When a psychiatric unit inpatient is not detained there under the Mental Health Act but has embarked upon voluntary treatment, different legal frameworks apply to their recovery if they absent themselves from care. Indeed, ‘legal recovery’ may not be possible at all without a full MHA assessment coordinated by an AMHP.
Nurses (of the prescribed class) and doctors have authority under the Mental Health Act to detain informal patients in certain circumstances but once patients have crossed the threshold and left the immediate hospital grounds, these authorities cease to apply. The police have no authority to detain an informal patient because they have absented themselves from care or because of any perceived need that they should return. The may only detain under s136 MHA if the criteria for that apply. Although such patients are regarded as ‘missing’, they are not formally AWOL under s18 MHA and liable to immediate re-detention.
So where informal patients are reported missing and the police locate them in a private dwelling, officers have no authority to detain them at all. It raises a question which should be borne in mind by mental health professionals and the police at the point an informal patient is reported missing:
“What do you actually want the police to DO, if we find them and cannot detain under s136 MHA?”
There are a couple of options:
- Confirm that the person is immediately safe and well but leave the patient in that known location and refer their whereabouts to the ward staff who may or may not then exercise the proper procedures to have an AMHP led assessment to detain the person formally under the MHA and have them (re-)admitted to the ward.
- Remain in as close a proximity to the patient as you are legally able to do and immediately contact a crisis team service for urgent re-assessment under the MHA.
- Which of these two will be appropriate should be based not just on professional opinion when reported missing; but on officers’ opinions about the context of them being found.
Neither option is filled with certainty and legal control from a police point of view and both of them raise previously highlighted questions about assessments on private premises: would you want to leave a psychiatric patient pending MH services arranging follow-up? How long will it take for Crisis to gather an urgent assessment together?
If and when a patient is re-assessed, the AMHP and DRs will determine necessary further follow-up and care. But as these issues will all come to a head when a patient is found, it is important that protocols for AWOL situations cover informal patients and the extra considerations which this blog imples.
It is also vital that NHS professionals understand both the lack of legal authority to recover informal patients and the duty of care which may necessitate timely support to the police in order to prevent patients who are at risk from being left where they are found for a want of legal authority to do otherwise.