Section 17 Leave Policy
Policy: M08
Policy Descriptor
The purpose of this policy is to outline the procedure and requirements for
staff covering leave for patients under Section 17 of the Mental Health Act
1983 amended 2007.
Do you need this document in a different format?
Contact PALS – 0800 0730741 or email [email protected]
Document Control
Policy Ref No & Title:
M08 - Section 17 Leave
Version:
v2.0
Replaces / dated:
Previous policy dated January 2013
Author(s) Names / Job Title
responsible / email:
Carole Camps, Mental Health Act Manager
[email protected]
Ratifying Committee
Quality, Experience and Safety Policy Ratification Sub Group
Director / Sponsor:
Executive Director of Nursing and Practice Paul Keedwell
Primary Readers:
All inpatient staff including Ward Managers, Responsible
Clinicians and nursing staff.
Additional Readers
Clinical Staff
Date ratified:
28th May 2015
Date issued:
May 2015
Date for review:
May 2017
Date archived:
Contents
1.
Introduction ............................................................................................................................ 3
2.
Purpose .................................................................................................................................. 3
3.
Duties ...................................................................................................................................... 3
4.
Definitions .............................................................................................................................. 4
5.
Planning Leave ....................................................................................................................... 4
6.
Granting Leave ....................................................................................................................... 5
7.
Recording Leave .................................................................................................................... 6
8.
Escorted and Accompanied Leave ....................................................................................... 7
9.
Restricted patients ................................................................................................................. 7
10. Care and Treatment while on Leave ..................................................................................... 7
11. Leave of Absence and other Hospitals ................................................................................. 8
12. Recall from Leave .................................................................................................................. 8
13. Absence without leave........................................................................................................... 8
14. Renewal of authority to detain .............................................................................................. 9
15. Training................................................................................................................................... 9
16. Monitoring .............................................................................................................................. 9
17. References.............................................................................................................................. 9
2
1. Introduction
1.1.
This policy should be read in conjunction with Chapter 27 of the Mental Health Act Code of
Practice 2008 (CoP).
1.2.
Section 17 of the Mental Health Act 1983 amended 2007 (the Act) allows for certain
patients who are detained under the Mental Health Act to be granted ‘leave of absence’
from the hospital in which they are detained for a specified or indefinite period subject to
particular conditions.
1.3.
Section 17 applies to patients detained under Sections 2, 3, and 37 of the Act. Responsible
clinicians cannot grant leave of absence from hospital to patients who have been remanded
to hospital under sections 35 or 36 of the Act or who are subject to interim hospital orders
under section 38.
1.4.
Only the detained patient’s Responsible Clinician (RC) can grant leave which must be
planned as well in advance as possible.
1.5.
In the absence of the patient’s RC permission for Section 17 leave can only be granted by
the Approved Clinician (AC) who is acting for the time being as the patient’s RC.
1.6.
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 and full details of the
proposed leave. Further information can be found on the Ministry of Justice website
http://www.justice.gov.uk/ or from the Mental Health Act Office.
1.7.
Please note: Whilst the term ‘people who use Trust services’ is more commonly used in
Trust policies and literature, the word ‘patient’ will be used here for clarity between this
policy and the Act.
2. Purpose
2.1.
To outline the procedures and requirements for staff implementing Section 17 of the Mental
Health Act 1983 amended 2007.
3. Duties
3.1.
Approved Clinician – will grant Section 17 leave when acting as the RC of a patient when
the RC is unable to do so, for example when on leave. See CoP 27.8
3.2.
Responsible Clinician – will grant Section 17 leave for their patient. They must ensure
that proper discussions are held with the patient and other professionals involved in the
overall care of the patient. They must ensure a proper risk assessment is carried out for the
leave and consider if a Community Treatment Order is more appropriate. RCs should
make leave subject to any conditions which they consider necessary in the interests of the
patient or for the protection of other people.
3.3.
Nursing staff – will monitor periods of leave in regard to the patient’s well being and
whether conditions were complied with and liaise with RCs/ACs. To report on the use of
Section 17 leave in nursing reports to Mental Health Tribunals and Hospital Managers
panels.
3.4.
Mental Health Act Administrator – will provide guidance regarding legal aspects of
Section 17 leave to clinicians. Will undertake regular audits of Section 17 leave to ensure
that Section 17 leave is granted in accordance with the Act and Code of Practice guidance.
3
4. Definitions
4.1.
Approved Clinician - A person approved by the appropriate national authority to act as the
responsible clinician for the purposes of the Section 17 Mental Health Act 1983 amended
2007.
4.2.
Leave - any excursion which takes the detained patient outside hospital grounds for any
period of time even with an escort.
4.3.
Escorted Leave – The RC may direct that the patient must be accompanied by an
authorised member of hospital staff. Friends and family cannot act as escorts as this would
involve the patient being in their legal custody.
