SOUTH CAROLINA DEPARTMENT OF MENTAL HEALTH
Columbia, South Carolina

OFFICE OF THE STATE DIRECTOR OF MENTAL HEALTH

DIRECTIVE NO. 794-95

(5-100)

TO:                 All Organizational Components

SUBJECT:      Unauthorized Patient Absences

I.        Purpose

The purpose of this directive is to establish standard guidelines and procedures which will be followed when a patient leaves the grounds of an inpatient facility without authorization or fails to return from a pass. These procedures are necessary to insure appropriate safeguards for the patient and prompt notification to concerned relatives and law enforcement agencies as appropriate.

II.      Classifications of Unauthorized Absences

Unauthorized absences are absences of patients who are (1) involuntarily admitted or voluntarily admitted but determined by the professional staff to be likely to cause serious harm to themselves or others if not rehospitalized and (2) have either eloped from a Departmental inpatient facility or have failed to return from pass. The Department will make appropriate attempts to return to the treating facility any patient classified as an unauthorized absence.

A. Elopement from Facility (EFF) - Applies to all involuntarily admitted patients and those voluntarily admitted patients considered to be likely to cause serious harm if not rehospitalized who leave the facility grounds without authorization.

B. Elopement from Pass (EFP) - Applies to all involuntarily admitted patients and those voluntarily admitted patients who have failed to return from Pass considered to be likely to cause serious harm if not rehospitalized.

]III.    Procedures

A. Search of Campus- Each facility shall prepare and implement procedures to assure the timely discovery of missing patients and procedures for effectively searching their respective campuses and surrounding vicinity when it is determined that a patient is not accounted for. Patients will be considered as having left the facility without authorization any time their whereabouts cannot be established by the utilization of the facility's procedures.

B. Notification Procedures- Immediately upon determining that a patient has been missing from the facility for over thirty (30) minutes or has failed to return from pass without explanation from the patient's correspondent/host, Nursing Services shall notify the Registrar's Office, or other office designated by the Facility Director. The applicable office shall ascertain whether the patient is a voluntary or involuntary admission and whether the patient has criminal charges pending or has been acquitted of a crime by reason of insanity. If the patient is a voluntary patient, the appropriate physician shall be contacted for a determination of whether the patient is believed to present a likelihood of serious harm because of mental illness or chemical dependency.

1.      If the patient was admitted involuntarily, the Facility Director or designee shall initiate the Notice and Request for Return of Involuntary Mental Patient or Involuntary Chemically Dependent Patient by signing the Verification section of the form.

2.      If the patient was admitted involuntarily or was admitted voluntarily and is considered likely to cause serious harm to themselves or others if not rehospitalized, the Registrar's Office (or other designated office) will:

(a)         Notify the following persons and record the name of the person spoken to, date, and time on the "Notice and Request for Return of Involuntary Mental Patient' or "Notice and Request for Return of Involuntary Chemically Dependent Patient" for involuntary patients and 'Notice Regarding Missing Mental Patient Likely to Cause Serious Harm" or "Notice Regarding Missing Chemically Dependent Patient Likely to Cause Serious Harm" for voluntary patients.

(1) Correspondent

(2) City or County Law Enforcement Agency, depending on the locality of the facility

(3) Office of Public Safety, Computer Services

(4) Sheriff in County of Patient's Residence

(5) Community Mental Health Center which referred the patient or which serves county of patient's residence.

(6) Probate Judge - if the patient was admitted involuntarily. Contact during normal office hours.

(7) Solicitor - if the patient has criminal charges pending or has been acquitted by reason of insanity. Notify the Solicitor in the county where the charges originated whenever the patient is missed. Contact the Solicitor at home if no member of the Solicitor's staff can be reached at the office number.

(8) Office of Communications - if the patient has or had outstanding criminal charges or if the patient is considered likely to cause serious harm.

(b) Contact the Office of Public Safety and request pickup of a photocopy of the Notice and Request for Return. (Note): This procedure is applicable only to involuntary patients.

(c) Forward a photocopy of Notice and Request for Return or Notice Regarding Missing Patient, as appropriate, signed by the Facility Director, or his designee, to the local City or County law enforcement agency, and the Sheriff's office in the County of the patient's residence within twenty-four (24) hours.

(d) If and when the patient is returned to the Department of Mental Health, notify the offices previously contacted and again record the name of the person spoken to, date, and time on the original form. In the case of a return of an involuntary patient, send a memo advising of the patient's return to the Office of Public Safety, Attention: Computer Services, House #2, SCSH.

(e) Place the completed original Notice and Request for Return or Notice Regarding Missing Patient in the patient's medical record.

