Written evidence submitted by Professor David Veale, Consultant Psychiatrist at King's College London, South London and Maudsley NHS Foundation Trust, & The Nightingale Hospital, London (MHB0004)

I wish to comment on the use of Section 17 of the Mental Health Act 1983. In my experience, it is not in keeping with the draft revised act.

Section 17 provides authority for a detained patient to be absent from hospital. Leave must be authorised by the responsible clinician and is often referred to as “section 17 leave”. It is a desirable element of a patient’s care as s/he recovers.

As the responsible clinician, I can place conditions on a s.17 leave, e.g. that my patient

• must be escorted by a staff member, or accompanied by relative or friend, or
• may go out for a specific time period or to a specific location.

An accompanying person has “legal responsibility” for the patient and must try to ensure that they stick to the conditions (without having authority to make the patient do anything).

My experience is that management will forbid another in-patient to be an accompanying person. I am told that a psychiatric patient cannot by definition be responsible for another, or that they are too vulnerable. At the core of this attitude is fear of incurring criticism for allowing another patient to fulfil the accompanying role should something go wrong. 

Unfortunately, some patients have no family members or friends interested enough or geographically close enough to go out with them. Furthermore, staff are often unavailable to escort a patient for social visits, and some patients feel embarrassed to have a staff member in uniform by their side.

It may be safer for a patient to go out with another patient, or for several patients to go out as a group, e.g. to the cinema. I argue that legal responsibility must depend on a capacity assessment. The accompanying person must understand what their responsibilities are and be capable of fulfilling them. Patients who agree and are deemed suitable to accompany a fellow patient find it helps to build a sense of responsibility and belonginess to the community. However, I am told that any in-patient can never be “responsible” for another, and I am therefore prevented from allowing some patients to take advantage of the section 17 provision until they can go out unaccompanied. The spirit of the revised Act is that it should give patients more control over their care and greater choice. If a patient asks for an accompanying person to be a fellow patient and the Responsible Clinician agrees that the nominated person has capacity and is able to be responsible for the patient, the Act should make it clear that the accompanying person can be another in-patient.

Accompanying persons are often asked to sign a document that they understand they will be legally responsible. Perhaps more important is for there to be a plan with clear guidance and relevant information (e.g. telephone numbers) to be followed if something goes wrong and for the accompanying person, whatever their relationship to the patient, to give formal acknowledgement that they understand the plan and will implement it should the need arise.

14 August 2022