This controlled document shall not be copied in part or whole without the express permission of the author or the author’s representative.
Title: / Grampian Mental Health and Learning Disability Service
Procedure and Guidance for Dealing with Missing Persons
Unique Identifier: / NHSG/XXX/XXX/XXX
Replaces:
Lead Author/Co-ordinator: / Shirley Porter, Directorate Nurse Manager, Adult Mental Health
Subject (as per document registration categories): / Procedure
Key word(s): / Missing Persons
Process Document: Policy, Protocol, Procedure or Guideline / Procedure and Guidance
Document application: / NHS Grampian
Purpose/description: / This protocol outlines the operational arrangements to be implemented for the organisation in the event of missing persons
Group/Individual responsible for this document: / Shirley Porter, Directorate Nurse Manager, Adult Mental Health
Policy statement: / It is the responsibility of all staff to ensure that they are working to the most up to date and relevant policies, protocols procedures.
Responsibilities for ensuring registration of this document on the NHS Grampian Information/ Document Silo:
Lead Author/Co-ordinator: / Shirley Porter, Directorate Nurse Manager, Adult Mental Health
Physical location of the original of this document: / Q Pulse
Job title of creator of this document: / Directorate Nurse Manager, Adult Mental Health
Job/group title of those who have control over this document: / (job/group title)
Directorate Nurse Manager, Adult Mental Health
Responsibilities for disseminating document as per distribution list:
Lead Author/Co-ordinator: / (job title) Shirley Porter, Directorate Nurse Manager, Adult Mental Health
Responsibilities for implementation:
Organisational: / Operational Management Team and Chief Executive
Sector / General Manager, Medical Leads and Nursing Leads
Departmental: / Clinical Leads
Area: / Line Manager
Review frequency and
date of next review: / This procedure will be reviewed in light of new guidance or changes to guidance. In the absence of core changes the document will be reviewed annually. May 2015
Responsibilities for review of this document:
Lead Author/Co-ordinator: / (job/group title) Directorate Nurse Manager, Adult Mental Health
Revision History:
Revision Date / Previous Revision Date / Summary of Changes(Descriptive summary of the changes made) / Changes Marked*
(Identify page numbers and section heading ) /
* Changes marked should detail the section(s) of the document that have been amended i.e. page number and section heading.
MENTAL HEALTH AND LEARNING DISABILITY SERVICE
PROCEDURE AND GUIDANCE FOR DEALING
WITH MISSING PERSONS
This paper outlines what actions should be taken and offers guidance for staff to consider when dealing with a missing person from an inpatient Mental Health setting or when a person is regarded as missing in the lead up to or during an escort to a mental health setting.
(Actions have been produced collaboratively by the Grampian Mental Health and Learning Disability Service and Police Scotland.)
Background
There will be occasions when an inpatient goes missing from care. Such absences cause carers and staff concern and the anxiety that an inpatient may come to harm whilst absent is a very real one. Of main concern is the safety and welfare of the missing person. The service has an obligation to take steps toward not only the safe return of the individual, but also to monitor the risks associated with any prescribed treatments during what may be difficult emotional times for the person.
People in need of the inpatient service can be regarded as voluntary patients, free to leave the hospital at any time or formal patients, those detained under the Mental Health (Care and Treatment) (Scotland) Act 2003 and held in hospital, often against their will. Some patients though voluntary would be regarded as liable to detention under certain circumstances. A third category, Restricted Patients, are detained under a variety of pre-disposal or post-disposal orders made under the Criminal Procedure (Scotland) Act 1995, as amended by the Mental Health (Care and Treatment) (Scotland) Act 2003.
All patients will be prescribed a level of nursing observation. This can range from general observation where a person’s general whereabouts are known to constant observation and special nursing where there is a real concern for someone’s safety which necessitates one to one nursing care.
