT) instead. 6.2.20 The above does not apply to restricted patients or to patients detained under Section 2 of the Act, as they are not eligible for SCT. 6.2.21 One use of leave for more than seven days may be to assess a patient s suitability for discharge from detention. Guidance on factors to be considered when deciding between leave of absence and SCT is given in the Code of Practice. 6.2.22 An explanation should 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. 6.2.23 Restricted Patients In the case of patients who are restricted, by virtue of being subject to Sections 41 or 49 of the Act, then leave can only be granted with the agreement of the Secretary of State. 6.2.24 The RC should use the standard leave forms and guidance issued by the Ministry of Justice in reporting of leave for restricted patients. 6.2.25 When leave has been authorised by the Secretary of State the RC may then grant leave under section 17 as above. 6.2.26 A restricted patient may have their leave revoked by the RC or the Secretary of State. 6.3 Missing Persons and Patients Absent Without Leave (AWOL) 6.3.1 Detained patients should be considered absent without leave (AWOL) if they: i) Are subject to detention under a Section of the Mental Health Act 1983 West London Mental Health NHS Trust Page 13 of 19
ii) iii) and, as an in-patient, absents themselves without leave having been approved under Section 17. Fail to return to hospital when recalled from a period of leave authorised under section 17. Are absent without permission from an address where they have been required to live as a condition of their period of leave granted under section 17, or by their guardian (patients restricted by a Guardianship Order only). iv) Absent themselves from hospital without leave granted under Section 17. v) Abscond whilst on escorted Section 17 leave (either within or outside of the hospital s grounds. vi) vii) Abscond whilst being accompanied by staff. This may be from the hospital grounds or on an escorted visit somewhere in the community. Leave a secure area without the knowledge or permission of staff. 6.3.2 Informal patients should be considered as missing persons rather than being absent without leave. They may be listed as missing persons if they: i) Fail to return from leave at an agreed time without giving details of their whereabouts to the ward, unit or department. ii) iii) Leave a ward, unit, or department without the knowledge of staff when they have been assessed as being High Risk (it is expected that such patients would normally be detained under the Mental Health Act). There is no power to re-take and return to hospital, a patient who is not liable to be detained under the Mental Health Act. Evade their escort (whilst being accompanied by staff) and cannot be found. 6.3.3 The Missing Persons and Patients Absent Without Leave (AWOL) Policy (P1) should be implemented under these circumstances. This policy includes reference to CQC reporting requirements. 6.4 Mental Capacity Act & Deprivation of Liberty Safeguards 6.4.1 Informal patients who have been assessed as lacking capacity in relation to treatment may be subject to periodic restraint in order to lawfully provide such treatment under the provisions of sections 5 & 6 of the Mental Capacity Act 2005 (MCA). 6.4.2 The capacity of such patients should also be routinely tested in relation to their freedom to leave the ward and/or the building, either alone or in the company of carers or others. The views of any carers or appropriate family members on this issue should be sought and recorded. 6.4.3 If it is concluded that it is unsafe for such a patient to leave the ward without an escorting member of staff or carer, or only to have access alone to a specified area, this may amount to a deprivation of liberty which is not permitted by the MCA. In all such cases, a carefully considered care plan, kept under regular West London Mental Health NHS Trust Page 14 of 19
review, which provides a degree of reasonable restriction specifically relating to their care and treatment needs but does not amount to a deprivation of liberty will be permissible. 6.4.4 In any case where the clinical team believe that the level of restriction in relation to freedom to leave the ward and/or the building is such that it appears to amount to, or may become, a deprivation of liberty, a referral for assessment under the Deprivation of Liberty Safeguards (DoLS) must be made. If necessary, an urgent authorisation may be appropriate to cover the period awaiting assessment. 6.4.5 Even if the referral does not lead to an order under DoLS, any ongoing restrictions on movement (including a requirement that the patient may only leave the ward/building with an escort) should be kept under regular, documented review to ensure that no unlawful deprivation of liberty occurs. 6.4.6 Where it is unclear whether the appropriate statutory scheme to consider is the Mental Health Act (MHA) or MCA, the Consultant Psychiatrist should seek advice. As a general rule of thumb, where there are concerns for the safety of anyone other than the patient, MHA will be the appropriate scheme. Where there are concerns only for the health or safety of the patient, MCA will be appropriate. 6.4.7 In all cases, carers and family members should be fully informed of the extent of any agreed restrictions and be invited to give their views. The only exception to this is where the clinical team believe that such contact would not be in the best interests of the patient e.g. where there are current safeguarding concerns. 6.4.8 In any case where such a patient has an attorney under a health and welfare Last Power of Attorney, or a Court Appointed Deputy, that person will usually be empowered to consent (or not) to restrictions on liberty which do not amount to a deprivation of liberty. They must be contacted in all cases as the legal, surrogate decision maker for the patient. 