3.      If the patient was admitted voluntarily but is considered likely to cause serious harm to themselves or others if not rehospitalized, the Registrar's Office (or other designated office) will in addition to the procedures in Paragraph 2. above, also implement the following:

(a) If the facility learns of the whereabouts of the patient and commitment proceedings have not been initiated, the Registrar's Office (or other designated office) will statistically discharge the person as a voluntary patient and will ensure that an Affidavit and Application for Emergency Admission is prepared by the appropriate facility physician and forwarded to the Probate Court in order that an Order of Detention can be issued. The Probate Judge should then notify law enforcement personnel that the patient is to be detained for the purpose of examination by a licensed physician as required for an emergency admission. If the examining physician completes the Application, the patient will be returned as an involuntary admission. (Under urgent circumstances, some Probate Courts may issue the Detention Order after being advised by phone of the substance of the Application for Emergency Admission, with written confirmation to follow.)

(b) If law enforcement officials or anyone external to the Department of Mental Health initiates emergency commitment proceedings in accordance with the "Notice and Request for Return the facility need only accept the patient upon return as an involuntary patient and simultaneously statistically discharge the person as a voluntary patient. (This procedure is more expeditious than commitment by the Department of Mental Health above described and should be encouraged.)

(c) If the patient returns to the facility before an Application for Emergency Admission has been initiated, the facility may accept the patient as a Return from Elopement unless the circumstances indicate the need to initiate involuntary commitment procedures.

4. If the patient was admitted voluntarily and is not considered to present a likelihood of serious harm by the appropriate physician, the procedures in paragraph V. should be followed.

C.      Reporting

It is the responsibility of the Registrar's Office or other office designated by the Facility Director to ascertain the facts surrounding every patient absence or departure and make a final determination as to whether or not the absence or departure constitutes an unauthorized absence within the scope of this directive. Such determination shall be made not later than twelve o'clock (12:00) noon of the first regular working day following the departure or absence.

This requirement for a final determination by the Registrar's Office or other designated office is to ensure the accuracy of statistical reporting. In no instance shall on duty personnel delay implementation of the procedures contained in Section III and associated facility policies and procedures when a patient is determined to have departed or be absent without authorization. Search procedures and notification when appropriate shall be instituted as soon as the initial determination of absence or departure has been made by Nursing Service.

IV.      Duration.

A.      A request for the reconfinement of an involuntary patient is effective indefinitely for patients with criminal charges pending and for patients committed to the facility after having been acquitted of a crime by reason of insanity. A request for the reconfinement of any other involuntarily committed patient will be effective for one year. After one year has passed following EFF or EFP, a patient in the latter category cannot be involuntarily reconfined without a new commitment proceeding being initiated. Accordingly, the facility shall statistically discharge such patients at the end of one year and so notify the applicable Probate Court. A memorandum should then be sent to the Office of Public Safety requesting the Request for Return be canceled.

B.      The procedures described herein for providing Notice regarding voluntary patients considered likely to cause serious harm parallel the statutory procedures regarding involuntary patients. Accordingly, a facility shall statistically discharge the voluntary patient after the expiration of one year or upon confirmation that they have entered another psychiatric hospital or treatment program, provided the patient has no associated criminal charges.

V.      Voluntary Patients.

A.      Adult patients who are voluntary admissions and are not considered to present a likelihood of serious harm by virtue of mental illness or chemical dependency shall not be considered unauthorized absences upon departure or absence from a facility. Such patients who depart against professional advice or fail to return from pass shall be administratively discharged and the correspondent and appropriate mental health center notified in accordance with facility procedures and policies.

B.      Adults who are voluntarily admitted, but who are suffering from medical conditions which are believed to put them at risk of harm if not treated, such as residents of the Department's nursing homes, shall not be considered unauthorized absences upon departure or absence from a facility for purposes of this directive. However, the facility shall immediately initiate steps to locate and secure the return of the individual to the facility, or to the custody of some other responsible party. The individual's immediate family shall be promptly notified of the resident's absence. Assistance shall be provided in notifying the appropriate law enforcement agencies to assist the individual and notify the facility if found. Department nursing homes and facilities which treat elderly patients shall prepare and implement procedures outlining the steps to be followed for missing residents who are voluntarily admitted, but who suffer from medical conditions requiring ongoing treatment.

C.      Patients under the age of 18 who are voluntarily admitted and who are not considered to present a likelihood of serious harm by virtue of mental illness or chemical dependency shall not be considered unauthorized absences upon departure or absence from a facility for purposes of this directive. However, the facility shall immediately initiate steps to locate and secure the return of the juvenile to the custody of their parent, guardian or legal custodian. The child's parent, guardian or legal custodian shall be promptly notified of the child's absence. Assistance shall be provided in notifying the appropriate law enforcement agencies to take the child into custody if found. Department facilities which treat juveniles shall prepare and implement procedures outlining the steps to be followed for missing juvenile patients who are voluntarily admitted and are not considered to present a likelihood of serious harm. Such patients shall be administratively discharged and the appropriate mental health center notified in accordance with facility procedures and policies.

VI. Release of Information.

All inquiries from the public concerning patients who have left without authorization will- be referred to the Office of Communications. The Office of Communications may release information if considered necessary in the interest of public or patient safety after consultation with facility administration and the Office of General Counsel.

This directive rescinds and replaces SCDMH Directive No. 765-92 entitled, "Unauthorized Patient Absences."

 

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Date: 6-21-95