A guiding principle of the inpatient service is to provide the least restrictive environment. Whilst there are areas within the hospital regarded as secure environments, the general adult admission wards do not routinely have locked doors. This allows for a freedom of movement for all general inpatients and inevitably there will be those who absent themselves without medical or nursing staff agreement.
When an Inpatient (other than a Restricted Patient) is thought to be missing
In all cases the Nurse in charge of the ward will: -
1. Arrange for a thorough search of the ward and surrounding areas, including any adjacent wards, except in cases where it can be corroborated by whatever means that the patient has left the grounds.
2. During office hours Monday to Friday 9.00am until 5.00pm the decision to assign a level of risk will be made by the patient’s clinical team.
3. Out of Hours the Nurse in Charge will seek the advice of the Duty Doctor and if necessary the On Call Specialist Registrar or On Call Consultant Psychiatrist and in conjunction with them assign a level of risk to the missing patient. For Moray this will be the on call consultant psychiatrist.
Any decision on assigning a level of risk will be based on a model that recognises the practical value of intuitive approaches balanced with a rational systematic analysis of the patient’s clinical condition at the time of being reported missing, the circumstances in which they have gone missing, and whether or not they are in hospital on a formal or informal basis.
There are three levels of risk available. Not all risk indicators may be relevant depending on the clinical assessment made by the Duty Doctor and Nurse in Charge of the ward at the time of the patient being reported missing.
LEVEL OF RISK
LOW RISK
Low Risk Indicators include
· Person is not considered a danger to themselves or others
· Person is an In-patient on a voluntary basis and unlikely to be considered for detention under the Mental Health (Care and Treatment) (Scotland) Act 2003 when absconded
· Person unlikely to be at risk while missing
· Person is known to need some time to themselves away from the ward
· Other absences have not resulted in harm and the are no significant differences this time
MEDIUM RISK
Medium Risk Indicators include
· Mental state may not allow for taking full responsibility over actions
· In-patient on a voluntary basis but may be considered for detention under the Mental Health (Care and Treatment) (Scotland) Act 2003 when absconded.
· May be more vulnerable to physical harm or exploitation/abuse by others
· No particular pattern surrounding any reported absences in the past
· It is not clear why the person may have absented themselves
BUT
· No active suicidal ideation noted / not prone to self injury
· Not seen as likely to come to physical harm
· Poses no serious threat to the community
· Not likely to commit a serious offence
HIGH RISK
High Risk Indicators include
· Has absconded whilst requiring a high level nursing observation due to risk of harm to self or others
· Formal in-patient detained under the Mental Health (Care and Treatment) (Scotland) Act 2003
· In-patient on a voluntary basis but may be considered for detention under the Mental Health (Care and Treatment) (Scotland) Act 2003 when absconded
· Person has voiced suicidal ideation or is prone to self injury
· May suffer from Type 1 Diabetes with no immediate access to insulin
· Mental state is such that the person cannot sustain themselves
· Person is vulnerable to physical harm or exploitation/abuse by others
· May well pose a serious threat to the community or may commit a serious offence
Course of action by Hospital staff and Police
If LOW RISK, the Nurse in charge of the ward will: -
1. Consider apparent circumstances and decide if MEDIUM RISK is required
2. Agree a time to next review the absence (variable depending on the patient and the circumstances surrounding their absence, but no more than six hours)
Police Response
· No requirement for police to become involved at this stage
· However, in the event that hospital staff elect to contact the Police Scotland Service Centre in relation to a LOW RISK patient, the Service Centre staff can refer to these Guidelines and record the relevant details on a 'STORM' incident, updating the Police National Computer with the appropriate marker. A Missing Person file need not be created on Crimefile at this stage.
· If the Police, in the course of their normal duties, find a patient who has absconded from hospital and has been graded as LOW RISK by staff, but who has not been reported to the Police as missing, no action other than telephoning them of the location of the patient, unless other circumstances so warrant, will be taken.
