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

Lots of times other patients found the missing patient as we knew them better and knew where they might go!

Have you watched the BBC documentary missing? One of the episodes was of a person leaving a mental health hospital and the process the police go through to find them. A very interesting watch that you can catch up with on iPlayer.

@RattleOfBars

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.

I've been a mental health nurse since 1990. I've never come across a patient remain on section due to housing alone. It's illegal. Do these patients never appeal against their section? As I said before, the MHRT would have a field day,

PS I'm not denying patients are kept on the ward while appropriate housing is found. It happens in general wards too (eg waiting for a nursing home bed.) Because of such shortages, it's inevitable, even though it is at the same time inappropriate. However, such patients MUST have their section rescinded and stay on the ward informally. Remaining on a section purely because of a lack of appropriate housing is wrong on every level. I'm shocked that's even happening. I've never heard it before, and have been in the game since 1990 (not including the 4 years I spent before as a HCA.) All guidelines say the least restrictive practice must be used and for as short a spell as possible. It can only be used when a patient is acutely unwell and will not remain on the ward in any other way.

However, such patients MUST have their section rescinded and stay on the ward informally. Remaining on a section purely because of a lack of appropriate housing is wrong on every level

Maybe I’ve got it wrong and their risks are the reason they’re still on section 3? Several of them are awaiting placements or supported accommodation. Really they shouldn’t be on an acute ward but the alternative is to present homeless to the council. Temp accommodation without robust community support puts them at high risk of isolation and deterioration.
Also some have learning disabilities as well as mental health disorders, so they’d be very vulnerable if discharged without a supportive home to go to, and likely to bounce back into acute.

I think it must be the risks they are presenting with, as a symptom of their mental illness.

The other alternative is them being informal but not allowed off the ward, if they have had a Best Interest assessment carried out. This is quite common in patients who have dementia or a learning disability, who lack the capacity to remain informal, don't have a florid mental health illness so can't be detained, but also are too risky to just discharge to a bed and breakfast. So that could cover, for instance, the use of baffle locks in an elderly care unit, or only letting som Leone out with a nurse escort. This would be the least restrictive option, to keep them safe. Obviiusl y this is understandable. My nan had dementia and was a "wanderer" but would just get lo st. The first home she was in had an open door policy but she wandered off a couple of times and had to be brought back by police. The second home she was in had baffle locks. This was before Best Interests Assessors but would have met the remit for being in her Best Interests. We were certainly happier knowing she was more secure.

I do think the provision out there is a shambles. I trained in one of the old asylums and yes they weren't perfect. When they were closing down, at least there was more supported housing and hostels put in place. Now there's very little, and tbh as councils and BHS trusts don't really run them any more, many are run for profit, with the exceptions of y hose run by voluntary organisations or Housing Associations. Over lockdown, I was going into patients homes to administer depots. Some of them were lucky, had nice flats and supportive family close by, but many were living in squalid conditions, in flats that were either bare and dirty or cluttered and dirty. When I asked how they were managing lockdown, the majority said 'Don't bother me, I never go out.' And there's nothing for them. Fay hospitals/centres shut down, no drop in centres, no work based environments, nothing. All the contact they had was a fortnightly visit from a nurse for their injection. And often, if they stopped engaging they were closed, when imo they're the ones who should stay open as they're the most vulnerable to exploitation.

Care in the community was mis sold as some kind of utopia, but it's not. It stinks. I don't know why I'm still in mental health nursing, i went jjn to help people but it's so demoralising.

Sorry about typos. I am, for instance, aware that BHS is a now defunct high street store, and did mean NHS. That was an autocorrect. The others are typos but you get my drift.

www.mind.org.uk/information-support/legal-rights/mental-capacity-act-2005/best-interests/

This is a good article about best interests and DoLS (deprivation of liberty safeguards) which explains least restrictive operations.

Patients who are going to be on a CTO are often kept on section in a hospital for many months while awaiting accomodation. They don't need to be in a hospital on section but if made informal would just self discharge without accomodation which would make them very vulnerable so they stay on section. It was very sad to see people in this situation.

In my experience as a nurse quite a lot kf effort is made to find missing patients. In 15 years I have never had a patient who wasn't located fairly swiftly.

my brother was sectioned just before Xmas; in early February he absconded (went over a fence) for the 3rd time and the unit discharged him in his absence - having just assessed his condition to have worsened.

Police were good a couple of times, but the unit were hardly interested at all

my brother was sectioned just before Xmas; in early February he absconded (went over a fence) for the 3rd time and the unit discharged him in his absence - having just assessed his condition to have worsened

Sorry to hear that.
IME patients who keep absconding often get discharged whilst AWOL, unless they’re very vulnerable or very psychotic.
Some wards have a rule that if a patient has capacity and decides to go AWOL (or engages in behaviour that upsets other patients) they get discharged. Usually they get a warning. But if they keep absconding or not returning from leave the MDT can argue the ward is not helping or therapeutic to the patient so they get discharged. They could also say jumping over a fence put other patients at risk of copying him. Or they argue the ward environment has caused the patient’s condition to get worse (very common with personality disorders and certain other illnesses, hospital stays can be detrimental).