Setting

This audit is relevant to all areas of psychiatry where patients are detained under the Mental Health Act 1983.

Background

Section 17 leave concerns the controlled movement of patients to areas outside of the ward, unit or hospital building. Leave can be either escorted or unescorted by staff. All section 17 leave for in-patients has to be granted by the responsible clinician in accordance with agreed guidelines within the trust, for restricted patients, within the limits of the leave granted by the Ministry of Justice. However, it is important that patients use their section 17 leave as granted, as non-adherence would render them absent without leave (AWOL), which may have serious implications.

Standards

Standards were drawn from chapters 21 and 22 of the Mental Health Act Code of Practice (Department of Health, 2008), in addition to Ministry of Justice policy relating to restricted patients (Ministry of Justice, 2008). Of particular relevance were the following:

ᐅ All patients who use leave should have been officially granted leave.

ᐅ All episodes of leave should be with the specified number of escorts.

ᐅ All episodes of leave should be within the stipulated time limits.

ᐅ The frequency of the episodes of leave should be in accordance with that documented by the responsible clinician and, in the case of restricted patients, by the Ministry of Justice.

Method

Data collection

Records of leave taken, together with section 17 leave forms, were obtained from ward administration staff and reception registers. The clinical notes, which contain section 17 leave care plans and documentation of leave taken, were examined. The following data were collected for every patient:

ᐅ If the patient had utilised leave, whether they had first officially been granted section 17 leave outside the secure perimeter of the unit.

ᐅ The leave had been taken by the patient according to the following prespecified conditions:

Data analysis

The outcome measures were expressed as the proportion of the total leave episodes complying with the above standards.