Unauthorised Leave of patients from MHJHADS Inpatient Units
Canberra Hospital and Health ServicesOperational ProcedureUnauthorised Leave of Admitted People from MHJHADS Inpatient UnitsContents TOC \o "1-3" \h \z \u Contents PAGEREF _Toc519089929 \h 1Purpose PAGEREF _Toc519089930 \h 3Alerts PAGEREF _Toc519089931 \h 3Scope PAGEREF _Toc519089932 \h 3Section 1 - Search for the Person, notifications and transportation back to the unit PAGEREF _Toc519089933 \h 31.1Adult Mental Health Unit (AMHU), Mental Health Short Stay Assessment Unit (MHSSU), Extended Care Unit (ECU) and Adult Mental Health Rehabilitation Unit (AMHRU) PAGEREF _Toc519089934 \h 31.1.1Notifications PAGEREF _Toc519089935 \h 41.1.2Transportation back to the unit PAGEREF _Toc519089936 \h 51.2 Dhulwa Mental Health Unit (DMHU) PAGEREF _Toc519089937 \h 51.2.1Person on a custodial order PAGEREF _Toc519089938 \h 51.2.2Person on a Mental Health Order Only PAGEREF _Toc519089939 \h 6Section 2 –ACT Policing (ACTP) Involvement PAGEREF _Toc519089940 \h 62.1 Adult Mental Health Unit, Mental Health Short Stay Assessment Unit, Extended Care Unit, Adult Mental Health Rehabilitation Unit. PAGEREF _Toc519089941 \h 62.2Dhulwa Mental Health Unit (DMHU) PAGEREF _Toc519089942 \h 72.2.1Person on a custodial order PAGEREF _Toc519089943 \h 72.2.2Person on a Mental Health Order Only PAGEREF _Toc519089944 \h 7Section 3 - Legislative Considerations PAGEREF _Toc519089945 \h 73.1Voluntary consumers PAGEREF _Toc519089946 \h 73.2Involuntary consumers PAGEREF _Toc519089947 \h 83.3Correctional Patient PAGEREF _Toc519089948 \h 83.4Section 309 under the Crimes Act 1900 PAGEREF _Toc519089949 \h 8Section 4 – Monitoring unauthorised leave and communication between Stakeholder Agencies PAGEREF _Toc519089950 \h 94.1Adult Mental Health Unit, Mental Health Short Stay Assessment Unit, Extended Care Unit and Adult Mental Health Rehabilitation. PAGEREF _Toc519089951 \h 94.2Dhulwa Mental Health Unit (DMHU) PAGEREF _Toc519089952 \h 9Section 5 – On return to bed based services PAGEREF _Toc519089953 \h 95.1Adult Mental Health Unit, Mental Health Short Stay Assessment Unit, Extended Care Unit, Adult Mental Health Rehabilitation Unit. PAGEREF _Toc519089954 \h 95.2Dhulwa Mental Health Unit (DMHU) PAGEREF _Toc519089955 \h 10Section 6 – Reporting requirements PAGEREF _Toc519089956 \h 106.1Adult Mental Health Unit, Mental Health Short Stay Assessment Unit, Extended Care Unit and Adult Mental Health Rehabilitation Unit PAGEREF _Toc519089957 \h 116.2Dhulwa Mental Health Unit (DMHU) PAGEREF _Toc519089958 \h 11Implementation PAGEREF _Toc519089959 \h 11Related Policies, Procedures, Guidelines and Legislation PAGEREF _Toc519089960 \h 12Definition of Terms PAGEREF _Toc519089961 \h 13Search Terms PAGEREF _Toc519089962 \h 15Attachments PAGEREF _Toc519089963 \h 15Attachment 1: Flow chart to follow if a person takes unauthorised leave from an inpatient mental health facility PAGEREF _Toc519089964 \h 16Attachment 2: Flow Chart Reporting an Escape of Unauthorised Leave from DMHU to ACT Policing PAGEREF _Toc519089965 \h 17Attachment 3: Mental Health - Unauthorised leave from an inpatient facility PAGEREF _Toc519089966 \h 18Risk Assessment PAGEREF _Toc519089967 \h 18Attachment 4: Mental Health: Notification of Return from Unauthorised leave (to be sent to ACTP) (e.g. only Brian Hennessy Rehabilitation Centre) PAGEREF _Toc519089968 \h 21PurposeThe purpose of this operational procedure is to provide information regarding the processes for staff to follow when a person leaves a mental health inpatient unit without approved leave. AlertsUnder Mental Health Act 2015 there is power to compel a person to return from leave where they are subject to Emergency Action, Emergency Detention or Mental Health Orders (e.g. Psychiatric Treatment Order).If a person is a voluntary patient and discharges themselves against medical advice, they may choose not to return to the Unit. If the treating team hold concerns for the safety of a person, who was a voluntary patient at the time they went on unauthorised leave, the emergency apprehension provisions of the Mental Health Act 2015 can be used to apprehend and assess the person, if that is deemed appropriate by the treating team. When a person is absent from an inpatient unit without authorisation both the unit Operational Director (or afterhours, Mental Health Director on call and the After Hours Hospital Manager (AHHM) should be notified immediately.When a person who is subject to an Order from the courts under the Crimes Act 1900 (including s.309, bail conditions restricting leave) or another type of Custodial Order (including s.54 Corrections Management Act 2007 or s. 109 of the Children and Young People Act 2008) takes unauthorised leave, Act Policing as well as the unit