To wonder how much effort they go to to find sectioned patients

[thedaywewillremeber]

My ds1 has been sectioned inpatient a number of times. He’s always returned on time but I wondering what happened to the people who don’t? Ds1 has links to
Multiple areas as I would imagine many do. He did go missing once after being placed on a 136 but obviously wasn’t properly detainedlike a section two or three patient is

It depends on what the risks are, (and what section etc etc) but generally the police will be alerted and will look for the patient. Obviously more urgently if there is thought to be higher risk.

Well the girl who kept going AWOL at the MH unit my relative was in was always found within 2 days. She had no family & as she wasn't responding well to any meds had been there 9 months which is highly unusual. Usually ,the student Nurse told me it's 3weeks stay,til your meds kick in ,then you're discharged.. The other woman who went AWOL was deemed ok to be left with family as she was only days off being discharged anyway.

Anyone who went missing when I was an inpatient was always found.

Loads of time and effort is spent looking for missing patients and is a bone of contention with police. It ties up so much police resources when in most case it could have be avoided or resolved by the NHS themselves.

I suppose they have to start letting people have leave to see how they will cope in the community.

The police are obliged to search for detained patients that go AWOL,but wether they prioritize it or not is a different matter.

@jdoejnr1

Loads of time and effort is spent looking for missing patients and is a bone of contention with police. It ties up so much police resources when in most case it could have be avoided or resolved by the NHS themselves.

Took the words out of my mouth.

@x2boys, the sad fact is that most police forces don't actually have the resources to prioritise it.

Yes patients do get section 17 leave , for varying amounts of time ,if they do not return to the unit on time and staff can't contact them then the police should be alerted ,the police should also be alerted for patients who leave mental health units without leave also .

Suppose it must be hard for both the patients and the staff

Depends on the patient. Someone who is psychotic or has genuine suicidal ideation or is considered a risk to themselves/others will be searched for by police and staff.

Someone with a personality disorder and capacity who frequently goes AWOL won’t be taken as seriously. People are often sectioned due to lack of housing or community support.

By law the police must be informed if a sectioned patient goes missing. But the risks are weighed up. Many people just go home or phone the ward after a few hours.

@RattleOfBars

Depends on the patient. Someone who is psychotic or has genuine suicidal ideation or is considered a risk to themselves/others will be searched for by police and staff.

Someone with a personality disorder and capacity who frequently goes AWOL won’t be taken as seriously. People are often sectioned due to lack of housing or community support.

By law the police must be informed if a sectioned patient goes missing. But the risks are weighed up. Many people just go home or phone the ward after a few hours.

That last part is just untrue. There is nothing in law that says police must be informed. What the law does say is if the location of the AWOL patient is known (and in many cases it is) then it is the responsibility of the NHS to return them not the police. So a s17 patient refusing to return does not require police involvement. However, they inevitably are.

When I worked in MH we would always know when a sectioned patient left, what they were wearing, where they were going and when they were due back. If they weren't back on time (we would usually allow them 5 mins grace period) we would call their mobile. If that didn't get an answer we would have a few different things to do. That depended on who they were and their history.

So we could call their parents as they had a habit of going home.
We would do a drive around the areas we knew they usually went to. 99% of the time we found them and bought them back.
If we didn't find them we would call the police who would try not to get involved. I can only remember once in 5 years when they actually came out to help find someone.

Most of the time though the patient came 'home' of their own accord because they were tired/hungry/bored.

My DB went awol the first time he was sectioned.

He somehow managed to get from Milton Keynes to my home in Croydon. Our DM had already rung me to say he'd not returned when he should have done and that the hospital had told her to ring the police of he turned up, so I rang the police and kept my DB talking.

They took 4 hours to come and pick him up and I had friends round for a meal.

That was an interesting evening.

When I was a mental health nurse ,we had a patient that went AWOL to Portugal @LakieLady

Thats impressive @x2boys! We had an informal patient who spent the night sleeping in a bus station because she missed the last bus home. She was about 5 towns away and didn't take her phone so couldn't call us and ask us to come and get her. We spent a very worried night trying to track her down

@x2boys

When I was a mental health nurse ,we had a patient that went AWOL to Portugal *@LakieLady*

We had one that got as far as Frankfurt airport, where he caused a major incident and nearly got himself shot.

An absolute ton of effort goes in, for multiple reasons. Legally if they are detained the police must try and find them. If someone is mentally unwell and in need of treatment, the MDT are worried about the impact of being away from hospital.
Often someone has no money, medication, keys, phone etc etc so you are painfully aware of what could happen and the effect of being AWOL on a persons mental state.
Too often patients are located in relatives houses who think that mh services are not needed.

There's an excellent episode of "reported missing" on BBC iPlayer now which demonstrated the huge lengths they went to to locate a missing mental health patient.

Thank you I did watch that episode but the man was under a section 136 which is different from other sections.

@thedaywewillremeber

Thank you I did watch that episode but the man was under a section 136 which is different from other sections.

The same amount of effort goes into finding a s2 or s3 patient. Also, its often a voluntary patient too. If you've an interest take a look at Michael Brown who's a cop who specialises in MH and policing. Google 'MH cop Blog' and have a read, you'll see the legal and moral dilemmas cops face every day when dealing with MH incidents.

@RattleOfBars

Depends on the patient. Someone who is psychotic or has genuine suicidal ideation or is considered a risk to themselves/others will be searched for by police and staff.

