NHS mental health services' policies on leave for detained patients in England and Wales: a national audit

Introduction: Considerable guidance is available about the implementation of leave for detained patients, but individual mental health services are free to determine their own policies.

Aim: To determine how consistent leave policies of NHS mental health services in England and Wales are with relevant guidance and legislation.

Method: A national audit of NHS mental health services' leave policies. Data were obtained through web searching and Freedom of Information requests. Policies were assessed against 65 criteria across four domains (administrative, Responsible Clinician, types of leave, and nursing). Definitions of leave-related terms were extracted and analysed.

Results: Fifty-seven (91.9%) policies were obtained. There were considerable inconsistencies in how policies were informed by relevant guidance: Domain-level consistency was 72.3% (administrative), 64.0% (Responsible Clinician), 44.7% (types of leave), and 41.9% (nursing). Definitions varied widely and commonly differed from those in the guidance.

Discussion: Mental health professionals are inconsistently supported by policy in their leave-related practice. This could potentially contribute to inconsistent practice and leave-related patient outcomes.

Implications for Practice: To ensure patients are treated fairly clinicians need to be aware of their responsibilities around leave. In some services they will need to go beyond their organisation's stated policy to ensure this occurs.