Section 17 leave: supporting unpaid carers

Introduction

Friends and family members often provide substantial support to people experiencing mental health problems. Sometimes an individual’s mental health problems may require them to be detained under the Mental Health Act (1983) (MHA) for assessment and/or treatment, which can mean they need to stay in hospital for a few days, weeks, months or even years at a time. It is important that during such periods the individual maintains contact with their family, friends and communities as these are helpful for their well-being. Maintaining these relationships is also important to carers.

Section 17 MHA is a provision for leave from hospital, which could include an hour in the hospital grounds, visits to local shops, or going home for a number of days, for example. This may be supervised so that the individual is accompanied by a friend or family member (‘carer’) or member of hospital staff, to ensure that they comply with the rules, for example around medication. However, unpaid carers are not always involved in meetings and decisions around s.17 leave, even where they are expected to visit or to take care of someone at home during the leave period. A recent small-scale study by the research team found that carers of people on s.17 leave struggled with anxiety, low mood, feelings of guilt, difficulties in paying for activities and taking the time off work to support s.17 leave. Also, some experienced discrimination, and most felt unsupported by practitioners and under-involved in decision-making. Research into the experiences of carers of older and disabled people has similarly found that caring can often have a significant impact on their physical health, emotional and mental wellbeing, and finances.

Objectives

This study aims to develop a new s.17 standard for the Triangle of Care (guidance for NHS Mental Health Trusts on how to fully engage with carers) and test if it shows promise in practice. The s.17 standard will define the support to be provided to carers before, during and after periods of s.17 leave.

Methods

The first part of the study has involved a scoping review of peer reviewed papers on support provided to unpaid carers of people with mental health problems when they are in hospital. Subsequent interviews with carers and workshops with practitioners who have experience of s.17 leave have explored how to better support carers.  The scoping review, interviews and workshops have informed the development of a new s.17 standard to be included in the Triangle of Care.

In the second part of the study the s.17 standard will be tried out to see how it works in practice, what it costs, and if there are signs that it makes a difference for carers. This will involve introducing it in two different locations and comparing the outcomes for carers within those to a third location which does not implement it. Carers will be interviewed in all these locations before and after an episode of s.17 leave.