Someone with a personality disorder and capacity who frequently goes AWOL won’t be taken as seriously. People are often sectioned due to lack of housing or community support.

By law the police must be informed if a sectioned patient goes missing. But the risks are weighed up. Many people just go home or phone the ward after a few hours.

They do not get sectioned for these reasons. They get sectioned because of a mental illness. Housing and community support are of course an important part of discharge plans but you cant remain on section if theyre not in place, though of course you might remain on the ward informally while such issues are resolved.

They do not get sectioned for these reasons. They get sectioned because of a mental illness.

Yes, they are initially sectioned due to mental illness. If a section 2 lasts long enough (possibly due to lack of supported housing or waiting for a Tier 4 placement) it progresses to a Section 3. A section 2 runs out after a certain number of weeks.
Sadly MH issues often go hand in hand with housing problems. Few MDTs will discharge a vulnerable patient as street homeless! They might take them off their section and tell them to present to the council as homeless (normally they go into temporary accommodation/B&B via this route) but not if they are psychotic or risky.

Often people with personality disorders threaten suicide (due to emotional intensity or fear of discharge) yet their behaviour and attitudes may suggest they are not at risk. As an inpatient they are closely observed.

Many patients go AWOL and ring the ward after a few hours to say they need a taxi! The classic case of ‘if you discharge me I’ll take an overdose’ or inciting other patients to self harm or tie ligatures; this usually activates a rapid discharge via the PD pathway. Long hospital stays for these patients can be detrimental to their welfare (and that of other patients on an acute ward. If the team feel their risks can be better managed in the community they may discharge with community support.

Other people get stuck on a section 3 because they have no home or family to return to, but are considered too risky or vulnerable to discharge. Even if they are well after treatment, there is a risk of relapse. Especially as Covid has caused a lot of community services and support groups to fold. The wait for specialist placements and supported accommodation can be very long.

I thought the ward has a duty of care to inform police if a sectioned patient goes AWOL? What the police do with this information I’m not sure, it depends on the patient and their risks I guess.

Informal patients can be very unwell but if they agree to stay voluntarily they are not always sectioned. However they may not be granted unescorted leave and if they try to insist on leaving the doctors can put them on a 2 if they feel they are too unwell to leave.

People are not sectioned, or kept on section due to lack of housing! If they are I would encourage them to sue the doctors who made that decision! And informal patients can't legally be denied leave.

A doctor or a nurse can use their temporary holding power, but then the patient is no longer informal.

An individual hospitals policy might be to inform police, but its not a legal requirement. We only informed the police if we couldn't find an awol patient. And tbh that applied equally to formal and informal.

@RattleOfBars

They do not get sectioned for these reasons. They get sectioned because of a mental illness.

Yes, they are initially sectioned due to mental illness. If a section 2 lasts long enough (possibly due to lack of supported housing or waiting for a Tier 4 placement) it progresses to a Section 3. A section 2 runs out after a certain number of weeks.
Sadly MH issues often go hand in hand with housing problems. Few MDTs will discharge a vulnerable patient as street homeless! They might take them off their section and tell them to present to the council as homeless (normally they go into temporary accommodation/B&B via this route) but not if they are psychotic or risky.

Often people with personality disorders threaten suicide (due to emotional intensity or fear of discharge) yet their behaviour and attitudes may suggest they are not at risk. As an inpatient they are closely observed.

Many patients go AWOL and ring the ward after a few hours to say they need a taxi! The classic case of ‘if you discharge me I’ll take an overdose’ or inciting other patients to self harm or tie ligatures; this usually activates a rapid discharge via the PD pathway. Long hospital stays for these patients can be detrimental to their welfare (and that of other patients on an acute ward. If the team feel their risks can be better managed in the community they may discharge with community support.

Other people get stuck on a section 3 because they have no home or family to return to, but are considered too risky or vulnerable to discharge. Even if they are well after treatment, there is a risk of relapse. Especially as Covid has caused a lot of community services and support groups to fold. The wait for specialist placements and supported accommodation can be very long.

I thought the ward has a duty of care to inform police if a sectioned patient goes AWOL? What the police do with this information I’m not sure, it depends on the patient and their risks I guess.

Informal patients can be very unwell but if they agree to stay voluntarily they are not always sectioned. However they may not be granted unescorted leave and if they try to insist on leaving the doctors can put them on a 2 if they feel they are too unwell to leave.

You’ve answered yourself there. The ones who cannot be discharged because of unstable accommodation are the ones who are too unwell to be discharged because the are risky or psychotic. Ergo, it’s their mental state preventing discharge. A MHRT would have a field day with someone being on a section simply due to social reasons. It has to be due to their mental health issues alone.

Obviously their mental health and risks play a part, but lack of housing is unfortunately the reason many patients remain on section in acute wards. It can take months to secure appropriate placements or housing. They may have recovered from the psychotic or manic episode, and be functioning well, but considered by the MDT too vulnerable for discharge until supported accommodation or a rehab/residential placement is found. Risk of relapse, risk of deterioration, self neglect, vulnerability etc. Most patients are happy to stay until the right accommodation is found. If not they can appeal their section via tribunal.

If an informal patient decides not to return from leave, they can be discharged from AWOL (at the discretion of the doctors).

But an informal patient who is very unwell may be agreeable to staying on the ward, with the understanding they will be placed on a Section 2 if they decide they want to leave.