Leave isn't discharge. They're still liable to be detained.
What is section 17 leave?
Section 17 leave is permission from the responsible clinician () for a detained patient to be away from the hospital. In general it's the only lawful way a detained patient can leave, even briefly (Code 27.3). They stay liable to be detained, so leave isn't discharge.
Moving around the hospital and its grounds doesn't need it, except for some restricted patients (Code 27.5). The RC can't grant it to patients on s35, s36 or s38 (Code 27.4).
Who can grant section 17 leave?
- Only the RC. It can't be delegated, and the hospital managers can't overrule it. If the RC is away, the approved clinician acting as RC decides (Code 27.8, 27.14).
- Staff, within limits. The RC can authorise short local leave, such as a weekly two-hour shopping trip, and leave the timing to the nurses. The RC sets the limits and reviews them (Code 27.15 to 27.17).
- The Justice Secretary too, for restricted patients. Officials in the Mental Health Casework Section (MHCS) decide on the Secretary of State's behalf ( leave guidance 2.1).
Section 17 leave conditions
The RC can attach any conditions they think necessary in the patient's interests or to protect others (s17(1)). Common ones:
- Escorted. The patient stays in the custody of hospital staff, or of someone the managers authorise in writing (s17(3); Code 27.27).
- Accompanied. By a friend or relative, who should only be made legally responsible if they understand and accept it (Code 27.29).
- Places and people. Such as not visiting particular places or people (Code 27.10).
- Where to live. A hostel or another hospital. Check it's available and funded first, because the condition obliges nobody to provide it (Code 27.14, 27.30).
How long can section 17 leave last?
The RC can grant it for specific occasions, a set period or indefinitely, and can extend it without the patient coming back (s17(2)). It can't outlast the section (s17(5)).
Leave should normally be short, and not normally more than seven days (Code 27.11). Longer leave to test readiness for discharge should have a set purpose or period, and not normally run over a month (Code 31.5). Don't use it instead of discharge or a (Code 27.37).
Leave of more than 7 days, or a CTO?
Before granting more than seven consecutive days, or extending leave past seven days in total, the RC must first consider a CTO (s17(2A), (2B)). Longer leave is still allowed, but record why a CTO, guardianship or discharge isn't suitable (Code 27.12). The rule doesn't apply to restricted patients, or in practice to s2 patients (Code 27.11).
| Longer-term leave | CTO | |
|---|---|---|
| The plan | A set purpose, a fixed period, or a deliberate trial | Confidence they're ready to leave hospital indefinitely |
| Further treatment | Likely to need more inpatient treatment without their consent or compliance | Good reason to think they won't need detaining for the treatment they need |
| Risk of things breaking down | Serious, more so than would suit a CTO | Serious enough to justify a CTO, but not very likely |
That's the Code's figure 18. For most patients who can live in the community, it sees a CTO as the better option (Code 31.5).
How to get section 17 leave: planning it
It's the RC's decision, and it should come out of the care plan. Build leave up in stages where you can. Before granting it, the RC should (Code 27.10, 27.18 to 27.20):
- Weigh it up. The benefits for recovery against risks to the patient and others, including child protection and, for Part 3 patients, any victims.
- Involve people. The patient and their carers, especially if the patient will stay with them. If the patient won't let you talk to carers, reconsider whether leave is safe.
- Line up support. Community services should know the dates and conditions, and the patient should know what to do if they need to come back early.
- Set stop rules. Say when leave shouldn't go ahead, such as a clear worsening since it was authorised.
The section 17 leave form
There's no statutory form. Trusts use their own, and the Code expects it to (Code 27.22, 27.23):
- Record the leave. What's authorised and every condition, with copies for the patient, the notes and anyone in the community who needs one.
- Plan for going missing. An up-to-date description and, if necessary, a photograph, taken with consent or under the .
- Record how it went. Including the patient's own view, to inform the next decision.
Treatment and aftercare while on leave
still applies on leave (Code 27.25). If you need to treat without consent, consider whether recall would be more appropriate, though it isn't legally required. See consent to treatment.
Section 117 aftercare applies on leave too (Code 27.26). It's likely to apply when someone's living in the community on leave, but not to escorted day trips (R (CXF), in the 2024 discharge guidance).
Revoking leave: recall to hospital
The RC can revoke leave if it's necessary for the patient's health or safety or to protect others. It's done by written notice to the patient or whoever is in charge of them (s17(4); Code 27.33).
Refusing medication isn't on its own a reason to revoke, but it's almost always a reason to consider it (Code 27.32). Explain the reasons, record that you did, and make sure carers can reach the RC quickly (Code 27.34, 27.36).
