A patient was taken out by the nearest relative on escorted leave. NR has refused to bring them back after the leave expired and has now written to request to discharge. I am thinking NR request to discharge is to discharge from Section and, as the patient is still liable to be detained then they can still request to discharge. Is this right? The patient is at home with the NR. Any advice on this… Thank you
As the leave has expired, the patient is AWOL.
The NR application under s23 MHA to discharge gives the RC a 72hr period of time in which to consider it and issue a notice under s25 MHA to block discharge, if the criteria are met.
So the patient can be returned and to decide whether that’s the right way to go, the RC could be asked to quickly consider whether it’s an obvious case where no s25 notice to block would be issued or whether the patient should be returned to allow proper consideration.
But the NR’s application doesn’t take immediate effect and it doesn’t allow them to keep the patient away from hospital. Depending on the circumstances of how they are doing that, the NR could be committing an offence under s128 MHA.
If the leave has been revoked, it is an offence under S.128 to assist a pt to absent themselves without leave.
If the NR’s position is that P does not require medical treatment (of a kind which can only be provided in hospital) but can be cared for safely at home, and this is what P wants, then this ought to be assessed in situ. It is very difficult for a carer to prove the viability of this position while P is detained in hospital. The purpose of hospitalisation is to get P back home safely and quickly. If P is now safe back at home then why should this be reversed by force, to satisfy correct procedure? Any identified risks ought to be addressed with the offer of community support.
The purpose of mental health law is to provide a remedy when there is a need to protect people from imminent harm and all other reasonable options preferred by P have been tried without success. Not to dictate what must be done regardless of circumstances and of other options. Criminalising P or NR is not likely to be helpful.
I totally agree with the last contribution by Barry Gale (I was an ASW for many years before I retired). The MHA is to enable the treatment of people in certain circumstances when they lack understanding of their circumstances due to their illness, it should not be used bureaucratically but creatively to help clinicians to act in the p’s best interests and in the least restrictive but effective ways. Get the clinical team to assess the p and NT at home and work cooperatively with them if at all possible.