4.4.
Accompanied Leave – The RC may authorise leave subject to the condition that a patient
is accompanied by a friend or relative (e.g. on a pre-arranged day out from the hospital).
The RC should specify that the patient is to be in the legal custody of this person only if it is
appropriate for that person to be legally responsible for the patient, and if that person
understands and accepts the consequent responsibility.
4.5.
Mental Health Act 1983 amended 2007 – The Mental Health Act is the legislation
governing all aspects of compulsory admission to Hospital, as well as the treatment,
welfare and after care of detained patients. It provides for mentally disordered persons who
need to be detained in hospital in the interests of their health, their own safety or the safety
of other persons. Compulsory admission to hospital is often referred to as ‘sectioning’. The
Act sets out when and how a person can be sectioned and ensures that the rights of those
detained are protected.
4.6.
Nearest Relative – The role of the Nearest Relative is legally defined and as such they
have a right to receive certain information at different stages of a patient’s detention. (See
Nearest Relative Policy).
4.7.
Responsible Clinician – The Responsible Clinician is the registered medical practitioner in
charge of the treatment of a detained patient and who is not professionally accountable for
that treatment to any other doctor.
4.8.
Risk Assessment – A Trust defined procedure which considers a number of factors to see
if it is advisable to proceed with a course or action or enter a situation.
4.9.
Statutory Treatment Forms – A patient on leave of absence is still subject to detention
and liable to the consent to treatment provisions of the Mental Health Act 1983 amended
2007.
4.10.
Community Treatment Order- The purpose of a CTO is to allow suitable patients to be
safely treated in the community rather than under detention in hospital, and to provide a
way to help prevent relapse and any harm – to the patient or to others – that this might
cause. It is intended to help patients to maintain stable mental health outside hospital and
to promote recovery. CoP 27.11
5. Planning Leave
5.1.
Leave of absence can be an important part of a detained patient’s care plan, but can also
be a time of risk. When considering and planning leave of absence, responsible clinicians
should:
•
•
consider the benefits and any risks to the patient’s health and safety of granting or
refusing leave
consider the benefits of granting leave for facilitating the patient’s recovery
4
•
•
•
•
•
•
•
•
•
balance these benefits against any risks that the leave may pose for the protection of
other people (either generally or particular people)
consider any conditions which should be attached to the leave, e.g. requiring the
patient not to visit particular places or persons
be aware of any child protection and child welfare issues in granting leave
take account of the patient’s wishes, and those of carers, friends and others who may
be involved in any planned leave of absence
consider what support the patient would require during their leave of absence and
whether it can be provided
ensure that any community services which will need to provide support for the patient
during the leave are involved in the planning of the leave, and that they know the leave
dates and times and any conditions placed on the patient during their leave
ensure that the patient is aware of any contingency plans put in place for their support,
including what they should do if they think they need to return to hospital early
liaise with any relevant agencies, e.g. the sex offender management unit (SOMU) •
undertake a risk assessment and put in place any necessary safeguards, and
(in the case of part 3 patients – see chapters 22 and 40 CoP) consider whether there
are any issues relating to victims which impact on whether leave should be granted and
the conditions to which it should be subject.
5.2.
The Recovery Coordinator should be consulted as part of the planning process to ensure
that community factors that may affect the leave are considered.
5.3.
A risk assessment should document the discussion and the arrangements that have been
put in place. See policy R03 Risk Management, Strategy, Policy and Risk Assessment
Process for more information.
5.4.
If the Section 17 leave is for more than seven consecutive days or the leave is extended so
that the total period is more than seven consecutive days, then the RC must first consider
whether the patient should go onto a CTO instead and document the reasons for their
decision. This does not apply to restricted patients or to patients detained for assessment
under Section 2 of the Act, as they are not eligible for a CTO. See M03 Supervised
Community Treatments Policy.
6. Granting Leave
6.1.
Written authorisation for Section 17 leave is given for any period of absence of a detained
patient outside the grounds of the hospital in which the patient is detained and the decision
to grant leave rests solely with the RC and cannot be delegated. However in the absence of
the usual RC, permission can be granted by the AC who is acting as RC for the patient in
place of the absent RC.
6.2.
Any conditions to leave should be specified. See section 7.1.
6.3.
The RC can only grant Section 17 leave to a patient who is detained under either Section 2,
3 or 37. Patients detained under Sections 4, 5(2), 5(4) 135 and 136 cannot be granted
Section 17 leave as these sections are for short term emergency assessment purposes
only. Patients under Sections 35, 36 and 38 can only be granted leave by the remanding
court.
6.4.