Operational Director (or afterhours, the Mental Health Director on call and AHHM) must be notified immediately and the contact documented in the clinical notes. A Riskman report is also to be completed and the Forensic Mental Health Team must be notified at the earliest opportunity. ScopeThis operational procedure applies to all staff working in mental health inpatient settings and has been jointly developed with the ACT Policing (ACTP) and the ACT Ambulance Services (ACTAS). Section 1 - Search for the Person, notifications and transportation back to the unit1.1Adult Mental Health Unit (AMHU), Mental Health Short Stay Assessment Unit (MHSSU), Extended Care Unit (ECU) and Adult Mental Health Rehabilitation Unit (AMHRU)When a person cannot be located or has not returned from approved leave, the following procedures are to be followed:Attempt to contact the person by their mobile or other phone number. Establish that the person has not been granted leave by the treating team (e.g. by reviewing clinical notes).Implement a search to ensure the person is not within the Unit, typically commencing from their bedroom and then moving through Unit areas in order of decreasing accessibility (unless information to suggest the person more likely to be in one particular location). Canberra Hospital Health Services (CHHS) Security should also be contacted as they may also be able to assist in search and also have access to Closed-Circuit Television (CCTV) video surveillance from the hospital to help establish the location or most recent known location of the person.Refer to Attachment 11.1.1NotificationsOnce it is established that the person is missing, the Nurse in Charge (NiC) of the shift and the treating team are to be advised, or if it is after hours the Psychiatry Registrar on call is to be contacted. After hours, if the absence is from the Canberra Hospital campus, the After Hours Hospital Manager is to be informed.The Unit Operational Director or Mental Health Director on call (after hours) must also be informed of all unauthorised absences from any inpatient units. After discussion with the Treating Psychiatry Registrar or the on call Psychiatry Registrar, and based on identified risk factors, follow-up action is planned, implemented and documented in the clinical notes by the NiC of the shift. This may include leave being granted or extended as a result of risk review. Medical staff and nursing staff are to review and update the Clinical Risk Assessment (CRA) for the person.If the person is deemed by the treating team to be at acute or immediate risk, staff will attempt to contact the person and request that they return to the Unit, offering them assistance to do so. The person’s carer, nominated person, guardian or family should be contacted to advise them of the current situation and establish if they are aware of the person’s whereabouts. For residents of ECU and AMHRU, ACTP must also be contacted (see section 2). If the person is not deemed to be at immediate risk and not requiring ACTP assistance, staff will still attempt to contact the person and request that they return offering them assistance to do so. When the person cannot be contacted, staff are to inform the person’s carer, nominated person, guardian, next of kin, close family to advise them of the current situation and establish if they are aware of the person’s whereabouts. During business hours when the person cannot be located or, if located and cannot be persuaded to return to the Unit, the clinical manager or community team responsible for the care of the person is to be contacted by the NiC of the shift and informed of the situation. The inpatient treating team will liaise with the community team around a possible plan to assist in locating and returning the person to the inpatient facility (e.g. home visit). As part of the discussion, both teams will determine who is responsible for taking any agreed course of action. In the event that the person is not managed by a regional community team, or it is after hours, the NiC of the shift will contact the Crisis Assessment and Treatment Team (CATT) through Mental Health Services (MHS) Triage to discuss a possible plan to assist in locating and returning the person to the inpatient facility (e.g. home visit). 