Developing the leave/abscond risk assessment (LARA) from the absconding literature: an aide to risk management in secure services

Abstract

Purpose -Leave is an important part of life for both patients and clinicians in secure mental health and learning disability settings. Patients breaching leave conditions (i.e. absconding or failing to return) represent a small percentage of leave episodes; however when incidents occur there can be far reaching negative outcomes for potential victims, the patient and the service. The purpose of this paper is to devise a risk assessment specifically for leave decision making based on the literature available.Design/methodology/approach -Using the approach followed in the violence risk assessment field, a literature review was carried out of papers relating to absconding. The results were used to develop the leave/abscond risk assessment (LARA).Findings -There are a number of problems with the available literature: there is a dearth of research, definitions for absconding are varied (often including escape) making comparisons difficult and much of the literature focuses on psychiatric acute wards making it difficult to translate into secure environments. Characteristics of absconders vary and are not idiosyncratic enough from which to develop a risk assessment. Socio-environmental factors are perhaps more important and so the LARA was devised around assessment of these.Research limitations/implications -The limitations of this paper are clear: a risk assessment tool is proposed that has not been evaluated or validated in any way. The authors feel that the process warrants publication and invite readers to use the tool for clinical and/or research purposes.Originality/value -The LARA is proposed as a specific leave-decision-making risk assessment tool for teams working in secure environments.

Measuring the profiles of the security needs of forensic psychiatric inpatients: Validation of the See, Think, Act Scale

“…The frequency and severity of the incidents and near‐misses could be considered quality indicators for forensic psychiatric services provided by the units (Chester, Alexander, & Morgan, ; Department of Health, ). Examples of incidents in secure forensic units include violence and aggression, self‐harm and suicide, and unauthorized leave and abscondence (Dickens, Picchioni, & Long, ; Hearn, Ndegwa, Norman, Hammond, & Chaplin, ; Peluola, Mela, & Adelugba, ; Sullivan, Bagshaw, Sharon, & Erin, ).…”

Never ever? Characteristics, outcomes and motivations of patients who abscond or escape: A 5‐year review of escapes and absconds from two medium and low secure forensic units

“…Suggested strategies to improve clinicians' ability to predict and manage this risk more effectively include: better documentation of the nature and content of multi‐disciplinary team discussions (Lyall and Bartlett, ), more transparent and recorded decision making (Kasmi and Brennan, 2015) and more structured and systematic processes around the granting of leave to patients (Nichols 2007). A dedicated Leave/Abscond Risk Assessment (LARA) tool has even been suggested (Hearn et al, ).…”

Critical Incidents During Leave From an Australian Security Hospital – A 12 Year Audit

“…However, the retrospective design of the present study precluded any statistical discrimination or any conclusions about each patient's motivation for the AWOP. Since AWOPs have been found to be largely context-dependent 56 and because of the very small numbers, no generalisation or sophisticated typology can be derived from this cohort.…”