Section 17 leave for restricted patients
- Consent first. They can't leave the hospital or unit named in their detention authority without the Justice Secretary's consent (s41(3)(c)(i); MoJ guidance 2.1). If they're detained to a particular unit, they need it even to go elsewhere in the hospital (Code 27.40).
- Medical leave. Authority for emergencies and routine appointments is normally given on admission, except for high-profile patients. In an emergency, act and tell MHCS as soon as possible (MoJ guidance 6.1, 6.2).
- Overnight and abroad. Continuous overnight leave is normally agreed for up to three months at a time, and leave outside the UK is never authorised (MoJ guidance 6.10, 6.18).
- Recall. The Justice Secretary can revoke leave too. If problems arise, suspend it and tell the Ministry of Justice at once (Code 27.35).
There's more on MHCS under restricted patients.
Section 17 leave and DoLS
A patient on leave may lack capacity and need to live in a care home in a way that deprives them of liberty. Then use or a Court of Protection order, which can run alongside leave if it doesn't conflict with the leave conditions (Code 31.8, 31.9).
If they need detaining in hospital to treat their mental disorder, the MCA can't authorise it: recall them (Code 31.10). Deprivation of liberty is now judged under AGNI, not the old acid test.
What happens if a patient goes AWOL?
A detained patient is absent without leave () if they leave without leave, don't return when it ends or is revoked, or leave where they must live (s18(1)).
- Who can bring them back. An , any member of the hospital's staff, any police officer, or anyone the managers authorise in writing (s18(1); Code 28.4).
- The time limit. A s3 or unrestricted Part 3 patient can be retaken until six months after going missing, or the end of their current detention if later. A s2, s4 or s5 patient can't be retaken once the section expires (s18(4), (5)). Restricted patients can be retaken while the restrictions last (Reference Guide 25.27).
- The police. Tell them the time limit whenever you ask for help, and tell them at once if a vulnerable, dangerous or restricted patient is missing (Code 28.15, 28.17).
- Getting in, and family. If you can't get access, the local policy should cover a s135(2) warrant. Tell the nearest relative if they're missing for more than a few hours (Code 28.12, 28.20).
If they're absent when their detention would end, or in the week before, it runs on until a week after they're back, or until they can't be retaken. That gives you time to examine them and renew (s21, s21A).
Back after more than 28 days? The RC must examine them within a week, consult another professional and an AMHP, and report on Form H6. Otherwise the detention ends, except for restricted patients (s21B; Code 28.21).
The rules in brief
- Who grants it. Only the RC. It can be escorted, conditional, for a set time or open-ended.
- Revoking it. The RC can recall them in writing if it's necessary for their health or safety or to protect others.
- More than 7 days. Before granting leave of more than 7 consecutive days, the RC must consider a CTO instead.
- Restricted patients need the Justice Secretary's agreement for leave.
- AWOL (s18). A s3 patient can be taken back up to 6 months after going absent, or until their detention would have ended, whichever is later. A s2, s4 or s5 patient can't be retaken once their section has run out.
Read more: MHA 1983, s17 · MHA 1983, s18 · MHA Code of Practice 2015, chapter 27: Leave of absence · MHA Code of Practice 2015, chapter 28: Absence without leave
Questions trainees ask
What is section 17 leave?
Permission from the responsible clinician for a detained patient to be away from hospital. They stay liable to be detained, so it isn't discharge, and the can recall them.
Who can grant section 17 leave?
Only the RC. Restricted patients also need the Justice Secretary's agreement.
How long can section 17 leave last?
As long as the RC decides, but never beyond the end of the section. Before granting more than seven consecutive days, the RC must consider a , and the Code says longer leave shouldn't normally exceed a month.
Is there a section 17 leave form?
There's no statutory form. Trusts use their own, which should record the leave and its conditions, with copies for the patient and anyone in the community who needs one.
Can section 17 leave be cancelled?
Yes. The RC can revoke it by written notice if that's necessary for the patient's health or safety or to protect others. Refusing medication alone isn't enough, but it's a reason to consider it.
How long can an AWOL patient be taken back?
A s3 patient can be retaken up to 6 months after going absent, or until their detention would have ended if that's later. A s2, s4 or s5 patient can't be retaken once the section has run out.
Can a patient on section 17 leave be under DoLS?
Yes, in a care home, if they lack capacity and the authorisation doesn't conflict with the leave conditions. If they need detaining in hospital for their mental disorder, recall them instead.
Test yourself
Quick-fire
Leave of more than how many days means the RC must consider a CTO?
Show the answer
7 days