1.1.2Transportation back to the unitIn all cases involving the transport of an individual back to an inpatient Unit, the least restrictive modes of transport required for the specific situation will be considered by all parties, as per the principles of the Mental Health Act 2015 and the Memorandum of Understanding between the ACT Ambulance Service, The Australian Federal Police (ACT Policing) (ACTP), Canberra Hospital, Calvary Public Hospital Bruce and MHJHADS Regarding People Requiring Mental Health Care. For example if ACT Policing locate a person and form the opinion that a law enforcement response is not required (because the person is compliant or not showing any signs of harm to self and/or others), ACT Policing will enter into negotiations with mental health and ACTAS to discuss the possibility of conveying the person in a less restrictive mode of transport rather than police transport. Medically compromised persons will always be transported in an ambulance. The safety and best interests of the person will be paramount when making these decisions. Any conflict or disagreements in opinion can be escalated to senior management at a later date – the main priority at the time of the incident is for the at-risk person to be transferred back to appropriate care. 1.2 Dhulwa Mental Health Unit (DMHU) When a person cannot be located or has not returned from approved leave, the followingprocedures are to be followed:establish that the person has not been granted leave or an extension of leave by the DMHU Leave Panel (e.g. by reviewing clinical notes).implement a search to ensure the person is not within the Unit, typically commencing from their bedroom and then moving through Unit areas in order of decreasing accessibility (unless there is information to suggest the person more likely to be in one particular location). Contact the Security Control Room Officer and request monitoring and reviewing all external perimeter CCTV cameras in an attempt to locate the missing person or if the consumer cannot be located, establish the location or most recent known location of the person.Refer to Attachment 21.2.1Person on a custodial orderAny person on a Custodial Order who escapes from DMHU, escapes or absconds while being transported from DMHU to another place (see Dhulwa: Secure Mental Health Unit Escort: Role of Security), or fails to return from leave is considered by ACTP to be an escapee (Memorandum of Understanding between The Australian Federal Police (ACT Policing), ACT Ambulance Service (ACTCS) ACT Health, Canberra Hospital, Calvary Public Hospital Bruce, and Mental Health, Justice Health, Alcohol and Drug Services Regarding People Requiring Mental Health Care).Once a consumer has been identified as an escapee or absconder, the ADON or NIC (after hours) must immediately phone ACTP on 0-131444 or 0-62567714 (Operations Sergeant) to advise them. Contact the ACT Health Agency Security Advisor or After-Hours On call Security Manager1.2.2Person on a Mental Health Order Only If a person is on a mental health order and is not a correctional transfer, and absconds from the DMHU or fails to return from leave, the NIC or another clinician will phone them and request that they return, offering them assistance to do so.If the allocated nurse cannot contact the person or the person refuses to return to the unit, DMHU staff will review the person’s Security Category and Leave Entitlement (SCALE) (see section 2.1 DHMU Leave procedure for an explanation) and, if the person’s SCALE is high, the ADON or NIC (after hours) will phone ACTP on 0-131444 or 0-62567714 (Operations Sergeant) to discuss the risk and request assistance in locating the person. Back to Table of ContentsSection 2 –ACT Policing (ACTP) Involvement2.1 Adult Mental Health Unit, Mental Health Short Stay Assessment Unit, Extended Care Unit, Adult Mental Health Rehabilitation Unit. If the person is deemed to be at significant risk and does not agree to return, ACTP must be notified immediately and asked to provide an emergency response. The Unauthorised Leave Risk Assessment Form, (See Attachment 3), should be completed and staff must scan and email the Risk Assessment form to actcommunications@.au. Staff must then phone ACTP on 0-131444 and ask to discuss the risk assessment with the Police Operations Sergeant. Staff should also discuss the unauthorised leave with ACTP mental health clinician in operations (MHCiOPs) if they are on duty.When ACTP receives an unauthorised leave notification, a joint decision will be made between ACTP, the treating team and the senior nurse on duty on how to triage the referral based on an assessment of the risks. ACTAS may need to be consulted as part of the decision-making process in cases where the person may be medically compromised. Cases where the NiC of the shift in consultation with the on-call Psychiatry Registrar assesses a person as low risk, including persons subject to a Psychiatric Treatment Order (PTO) or Community Care Order (CCO), do not have to be reported to ACTP. However, the decision not to report these to ACTP must be clearly documented in the person’s electronic medical record (EMR) including the rationale for not reporting the unauthorised leave to ACTP and the clinicians involved in