If MEDIUM RISK, the Nurse in charge of the ward will: -
1. Arrange for a thorough search of the ward and surrounding areas, including any adjacent wards, except in cases where it can be corroborated by whatever means that the patient has left the grounds.
2. Notify medical staff. During office hours Monday to Friday 9.00am until 5.00pm the decision to assign a level of risk will be made by the patient’s clinical team. Out of Hours the Nurse in Charge will seek the advice of the Duty Doctor and if necessary the On Call Specialist Registrar or On Call Consultant Psychiatrist and in conjunction with them assign a level of risk to the missing patient. For Moray this will be the On Call Consultant Psychiatrist.
3. Contact the Police Scotland Service Centre (Tel. 101) to advise them of the missing patient and give a verbal Risk Assessment of Medium based on the criteria above in the event that Officers encounter the person while on patrol. At this stage no immediate enquiry or search may be required at the discretion of the relevant Community Policing Team Inspector.
4. Check the patient’s belongings, taking particular note of any evidence of the patient having finalised their affairs. It is also important to note if the patient has taken all or some of their belongings and any money.
5. Contact next of kin or another named person to advise them of the situation and request any information around possible whereabouts.
6. Where relevant and necessary arrange for any CCTV footage to be reviewed for the relevant period.
7. Nursing staff complete a Missing Person Incident Report for collection by the police (Appendix 2).
8. In the case of a MEDIUM RISK person going missing during office hours, the Directorate Nurse Manager should be notified. If out of hours the Senior Clinical Nurse (Site Bleep holder) or Senior Clinical Nurse (Night Services) should be notified. They will use their discretion when to notify the On Call Nurse Manager
9. Agree a time to next review the absence (variable depending on the patient and the circumstances surrounding their absence, but no more than six hours)
10. Record all incident details in the nursing documentation.
11. Complete a DATIX form (For MEDIUM and HIGH RISK cases).
· Directorate Nurse Manager or Senior Clinical Nurse will complete an untoward incident report when a MEDIUM RISK or HIGH RISK is reported to the police
· If the patient’s whereabouts are known and are local, provided it is clinically safe to do so attend at the address to collect the patient and return them to their ward. If the patient refuses to return, consult the clinical team or out of hours seek the advice of the Duty Doctor and if necessary the On Call Specialist Registrar or On Call Consultant Psychiatrist to determine if an informal patient requires to be detained or if detained the patient requires to be returned to hospital. For Moray this will be the On Call Consultant Psychiatrist. In either case seek the assistance of the police if required but note that the decision on whether to request that the Police collect and return a patient to their ward in the above circumstances should be the exception rather than the rule.
Police Response
After having been notified of the missing person the Police action will comprise:-
· Police Scotland Service Centre staff, on receipt of information from hospital staff, will create a STORM incident and raise a Crimefile Missing Person Report, but not completing the Risk Assessment. They will thereafter contact the relevant Duty Sergeant and advise of the missing person enquiry
· The relevant Duty Sergeant, on being advised of the missing person will as soon as is practicable contact hospital staff and clarify details before completing the Crimefile Risk Assessment (i.e. Low, Medium or High Risk) which will generally mirror the clinical assessment previously carried out by hospital staff.
· The Police will not mount a search or carry out enquiries at this stage, however, this decision will be taken by the relevant Community Policing Team Inspector within the Division, after a review of the circumstances.
· The missing patient’s details will be logged on the Police National Computer by Area Control Room staff and details circulated as appropriate
· If the patient’s home address is outside of the Aberdeen City or Aberdeenshire and Moray areas, a fax or email will be sent to the local area Division or Police Force.
· The Police will maintain regular contact with the ward for any updates
· Status may be raised to HIGH RISK at a future point in this incident
· In exceptional circumstances, and where it would not be clinically safe for hospital staff to do so themselves, the Police will collect and return the patient to their ward provided their whereabouts are known and are local, but note that the decision on whether to request that the Police collect and return a patient to their ward in the above circumstances should be the exception rather than the rule.