6.4.9 For any patient already subject to an order under DoLS authorising their deprivation of liberty in one of our hospitals, there may be a condition in the best interests assessment documentation relating to freedom to come and go from the hospital. If so, decisions on leave should be in accordance with that condition. If this needs to be varied, it will be necessary to contact the supervisory authority, currently through the relevant joint CCG/Borough DoLS office. 6.4.10 Unless explicit in the DoLS documentation, decisions relating to leave within the hospital grounds will be at the discretion of the Responsible Consultant. Any decision to arrange leave outside the hospital, unless already covered by the DoLS documentation will require review by the supervisory authority. 6.4.11 Routine leave for medical treatment will normally be at the discretion of the Responsible Consultant. Leave for any urgent medical treatment should be facilitated immediately with any formalities dealt with afterwards. 6.4.12 In the extremely rare event that a person subject to both DoLS and a Community Treatment Order is recalled to hospital from a care home, all decisions about leave will be regulated entirely under the MHA. West London Mental Health NHS Trust Page 15 of 19
7 IMPLEMENTATION 7.1 All clinical staff are responsible for ensuring that this policy is effectively implemented. 7.2 The full implementation plan is embedded within this document. 7.3 This policy will be available on the Trust Exchange. 7.4 There is a rolling programme of Mental Health Law training and specific training is available to individual teams on request, which covers all the key elements of the Mental Health Act 1983 and its implementation. 8 AUDIT 8.1 Routine audit/monitoring of compliance with the policy should be part of normal operational management responsibilities. 8.3 Appendix 2 provides a Checklist that should be used to monitor adherence to this policy 8.2 All documentation relating to the Mental Health Act will be audited by MHA personnel as they arrive in the Department and also routinely audited by senior MHA personnel on an ad hoc basis for compliance with the requirements of the Act. 9 TRAINING 9.1 All staff are required to attend induction and mandatory training as per their training passports. 10 RELATED DOCUMENTS/REFERENCES 10.1 The authorising of leave under Section 17 MHA 1983 is subject to a range of guidance and regulations in a number of publications, which must be read by all staff directly involved in its operation. The principle publications are: The Mental Health Act 1983 Reference Guide paragraphs 12.39-12.56 The Code of Practice Mental Health Act 1983 Chapter 21 The Quality Care Commission Guidance Note 18 The Ministry of Justice Leave of absence for patients subject to restrictions Guidance for Responsible Clinicians HSG (96)28 The use of trial leave under section 17 of the Mental Health Act 1983 to transfer patients between hospitals. West London Mental Heath Trust Policy P1 - Missing Persons and Patients Absent Without Leave (AWOL) West London Mental Heath Trust Policy C2 Care Programme Approach West London Mental Heath Trust Policy C27 Clinical Risk West London Mental Health NHS Trust Page 16 of 19
11 GLOSSARY / ACRONYMS CPA MHA RC AC SCT MDT AWOL DoLS CCG MCA Care Programme Approach Mental Health Act Responsible Clinician Approved Clinician Supervised Community Treatment Multi Disciplinary Team Absent Without Leave Deprivation of Liberties Clinical commissioning group Mental Capacity Act West London Mental Health NHS Trust Page 17 of 19
APPENDIX 1 Record of Granting Section 17 Leave of Absence Patient Name( Print) is currently detained on Ward under Section the Mental Health Act 1983 Leave of absence is authorised as follows: (specified periods) From time/date To time/date At discretion of:.. Up to: (delete which is Not applicable) minutes Escorted by Ward Staff: daily hours Escorted with day services daily hours Unescorted leave daily OTHER LEAVE: CONDITIONS: escorted, destination, no alcohol and full address of any overnight leave. (If leave extends seven days give reasons why Section 17 Leave is an alternative to a Supervised Community Treatment Order) Review Date: OVERNIGHT LEAVE LONG TERM LEAVE (conditions of leave as follows) From (date) To: (date) Responsible Clinician Signature: (if signed in the absence of the regular Responsible Clinician, please confirm you are the official covering Consultant) Patient Signature This Section 17 Leave Form is a record of the Responsible Clinicians authorisation of leave and consequently should be signed by the Responsible Clinician and recorded in the Case Notes. (Original Section 17 Leave Form should be filed in Case Notes Clear copies to be given to the Patient Nearest Relative and the Mental Health Act Office) WARD CONTACT NUMBER: West London Mental Health NHS Trust Page 18 of 19 Policy L5 First Date of Issue: Aug 12 This is current version L5/01 Aug 12
INPATIENT LEAVE CHECKLIST DETAILS APPENDIX 2 CONFIRMED DATE for leave to start Those involved in agreeing leave: RC Patient Carer/relative MDT inpatient team MDT community team Other Aims of leave Risks considered Leave plan Overnight leave Address Contact details Section 17 form applicable Yes/no Copy given to patient Practical issues: Accommodation Food Money Medication: Ordered Collected Crisis Plan: What to do Who to contact Contact details Feedback from leave DATE/PLACE for leave review West London Mental Health NHS Trust Page 19 of 19 Policy L5 First Date of Issue: Aug 12 This is current version L5/01 Aug 12