reaching that decision. The Operational Director (Director on call after hours) and the treating Consultant (Consultant on call after hours) must be informed by the nurse in charge of the shift when a person is on unauthorised leave, is assessed as low risk and doesn’t require follow up by ACTP. 2.2Dhulwa Mental Health Unit (DMHU)2.2.1Person on a custodial orderWhen a person on a Custodial Order is missing from the DMHU, or fails to return from leave, the ADON or NiC (after hours) will immediately phone ACT Police on 0-131444 or 0-62567714 (Operations Sergeant) to advise them that a person has escaped.The ADON or NiC (after hours) will complete the Correctional Escapee from the Dhulwa Mental Health Unit—Risk Assessment providing information about the person’s escape and their risk level. The risk assessment is available on the Clinical Forms RegisterACT Policing will commence a search for the escapee.The NIC will contact the ACT Health Agency Security Advisor or After-Hours On call Security Manager.2.2.2Person on a Mental Health Order OnlyIf the person has a high SCALE, the ADON or NiC (after hours) will phone ACT Policing on 0-131444 or 0-62567714 (Operations Sergeant) to discuss the risk and request assistance in locating the person. Risk issues to consider may include, but not be limited to:recent thoughts of suicide or self-harm;the involvement of a victim (affected person) in the person’s offending history; and/orrecent homicidal delusions.A joint decision will be made about how to proceed. If the ACTP agree to search for the wanted person, the ADON or NIC (after hours) will complete the Wanted Person from the Dhulwa Mental Health Unit—Risk Assessment, available on the Clinical Forms Register. Back to Table of ContentsSection 3 - Legislative Considerations3.1Voluntary consumersIf a person is a voluntary patient and discharges themselves against medical advice, they may choose not to return to the Unit. If the Treating Team hold concerns for the safety of a person, who was a voluntary patient at the time they went on unauthorised leave, the emergency apprehension provisions of the Mental Health Act 2015 can be used to apprehend and assess the person, if that is deemed appropriate by the treating team.If a person is not subject to a Mental Health Order, ACTP and ACT Ambulance Services (ACTAS) Paramedics are reliant on the emergency provisions in accordance with section 80(1) of the Mental Health Act 2015. Therefore, if ACTP or ACTAS paramedic locate a person on unauthorised leave from an inpatient Unit and do not have reasonable grounds for completing an Emergency Apprehension Order in accordance with s.80(1) of the Mental Health Act 2015, the person cannot be apprehended. In these cases, mental health staff (CATT or treating community team) will need to attend with ACTP and or ACTAS to assess the person and, if appropriate, initiate an emergency apprehension in accordance with s. 80 (2) of the Mental Health Act 2015. 3.2Involuntary consumersThe power to compel a person to return from leave requires that they are subject to Emergency Action, Emergency Detention or Treatment Orders under the Mental Health Act 2015. If a person is subject to Mental Health Order which states they are to be detained at the approved inpatient unit and they abscond, then this is considered a contravention of their mental health order in accordance with s. 78-Contravention of a Mental Health Order-Absconding from facility or s. 125 Contravention of a Forensic Mental Health Order-Absconding from facility of the Mental Health Act 2015. In this instance:ACTP, an authorised ACTAS Paramedic, mental health officer or doctor may apprehend that person.The ACTP member, authorised ambulance paramedic, mental health officer or doctor who apprehends a person in accordance with s. 78 or s. 125, they must tell the person the reason for the apprehension.If a person is detained under s. 78 or s. 125, the relevant official for the order must, within 12 hours of the person being detained, tell the ACAT and the public advocate in writing.Additionally, s. 263.1(c) (Powers of entry and apprehension) and s. 264(1)(e) (Powers of search and seizure) of the Mental Health Act 2015 may also apply.3.3Correctional PatientAn ACTP member, authorised ambulance paramedic, mental health officer of doctor has the power to detain and return a person from unauthorised leave from DMHU subject to s. 144D(4) of the Mental Health Act 2015.A Correctional Patient is a voluntary consumer under s. 135 of the Mental Health Act 2015 in terms of their ability to consent to mental health treatment, care and support.If a Correctional Patient’s mental health status warrants it, they may be detained subject to emergency provisions in accordance with s. 80(1) of the Mental