Absconding Abroad?

Interesting one. My guess is that the duty of care would pass to whichever country she wound up in, and their respective mental health services. But I’m not a legal expert.

We had a patient on a section 3 who absconded and went to Australia. There was nothing we could do about this, until her family got fed up with her and stuck her on a plane back to the UK. She was readmitted and her section just started again.

Now if it’s any other section, I’m sure there is not a lot that can be done, generally wait for the situation to deteriorate and wait for them to be repatriated by the respected country. However surely with the 37, which is obviously a hospital order by the courts, when otherwise the outcome might have been a prison sentence, surely the home office would have some responsibility in her return.

But in short, I don’t know either for sure; I’d pass it up the chain and let them formulate a risk management plan, including the Mental Health Administrator.

If they do abscond abroad then suggest they go somewhere sunny then you can volunteer to get them back.

After posting earlier as Anonymous, I have spoken with our all knowing fountain of knowledge Mental Health Act administrator, who is normally very good; she has come up with the definitive answer, “I Don’t Know” !!

Contary to my earlier opinion that the 37 would hold some weight in getting her back, she reckons the 41 would have the Home Office more interested in making moves, obviously depends where they end up.

I think you’d be hard pressed to get a definate answer of anyone.

What the law says and what really happens may be two different things.

The law precludes travel abroad, he’s on a section 41. Legally, he can’t just go abroad, so that’s that. Thus, my understanding’s that there’s no need for mechanisms to bring him back, since it can’t happen.

Perhaps she has gone to France.

France still keep most of their Mental Hospitals complete with Medical Superintendents, none of this business of having CEO from the non health related industry.
They have the highest number of psychiatrists and psychiatric nurses per capita anywhere in the world. They hardly have any mentally ill homeless.

France has probably one of the most highly rated health service in the world.

The Cockroach Catcher

Ah, but if you go to France for treatment, it helps to speak French.

Here’s a primer for healthcare-focussed Francais:

Oui
Non
Merci
S’il vous plait
Est-ce absolument necessaire de mettre cela dans mon cul?

Oui. C’est absolument necessaire. Alors, enlevez votre pantalon et fermez vos yeux.

Frappe mon head sur la keyboard.

To further the above a la Defector; The MHA is a UK legislatino and only enforceable inside the UK. However, Section 41 is Home Office affairs and repatriation could be actioned under an extradition order with interpol if felt necessary. It’s essentially the same as a criminal absconder such as Ronnie Biggs.

Tho I like Shrink’s answer “It’s not a problem cos she’s not allowed to go” heh - tho I do wonder if all s41’s are on customs red-flag lists nowadays?

In terms of risk to the organisation - if the treating psychiatrist permits it - they have assessed risk as not significant or unlikely. THerefore, should she take flight abroad - the psych will have “some interesting questions” to provide to the Home Office.

If you think she is a flight risk, it’s your task to prove it. Previous AWOL’s are a strong indicator as is any non-compliance with other monitoring or supervision requirements - such as attending appointments; remaining abstinent from substances (if so required); returning from unescorted leave on time; etc.
A good way to test this is to have the patient perform compliance tests - such as when out of the unit for more than 3 hours - they are required to phone the unit or to arrive at a certain place such as a day centre or CPN office. It’s a bit like probation orders - but essentially that’s what they are there for - to check compliance and minimise chances of evasion.

There’s a strange set of affairs here in my part of Oz - MHRT grant the extent of leave conditions to anyone under Forensic Order (s37 comparable) and the treating psychiatrist can only grant leave within these parameters (eg If MHRT states:”escorted leave only on or off hospital grounds” - consultant can graduate leave ‘escorted grounds’ to ‘escorted community leave’ but cannot give unescorted leave until MHRT approve such at their 6 monthly review).
A s37/41 would be comparable to a “Special Notification Forensic Patient” (determined by the nature of the crime from a set list such as murder, rape, etc).
As MHRT grant leave they determine ‘risk’ and this remains their responsibility. It makes them more cautions than the clinicians who are happy to grant leave based on more intimate knowledge of the patient but MHRT are legally bound (as in the MHA states so) to consider the societal issues of risk (which means we don’t have to- YaY! - but we have to provide the skills to the patient to avoid incident or ‘relapse’ while undertaking the leave levels granted).
Civil section (s3) (down here = Involuntary Treatment Order or ITO) leave is determined by the treating psychiatrist - as there is no record of actual harm to others (or law breaking) - just a “risk” of harm to self or others.

As another note: MHA is for the protection of UK citizens. If the ‘risk’ goes abroad - who needs the Act?

Found this also…
http://noms.justice.gov.uk/new.....iew=Binary

RECALL POLICY
MHU policy is that a conditionally discharged restricted patient will be recalled where it is necessary to protect the public from the actual or potential risk posed by the patient provided that the risk is linked to his or her mental disorder. It is not possible to specify all the circumstances in which recall will be appropriate but public safety will always be our key consideration.
Recall does not require any evidence of deterioration in the patient’s mental state. However, except in an emergency when it is possible to recall for assessment, medical evidence that the patient is mentally disordered is required.
Breach of the conditions of discharge cannot lead to recall but will often be a sign that further consideration of the risk the patient poses to the public is required. Substance and alcohol misuse cannot in itself lead to recall. However if there is evidence that these are behaviours that have a detrimental impact on the patient’s mental state, consideration will be given to recall. If a RMO or social worker has any concerns about a conditionally discharged patient they should discuss them with the Casework Manager without waiting until the next report is due.

One of my patients when I was in the community skipped out of the country to Thailand in pursuit of his Thai girlfriend. I spoke to someone at the FO consular section who contacted the Embassy in Bangkok and someone from there made a well fare visit but in the end it was his brother who went out and brought him home when his money ran out. He was informal though.