Leave of absence may be granted for specified occasions or for specific or indefinite
periods of time and that period may be extended in the absence of the patient. Leave
should normally be of short duration and not normally more than seven days. 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, responsible
5
clinicians should also consider whether the patient should go onto a community treatment
order (CTO) instead and, if required, consult any local agencies concerned with public
protection. This does not apply to restricted patients, nor, in practice, to patients detained
for assessment under S2 of the Act, as they are not eligible to be placed on a CTO. Leave
should not be used as an alternative to discharging a patient although it may be used to
assess a patient’s suitability for discharge and appropriateness for a Community Treatment
Order.
6.5.
The option of using a CTO does not mean that the RC cannot use longer-term leave if that
is the more suitable option, but the RC will need to be able to show that both options have
been duly considered. Decisions should be explained to the patient and fully documented,
including why the patient is not considered suitable for a CTO, and also guardianship or
discharge.
6.6.
Leave may be granted for as long as the patient remains liable to detention.
6.7.
Hospital managers cannot overrule a RC’s decision to grant leave. The fact that a RC
grants leave subject to certain conditions, e.g. residence at a hostel, does not oblige the
hospital managers, or anyone else, to arrange or fund the particular placement or services
the clinician has in mind. RC’S should not grant leave on such a basis without first taking
steps to establish that the necessary services or accommodation (or both) are available
and will be funded.
6.8.
Prior to a patient using their S17 leave the nurse responsible should ensure that there are
no clinical risk factors that would prohibit the use of S17 leave at this point in time. Prior to
the patient going on leave, the nurse in charge/key worker should satisfy themselves that
any earlier risk assessments remain valid. Where there is cause for concern, the nurse in
charge/ key worker will implement any necessary risk management strategies, such as
reviewing the current arrangement for S17 leave at this point in time. The concerns and
strategies should be documented in the patient’s care record on RiO. The nurse
responsible should alert the RC and discuss arrangements for the patient’s S17 leave given
the increased clinical risk factors.
7. Recording Leave
7.1
The CoP suggests that Hospital Managers should establish a standardised system by
which RCs can record the leave they authorise and specify the conditions attached to
leave. The Trust uses the S17 leave library on the digital care plan as a standardised
system to record S17 leave. Copies of the authorisation should be given to the patient and
to any carers, professionals and other people in the community who need to know. A copy
should be kept in the patient’s notes. In case they fail to return from leave, an up-to-date
description of the patient should be available in their notes. A photograph of the patient
should also be included in their notes, if necessary with the patient’s consent (or if the
patient lacks capacity to decide whether to consent, a photograph is taken in accordance
with the Mental Capacity Act (MCA)
7.2
Once an RC has agreed authorised leave it should be recorded in the Section 17 leave
library care plan on the patients’ electronic care record specifying any conditions that are
attached to this including:




Address the patient will be staying
Start and finish times of leave
Conditions attached i.e. avoiding specific areas, avoiding alcohol/drugs, avoiding
specific persons
Contact numbers of the patient and carer
6
7.3
Leave does not need to be authorised and documented when the patient is allowed to go
off the ward but remains in the grounds of the hospital or unit.
8. Escorted and Accompanied Leave
8.1
A RC may direct that their patient remains in custody while on leave of absence, either in
the patient’s own interests or for the protection of other people. Patients 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. Such an arrangement is often useful, e. g. to enable patients to
participate in escorted trips or to have compassionate home leave.
8.2
While it may often be appropriate to authorise leave subject to the condition that a patient is
accompanied by a friend or relative (e.g. on a pre-arranged day out from the hospital), RCs
should specify that the patient is to be in the legal custody of a friend or relative only if it is
appropriate for that person to be legally responsible for the patient, and if that person
understands and accepts the consequent responsibility.
9. Restricted patients
9.1.
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 and full details of the
proposed leave.
9.2.
Where the courts or the Secretary of State have decided that restricted patients are to be
detained in a particular unit of a hospital, those patients require leave of absence to go to
any other part of that hospital as well as outside the hospital.
9.3.
The Secretary of State would normally consider any request for Section 17 leave for a
restricted patient to be in the community for more than a few consecutive nights as an
application for conditional discharge.
10. Care and Treatment while on Leave
10.1. The RC’s responsibilities for their patients remain the same while the patients are on leave.
10.2. A patient who is granted leave under Section 17 remains liable to be detained and the rules
in Part 4 of the Act about their medical treatment continue to apply. If it becomes necessary
to administer treatment without the patient’s consent then consideration should be given to
whether it would be more appropriate to recall the patient to hospital although recall is not a
legal requirement (CoP 27. 32-36).
10.3. The duty on Local Social Services Authorities (LSSA) and Clinical Commissioning Groups
to provide after-care under S117 of the Act for certain patients who have been discharged
from detention also applies to those patients while they are on leave of absence under
Section 17 of the Act.