Health Act 2015. Under such circumstances, their status as a Correctional Patient ceases, as they are involuntarily detained.A Correctional Patient who escapes from custody while in DMHU is deemed to have escaped from court ordered custody, which is potentially an offence under the Crimes Act 1900 (s. 144G of the Mental Health Act 2015).3.4Section 309 under the Crimes Act 1900ACTP have powers to detain and return a person from unauthorised leave if they are subject to s. 309 of the Crimes Act 1900.Back to Table of Contents Section 4 – Monitoring unauthorised leave and communication between Stakeholder Agencies4.1Adult Mental Health Unit, Mental Health Short Stay Assessment Unit, Extended Care Unit and Adult Mental Health Rehabilitation.All cases of unauthorised leave referred to ACTP are to be monitored by the person’s relevant treating team (e.g. adult community mental health team or CATT if not a clinically managed mental health consumer). The treating team must receive a message from the relevant inpatient unit through the mental health electronic medical records (EMR) system messaging notifying them of the unauthorised leave. On a daily basis the role of the clinicians in the Police Operations Centre is to facilitate the effective information exchange between all agencies involved in the active search for a person and make relevant records in the individuals’ EMR. This will be the case even in circumstances when the unauthorised leave period continues for days or weeks. The clinician in the Operations Centre will play a leadership role in ensuring that all parties know whether there are any new risks or information that increase or decrease the need for police to continue their search. 4.2Dhulwa Mental Health Unit (DMHU)All cases of unauthorised leave referred to ACTP are to be monitored by the ADON. On a daily basis the role of the clinicians in the Police Operations Centre is to facilitate the effective information exchange between all agencies involved in the active search for a person and make relevant records in the individuals’ EMR. This will be the case even in circumstances when the unauthorised leave period continues for days or weeks. The clinician in the Operations Centre will play a leadership role in ensuring that all parties know whether there are any new risks or information that increase or decrease the need for police to continue their search. Back to Table of Contents Section 5 – On return to bed based services5.1Adult Mental Health Unit, Mental Health Short Stay Assessment Unit, Extended Care Unit, Adult Mental Health Rehabilitation Unit.On return of the person to the Unit, the NiC of the shift is to notify the psychiatry registrar, CATT, the Clinical Manager, guardian and / or relative, carer and Next of Kin (NOK) (if consent has been provided). The unit Operational Director (and the Mental Health Director on call and AHHM must also be notified).The treating team must receive a message through the EMR messaging capacity from the relevant inpatient Unit, notifying them of the person’s return from unauthorised leave. For consumers in ECU and AMHRU the Notification of Return from Unauthorised Leave form (located on the Clinical Forms Register, See Attachment 3) is to be completed in the persons EMR and ACT Policing are to be notified if they have been involved in the search. The NiC of shift is to discuss with the person and document in the EMR their reasons for leaving and activities undertaken while on unauthorised leave.A medical examination of the person is to take place as soon as practicable but within four hours of returning to the in-patient facility. The Riskman entry should be updated.On return to the Unit the NiC of the shift will consult with the Psychiatry Registrar (business hours) or the after-hours on duty Psychiatry Registrar to review the current At Risk Category (ARC) score and following assessment determine a revised ARC level, which is then recorded in the persons EMR (MHAGIC) and referred to at clinical handover. As soon as is practicable the Psychiatry Registrar (business hours) will adjust and sign the Clinical Risk Assessment (CRA) and order any necessary changes to the person’s care and treatment. A person who leaves an inpatient unit without authorised leave on more than two occasions requires a full review by a Consultant Psychiatrist as soon as practicable and a detailed plan recorded in their care plan. The Clinical Nurse Consultant will coordinate this review during business hours.For people who have been on unauthorised leave for longer than 48 hours, a multidisciplinary review must be undertaken as soon as practicable and a follow up plan recorded in the person’s clinical file.Where a person has been on unauthorised leave for longer than 48 hours from the Adult Mental Health Unit (AMHU) or the Mental Health Short Stay Unit (MHSSU) staff will revise the care plan and notify the community team and the CATT- ACTP Communications clinician (who will notify ACTP) that the person is not to be brought directly to AMHU or the MHSSU if they come to ACTP attention. The person must re-present through the Emergency Department (ED) for assessment of ongoing care needs and will not be directly admitted back to AMHU or the MHSSU. 