A review of AWOL policy in use across London; a case for greater standardisation
| Pages | 156-162 |
| Published date | 02 September 2014 |
| Date | 02 September 2014 |
| DOI | https://doi.org/10.1108/MHRJ-01-2014-0001 |
| Author | Sachin Patel |
| Subject Matter | Health & social care,Mental health |
A review of AWOL policy in use across
London; a case for greater standardisation
Sachin Patel
Dr Sachin Patel is a ST6 in
General Adult Psychiatry,
based at West London Mental
Health Trust, London, UK and
Centre for Mental Health,
Imperial College, London, UK.
Abstract
Purpose – The purpose of this paper is to appraise local absent without leave/missingpersons policy in use
across the nine NHS mental health trusts providing services across the Greater London region.
Design/methodology/approach – A review of the literature on best practice management was
conducted, evidence collated and an appraisal tool produced. This tool was used to systematically appraise
individual policies.
Findings – Despite some core consistency in policy, there was some notablevariability in guidance. Novel
and unique approaches to management were also identified.
Research limitations/implications – It is recognised that policies often arise from pragmatic approaches
using local multi-agency agreements and therefore some variability across London was expected. It is also
recognised that the audit tool produced is unvalidated but does reflect the best available evidence.
Practical implications – The authors have shown policy variability in the management of what is a
common psychiatric problem across a relatively homogenous population. Standardisation of policy is likely
to improve the efficiency in managing these incidents as well as encourage sharing of innovative practice.
The authors also illustrate practical implications for local policy benchmarking in the absence of clearly
defined national standards.
Originality/value – This study has shown the variability of policy in managing a common problemfaced on
psychiatric wards. It also highlights issues related to policy development on a local and regional level.
Keywords Best practice, Standardisation, Policy, Audit tool, AWOL, Missing persons
Paper type General review
Introduction
Patients admitted to psychiatric wards either voluntarily or as formal patients under the Mental
Health Act (Department of Health, 2008) frequently absent themselves without leave. These
incidents can occur when patients leave hospital premises without authorisation, fail to return
from unescorted periods of approved leave or when they disengage from escorting staff when
on leave. A recent ten year UK clinical survey showed that 25 per cent of all in-patient suicides
occurred after they had absconded (Hunt et al., 2010).
Primary prevention of these events by establishing a suitably restrictive but therapeutic ward
environment is of course d esirable. Preventive measures als o include the individual asses sment of
risk prior to authorising leave. There is evidence that valid patient specific predictors can be
identified (Dickens and Campbell, 2001; Miller et al., 1983) as well as situational and environmental
factors (Meehan et al., 1999). These predictors have been developed into leave specific risk
assessment tools in secure settings (Hearn et al., 2012) and may prove valid for more general
psychiatric settings. If, however, patients do abscond,effective and prompt management is vital in
order to manage risk as well as ensuring minimal disruption to continuity of treatment. Prompt
action and successful return also has an economic implication in minimising resource expenditure.
The practice of managing missing patients or those absent without leave (AWOL) is guided by
a combination of legislation and best practice developed through service experience. Often a
The author is grateful for the
guidance and support of Dr Nick
Broughton of West London Mental
Health Trust and Mike Partridge of
NHS London.
PAGE 156
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MENTAL HEALTH REVIEW JOURNAL
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VOL. 19 NO. 3 2014, pp. 156-162, CEmerald Group Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-01-2014-0001
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