What happens if somebody refuses to leave a hospital bed?

[FABAdvice]

NHS Patient is physically well but refusing discharge. Does anybody have experience of this? Will the police be involved?

Thanks.

www.bbc.com/news/articles/c897ew0ekp4o

@thornbury thats a very enlightening article.

This can be very difficult. Ultimately, it depends on why they don’t want to leave and on what kind of ward it is. Various laws will also usually come into play, depending on where the person is going to be discharged to. Ironically, it’s much easier to discharge someone against their will from a psychiatric ward than a physical health ward as mental health is more familiar with the laws around mental health/liberty deprivation/aftercare and is more likely to have an up to date psychiatric assessment. Physical health tend to be nervous about making those kinds of decisions, especially if there’s relevant history. Homelessness can make things really messy too. Generally speaking, if someone was admitted in the first place they’re too vulnerable to discharge onto the street which means that social care has to get involved, again delaying everything. It’s very very unusual for the police to be involved unless there’s outright malingering or drug theft. Usually these situations are just very sad.

As a carer I have refused to take someone home without certain conditions being met, keeping them in hospital an extra three days waiting for equipment to be delivered. I take no pride or joy in frustrating the NHS, but until social care have the resources to meet demand one needs to be the squeaky wheel.

We had a situation in our family when a son went to collect his mother from hospital to take her home after discharge, but point blank refused when he saw the condition of her. She was readmitted onto a different ward

It depends

A few days and refusing to go because they don't feel well enough or family don't feel they are well enough then they probably will stay put and then be discharged when ready.

A few weeks because they or family are refusing to make a decision about care options but they are DCR/MFFD (Discharge Ready or Medically Fit For Discharge) then they may be D2A-d or TOC-d (discharged to assess or Transfer of Care) where basically the hospital will pay for your care elsewhere or sort care out for you until social care can catch up with you.

Any longer than that the hospital will take legal action and will (and do) evict. With police/security if necessary

The patient has agoraphobia.

And is in the hospital for an unrelated, medical condition?
And managed to get to the hospital or was able to be brought to the hospital at the start of treatment?

How did they arrive at hospital?

What part of leaving the hospital is triggering the agoraphobia? It'll help work out how to manage the departure.

I refused to have DH home until a proper care package and the necessary equipment was in place, and they suddenly were able to produce it all much more quickly than originally anticipated!

@Peaktime how long did that take?

They originally told me the care package would take an undefined amount of time to put in place because of a lack of available staff. When I made it clear I couldn't have him home without it, it was done in 48 hours.

It will depend on the exact circumstances but all hospitals will have a reluctant discharge policy.

Has mental health services stepped in to help

Sometimes I think refusing discharge is entirely sensible. I fully intend to be an irritant on behalf of my own parents as I’ve seen unsafe discharges too often.

When DH was eventually discharged, his discharge letter referred to his "supportive" wife, which I took to be code for complete pain in the rear 😆

I agree iv had multiple failed discharges its dangerous and expensive

Whilst I do have sympathy for the woman in the story I think it’s absolutely bonkers thst someone who doesn’t need to be in hospital can stay for that length of time and the cost!

It just seems like an inefficient use of resources, I wonder how many times patients have had to wait to be admitted due to a lack of beds.

@FABAdvice I’m a MH nurse. If the hospital has a psychiatric liaison service (most medium to large hospitals do) you need to talk to them. Do they have regular input from the CMHT? If yes, is there a contact (CPN, psychiatrist) the hospital can talk to? If not, maybe a GP or counsellor? Does the patient have a clear idea of where they want to be discharged to or is it anywhere but home? Adult services could also get involved if there’s a clear need for more suitable housing. Start with psych liaison first though. Have a chat with their assigned nurse and they should be able to link you up with the right person.

I am not a lawyer, but as I understand it, trespass is a civil offence and a hospital needs a court order to evict the patient, unless the patient is being violent?