5.2Dhulwa Mental Health Unit (DMHU)On return of the person to the Unit, the NiC of the shift is to notify the Consultant Psychiatrist, Clinical Director DMHU, Executive Director MHJHADS, Operational Director DMHU, guardian and / or relative, Nominated Person, carer and Next of Kin (NOK) (if consent has been provided). The person should be taken to the de-escalation area for searching and debriefing. The person will be medically examined as soon as practicable, and a clinical review will be undertaken.The Multi-Disciplinary Team (MDT) will review the person’s SCALE (see DMHU Leave Procedure for more information about SCALE).Any adjustment to the person’s SCALE must be documented in the person’s EMR.The Riskman entry should be updated.Back to Table of Contents Section 6 – Reporting requirements6.1Adult Mental Health Unit, Mental Health Short Stay Assessment Unit, Extended Care Unit and Adult Mental Health Rehabilitation UnitWhen a person is on unauthorised leave, staff must comply with the Significant Incident Reporting Clinical Procedure. A Riskman must also be completed.Mental Health staff to be informed when a person has taken unauthorised leave include: the NiC of the shift;the treating team, including the registrar and Consultant;Team Leader; andOperations Director (Business hours) or Director on Call (After hours) if the unauthorised leave is after hours. Staff are to record in the EMR all actions taken when that person cannot be located. The Risk Assessment form (See Attachment 3) is also to be completed in the person’s EMR.6.2Dhulwa Mental Health Unit (DMHU)When a consumer is on unauthorised leave, staff must comply with the Significant Incident Reporting Clinical Procedure. A Riskman must also be completed.Mental Health staff to be informed when a person has taken unauthorised leave include: the ADONthe NIC of the shift;The Security Manager;The Operational Director of Justice Health Services;The Clinical Director of Forensic Mental Health Services;The Executive Director MHJHADS;Consultant Psychiatrist on Call (after hours);Director on Call (after hours) if the unauthorised leave is after hours. The ADON or NIC (after hours) must report the escape of a person from DMHU to:the ACAT;the Public Advocate;the Nominated Person, if the person has one;each person with parental responsibilities, if the person is a child;the Children and Young Person Director-General, if the person is a young detaineethe Corrections Director-General, if the person is a detainee;the Director-General responsible for the ACT Civil and Administrative Tribunal Act 2008, if there is a registered affected person. using the Dhulwa Mental Health Unit Escape From Custody Report Form Staff are to record in the EMR all actions taken when that person cannot be located. A copy of the Correctional Escapee from the Dhulwa Mental Health Unit—Risk Assessment form or the Wanted Person from the Dhulwa Mental Health Unit—Risk Assessment is also to be completed in the person’s EMR. Back to Table of ContentsImplementation This procedure is provided to staff as part of local orientation. A hard copy will also be available to all staff in the stations.Back to Table of ContentsRelated Policies, Procedures, Guidelines and LegislationMOUMemorandum of Understanding between ACT Ambulance Service, The Australian Federal Police (ACT Policing), and Canberra Hospital, Calvary Public Hospital Bruce, Mental Health, Justice Health, Alcohol and Drug Service Regarding People Experiencing Mental Illness.PoliciesMental Health, Justice Health and Alcohol and Drug Service (MHJHADS) Policy: Confidentiality and Privacy. MHJHADS Clinical Risk Assessment clinical procedure for MHAU and AMHUMHJHADS Clinical Risk Assessment and Observation Clinical procedureMHJHADS CATT Clinician Working in ACT Policing Operations clinical procedureProceduresDhulwa: Secure Mental Health Unit Escort: Role of Security DHULWA Leave ProcedureStandards National Safety and Quality Health Service Standards HYPERLINK " Standards for Mental Health Service 2010. .au/internet/main/publishing.nsf/Content/mental-pubs-n-servstds-toc" National Standards for Mental Health Service 2010 LegislationMental Health Act 2015Mental Health (Secure Facilities) Act 2016 Human Rights Act 2004Carers Recognition Act 2010Guardianship and Management