Missing from Hospital

Every year over 20,000 people are reported missing or ‘absent without leave’ from hospitals or other healthcare settings.

These people are often vulnerable, and at serious risk of harm, and yet there is very little information about who they are, what happens to them, what drives people to go missing in this situation, or how we can best support them.

The majority of those incidents are reported from ‘acute/general hospitals’ which would include A&E departments; and mental health services, as shown in the table below:

There is disagreement about who should be responsible for responding to these incidents. The Right Care Right Person national partnership agreement suggests that health should take the lead when someone walks out of a hospital or mental health services. And in some ways that’s absolutely right, people who are in mental health crisis should not be over-policed. People should have the right to go where they want, unless they are at immediate risk to themselves or others, and the police should not be investigating someone’s life if there’s no good reason to do so.

However, when does someone leaving hospital become a missing person incident? Where is the threshold for police intervention, where we acknowledge the need for specialist police resources, expertise and tools in finding someone and ensuring their safety?

When someone arrives at hospital, or is being cared for under mental health services, we expect them to be kept safe. So wouldn’t we expect the police to react if they go missing from those settings and they might come to serious harm while away?

And maybe it’s not just about what happens when someone leaves or goes missing. What is happening before then? If this is happening more than 20,000 times each year, what is being done to prevent people from going missing from healthcare settings? Do we know who is most high risk? Are we giving people the opportunity and help to stay safe?

What have we done so far?

In 2018 we supported the APPG Inquiry into safeguarding missing adults who have mental health issues. The report put a spotlight on issues in the health and police response to missing from hospitals, and subsequently we led the development of a Framework for Multi-agency response for adults missing from health and care settings, which was published in 2020. This Framework sets out good practice in planning, prevention and response when someone goes missing from a healthcare setting.

However, the Framework has not been widely implemented. There is very little oversight of whether hospitals, NHS trusts, police forces, or wider safeguarding partnerships are working effectively to respond to these missing people.

Tragically this leaves people to fall through the gaps. Earlier this year we published a review of Prevention of Future Death Reports from Coroners, and Safeguarding Adults Reviews, which identified 21 people who had died after going missing from hospital. The review acknowledged failures in multi-agency working and understanding about the roles and responsibilities of each agency as a key theme in many of these deaths.

Without improving national guidance on missing from hospital, there is a risk that even more people will die. People who were supposed to be kept safe by health services and police.

What next?

To better understand these issues, it is vital that we hear more from the people who have actual lived experience: people with experience of mental ill-health, distress and trauma, who have been reported missing from healthcare settings. They should be at the centre of any developments in policy and practice affecting others facing similar circumstances in the future.

We hope in the coming months to work with formerly missing people to shape next steps in this area, and to ultimately improve the support that people receive when they are at risk of going missing, when they leave healthcare settings unexpectedly, and when the police are called.

If you are interested in this work and would like to get in touch, please email josie.allan@missingpeople.org.uk.