10.4. The outcome of leave, whether or not it went well, particular problems encountered,
concerns raised or benefits achieved, should also be recorded in patient’s progress notes to
inform future decision-making. The outcome of leave – whether or not it went well,
particular problems encountered, concerns raised or benefits achieved – should be
recorded in patients’ notes to inform future decision-making. Patients should be encouraged
to contribute by giving their own views on their leave; some hospitals provide leave records
specifically for this purpose
7
11. Leave of Absence and other Hospitals
11.1.
Section 17 Leave can be granted allowing a patient to reside in another hospital. This may
be required for a medical procedure to be carried out with the patient returning to
psychiatric hospital within a short space of time.
11.2.
The RC at the original hospital retains overall control and responsibility for the detained
patient.
11.3.
If it is thought that the clinician at the other hospital should become the RC the patient
should then be transferred. See C40 Admissions, Transfer and Discharge Policy
11.4.
Patients on Section 17 leave or AWOL who are taken to hospital other than the hospital
that they are currently liable to be detained in can be held by that hospital whilst
arrangements are made for their prompt return to the detaining hospital.
11.5.
A patient may be kept in the custody of an officer on the staff of the hospital where the
patient is liable to be detained or in the custody of any person authorised in writing by the
Hospital Managers of the detaining hospital.
12. Recall from Leave
12.1.
A RC (or in the case of restricted patients, the Secretary of State) may revoke the patients
leave at any time if they consider it necessary in the interests of the patients’ health or
safety or for the protection of other people. The RC must be satisfied these criteria are met
and the effect being recalled may have on the patient.
12.2.
The RC must arrange for a notice in writing revoking the leave to be served on the patient
or on the person who is for the time being in charge of the patient. The reasons for recall
should be fully explained to the patient and a record of the explanation recorded in the
patient’s care record.
12.3.
A restricted patient’s leave may be revoked either by the responsible clinician or by the
Secretary of State for Justice. If a problem were to arise during a restricted patient’s leave
of absence the responsible clinician should immediately suspend the use of that leave and
notify the Ministry of Justice who would then consider whether to revoke or rescind the
leave or let the permission stand.
12.4.
It is essential that carers (especially where the patient is residing with them while on leave)
and professionals who support the patient while on leave should have easy access to the
patient’s responsible clinician if they feel consideration should be given to return of the
patient before their leave is due to end.
13. Absence without leave
13.1.
Under section 18 of the Act, patients are considered to be AWOL in various circumstances,
in particular when they:




Have left the hospital in which they are detained without leave being agreed (under
S17 of the Act) by their responsible clinician
Have failed to return to the hospital at the time required to do so under the conditions of
leave under S17
Are absent without permission from a place where they are required to reside as a
condition of leave under S17
Have failed to return to the hospital if their leave under S17 has been revoked
8



Are patients on a community treatment order (CTO) who have failed to attend hospital
when recalled
Are CTO 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
Are guardianship patients who are absent without permission from the place where
they are required to live by their guardian.
13.2. Detained patients who are AWOL may be taken into custody and returned by an Approved
Mental Health Professional (AMHP), any member of the hospital staff, any police officer, or
anyone authorised in writing by the hospital managers.
13.3. A patient who has been required to reside in another hospital as a condition of leave of
absence can also be taken into custody by any member of that hospital’s staff or by any
person authorised by that hospital’s managers.
13.4. Responsibility for the safe return of patients rests with the detaining hospital. If the
absconding patient is initially taken to another hospital, that hospital may, with the written
authorisation of the managers of the detaining hospital, detain the patient while
arrangements are made for their return. In these (and similar) cases people may take a
faxed or scanned copy of a written authorisation as evidence that they have the necessary
authority without waiting for the original. Further guidance can be found in the Trusts’ C02
Missing Person Policy. Incident reports for AWOL and missing person’s should be
submitted via the Trust online incident reporting system.
14. Renewal of authority to detain
14.1.
It is possible to renew a patient’s detention while they are on leave if the criteria in section
20 of the Act are met (see chapter 32). Leave should not be used as an alternative to
discharging the patient either completely or onto a CTO where that is appropriate. Chapter
31 gives further guidance on factors to consider when deciding between leave of absence
and a CTO. This does not apply to restricted patients.
15. Training
15.1.
Ward/Unit/Team Managers are expected to brief their staff about the key elements of this
policy.
15.2.
Section 17 will feature in regular introductory and refresher MHA training run by the Trust.
16. Monitoring
16.1.
Issues relating to Section 17 leave will be raised at the Trust Safeguarding Group and the
Quality and Safety Committee.
16.2.
Audit of Section 17 leave will be undertaken on a three monthly basis by Mental Health Act
administrators and results considered at the Trust Safeguarding Group and the Quality and
Safety Committee.
17. References
Mental Health Act 1983 and 2007 amendments
Code of Practice to the Mental Health Act 1983 January 2015 Chapter 27
Reference Guide to the Mental Health Act
9