of Property Act 1991Crimes Act 1900 Corrections Management Act 2007ACT Civil and Administrative Tribunal Act 2008 Back to Table of ContentsDefinition of Terms Abscond: breaking the conditions of regulated authorised leave from a unit or facility.Approved health facility: a health facility approved by the Minister under s. 261 of the Mental Health Act 2015. This is a facility to which persons may be taken under a Psychiatric Treatment Order, Emergency Action, and breach of PTO etc. In the ACT this is the Canberra Hospital.Authorised ambulance paramedic: A member of the ambulance service who is: employed as a paramedic; andauthorised by the chief officer (ambulance service) to apprehend people with a mental disorder or mental illness. Custodial transfers to health facilities (s.54):The Director General (AMC) may direct that a detainee be transferred to a health facility at a correctional centre, or outside a correctional centre, if the Director General believes, on reasonable grounds, that it is necessary or desirable for the detainee to receive health services at the facility.The Director General must have regard to the advice of a doctor appointed under section 21 (Doctors—health service appointments) when considering whether to make a direction under subsection?(1). The Director General may direct an escort officer to escort the detainee to or from the health facility, or while at the facility. The detainee may be discharged from the health facility only if—The health practitioner in charge of the detainee’s care approves the discharge; orThe Director General directs that the detainee be removed from the facility. Example of direction for removal of detainee from health facility, where the detainee is a danger to the safety of people at the facilityThe Director General may give a direction for ensuring that a detainee discharged from a health facility under this section is returned to a correctional centre stated in the direction.Escape: breach of the physical secure perimeter of the building. Escapee: a person on a Custodial Order who escapes from DMHU, absconds while being transported from DMHU to another place or fails to return after being granted a period of leave from DMHU.Involuntary person: Is a person who is subject to an Emergency Action (EA), or an Emergency Detention Order (ED3 or ED 11) or a Psychiatric Treatment Order (PTO), a Community Care Order (CCO) or Restriction Order under the Mental Health Act 2015 or who may be subject to a Custodial Order.Mental Health Officer: a person appointed by the Minister as a mental health officer under s. 201 of the Mental Health Act 2015. Mental health order: a psychiatric treatment order, a community care order or a restriction order. s.309 Crimes ACT 1900 - Assessment whether emergency detention required:If, in a proceeding in the Magistrates Court, the court has reasonable grounds for believing that an accused needs immediate treatment or care because of mental impairment, the court may, without requiring the accused to submit to the jurisdiction of the ACAT, order that—the accused be taken by a police officer or corrections officer to an approved health facility for clinical examination for the purpose of deciding whether the accused needs immediate treatment or care because of mental impairment; andThe accused may only be released into the custody of a police officer—By the person in charge of the approved health facility; or If the accused is found to need detention and care because of mental impairment—by the person who is in charge of an approved health facility or approved mental health facility where the accused is detained for care; Unauthorised leave: (previously known as AWOL/ absent without leave/ absconding) refers to people leaving a bed-based setting without leave being approved by the treating team and against medical advice. A person is considered to be on unauthorised leave if they have:Been absent from an inpatient unit and failed to notify staff of their intention to leaveFailed to return from authorised leaveLeft an organised activity outside of an inpatient unit and failed to return with other people and staff from the activityBeen a person subject to an Order under the Mental Health Act 2015 and are either missing or are known to have left against advice or without seeking approvalA person subject to s.309 of the Crimes ACT 1900 who departs from MHJHADS custody before being assessed in the ED or after they have been admitted to the Adult Mental Health UnitA person subject to s.54 of the Corrections Management ActVoluntary person: Is a person who has been admitted to a bed based program and is not under any Emergency Detention or Treatment orders under the Mental Health Act 2015. Back to Table of ContentsSearch Terms Unauthorised leave, Inpatient, Mental health, AMHU, MHSSU, BHRC, 2N, AWOL, DMHU, Escape, BreachBack to Table of ContentsAttachmentsAttachment 1: Flow chart to follow if a person takes unauthorised leave from a mentalhealth inpatient facility.Attachment 2: Mental Health - Unauthorised leave from an inpatient facility: Risk AssessmentAttachment 3: Flow Chart Reporting an Escape of Unauthorised Leave from DMHU to ACT PolicingAttachment 4: Notification of Return from Unauthorised leave (to be sent to ACTP) (e.g.only)Disclaimer: This document has been developed by Health Directorate, MHJHAD specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.Date AmendedSection AmendedApproved By05/12/2016Inclusion of DMHU specific informationDDG CHHSAttachment 1: Flow chart to follow if a person takes unauthorised leave from an inpatient mental health facilityAttachment 2: Flow Chart Reporting an Escape of Unauthorised Leave from DMHU to ACT PolicingAttachment 3: Mental Health - Unauthorised leave from an inpatient facility Risk AssessmentSection 1. Health Facility (tick )Adult Mental Health UnitYes□Mental Health Short Stay UnitYes□Adult Mental Health Rehabilitation Unit Yes□Older Persons Inpatient UnitYes□2 North, CalvaryYes□Date and time of unauthorised leave:Circumstances surrounding the leave:Section 2. Patient Particulars Surname:Other Names:Sex:DOB:Admission date:Residential address:Contact phone number:Clinically managed by mental health services? Yes□ No □ Subject to a Psychiatric Treatment Order, Community Care Order, S.309 or Custodial Order? If yes, date of expiry of the Order: Yes□ No □ Please specify:Section 3. Hospital Information Reporting Persons Name:Designation:Phone No:Action taken by staff to locate the patient:(Details)Section 4. Next of Kin Details Informed: Y/NBy whom:Date: Time:Name:Relationship:Address:Phone No:Are there children involved and who may be at risk? Section 5. Details of Patient RiskCurrently suicidal? Yes□ No □ Details: Currently at risk of serious self-harm? Yes□ No □ Details: Currently at risk of violence toward others? Yes□ No □ Details: Life threatening medical issues? Yes□ No □ Details: Other Yes□ No □ Details:ESTIMATED LEVEL OF RISK (following discussion with the treating team)(tick)Additional Notes: Moderate □High □ Moderate to High □Extreme □Assessed by:Section 6. Legal Status and options for the safe return of the personN.B. If the person is on an S.309 or Custodial order(s.54) ACTP must be notified and asked to assist to return the person (see alert page 1).Psychiatric Treatment Order, Restriction Order or Community Care Order?Is the person to be apprehended and returned to the inpatient facility pursuant to one of these types of Orders? Yes□ No □ Emergency Apprehension Are mental health clinicians planning on asking CATT or a community team to attend on-site with police to initiate an Emergency Apprehension? Yes□ No □ Other Options Are there any other expectations of police if and when the individual is located (e.g., general welfare check and notification to Triage for CATT or community team follow up)? Details:Section 7. Patient Description Height (cm): Weight (kg):Build:MediumMuscularObeseSolidThinHair:BlackBlondeBrownColouredFairGreyWhiteRed/GingerLight BrownBald/ShaveEyes:BlackBlueBlue/GreyBrownGreenHazelOther:Complexion:Acne/SpottedBlackDark BrownFairFreckledMediumOliveTannedOther:Cultural Background:AboriginalBlack/AfricanAsianIndian / PakistaniWhite / EuropeanMediterraneanMiddle EasternSouth AmericanPacific IslanderDistinguishing Features:Scars:Tattoos: Disability: Last known address:Access to transport:Last known contact number/s:Attachment 4: Mental Health: Notification of Return from Unauthorised leave (to be sent to ACTP) (e.g. only Adult Mental Health Rehabilitation Unit)Section 1. Health Facility (tick )Adult Mental Health UnitYes□Mental Health Short Stay UnitYes□Adult Mental Health Rehabilitation UnitYes□Older Persons Inpatient UnitYes□2 North, Calvary Yes□Date and time that the person returned from unauthorised leave and means of return:Section 2. Patient Particulars Surname:Other Names:Sex:DOB:Residential address:Contact phone number:Clinically managed by mental health services? Yes□ No □ Subject to an Emergency Detention Order, Psychiatric Treatment Order or Community Care Order? If yes, date of expiry of the Order: Yes□ No □ Section 3. Hospital Information Reporting Persons Name:Designation: Date:Phone No:If the person was subject to an order at the time they left the unit, the ACAT and the Public Advocate must be advised in writing within 12 hours of their return in accordance with s.78 (Contravention of mental health order – absconding from facility) of the Mental Health Act 2015. ................
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