Section 17 leave: supporting unpaid carers

Developing a Standard to support unpaid carers around patients’ s.17 leave from hospital and evaluating implementation in mental health wards.

Research team

About the research project

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

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. This may be supervised so that the patient is accompanied by a friend or family member (‘carer’) or member of hospital staff. However, 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.

Phases of the research

This study consisted of two phases:

Phase 1

During phase one we undertook interviews with carers of people who had been detained under the Mental Health Act (1983) and experienced s.17 leave, and also held workshops and interviews with practitioners and Responsible Clinicians (RCs) involved with s.17 leave. We sought to understand the views of carers, practitioners’ and RCs’ around s.17 leave in terms of what they thought worked well for carers around s.17 leave, what they thought could be improved for carers, and the barriers to such improvements for carers.

At the end of phase one we developed a ‘s.17 Standard’ which defined the support to be provided to carers before, during and after periods of s.17 leave. This was developed following interviews with carers and practitioners to produce something that carers felt would help them to feel more involved in communication and decision-making around s.17 leave but also something that practitioners felt was feasible in practice.

Phase 2

In the second phase of the study the s.17 Standard was 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 involved implementing the Standard in selected wards (‘intervention wards’) in the study sites and comparing the outcomes for carers with those in other wards in which the Standard was not introduced (‘control wards’). We interviewed carers of patients in both intervention and control wards before and after an episode of s.17 leave and again six months later.

Practitioners and Responsible Clinicians in intervention wards were also invited to take part in interviews to discuss implementation of the S.17 Leave Standard, what they felt worked well and barriers to working with carers. Practitioners and RCs could instead take part in an anonymous online survey. Wider research, clinical and managerial staff across the Trusts were also invited to take part in a survey exploring issues around implementing interventions in inpatient mental health wards and around undertaking research with carers.

Study Findings

Section 17 Leave: Supporting Unpaid Carers - Research Participant Summary Dec23 (PDF , 665kb)

Tucker, L., Moran, N., Naughton-Doe, R., Wakeman, E., Wilberforce, M. and Webber, M. (2024) Section 17 Leave - Supporting unpaid carers: Research participant summary. University of York. DOI: doi.org/10.15124/yao-jsdq-d334

Resources for practitioners and for unpaid carers

The research team have developed a variety of products to illustrate the S.17 Leave Standard, indicate how it can be used in practice by practitioners on mental health inpatient wards/units, and explain more about s.17 leave to carers. These resources can be viewed online at the links below and some can be printed at your discretion (where indicated):

Resources for unpaid carers (including for practitioners to share with carers)

Carers s.17 leave information leaflet
- These 4-page documents explains what s.17 leave is, who decides when somebody is ready for s.17 leave, how long s.17 leave may be for, where people can go and what they can do during s.17 leave, carer involvement in planning s.17 leave, changes to s.17 leave at short notice, what carers could do if they have any concerns during the s.17 leave, feedback following s.17 leave, and carer support services. Some of this information may also be useful for carers of people who are in hospital voluntarily.

Carers s.17 leave information leaflet (screen read version) (PDF , 170kb)

Moran, N., Tucker, L., Naughton-Doe, R., Wakeman, E., Wilberforce, M. and Webber, M. (2024) S.17 Standard - Carers s.17 leave information leaflet. University of York. DOI: doi.org/10.15124/yao-qhvd-f849

Carers s.17 leave information leaflet (Print version) (PDF , 2,981kb)

Resources for inpatient mental health staff

Practice Guidance: Supporting unpaid carers around hospital leave
- A 30-page Practice Guidance document outlining the benefits of the Standard for practitioners, carers and patients; the importance of working with carers; how the guidance was developed; an overview of the S.17 Leave Standard; and guidance on what practitioners need to do (and why) for each of the 10 items in the Standard.

Practice Guidance (PDF , 858kb)

Moran, N., Webber, M., Naughton-Doe, R., Wilberforce, M., Wakeman, E. and Tucker, L. (2024) S.17 Standard - Practice Guidance: Supporting unpaid carers around hospital leave. University of York. DOI: doi.org/10.15124/yao-4jep-kz20

Summary Guidance for practitioners: Supporting unpaid carers around hospital leave
- A 14-page summary of the Practice Guidance document for practitioners presenting an overview of the S.17 Leave standard and guidance on what practitioners need to do for each of the 10 items in the Standard.

Summary guidance for practitioners (PDF , 687kb)

Moran, N., Webber, M., Naughton-Doe, R., Wilberforce, M., Wakeman, E. and Tucker, L. (2024) S.17 Standard - Summary guidance for practitioners: Supporting unpaid carers around hospital leave. University of York. DOI: doi.org/10.15124/yao-1q6z-6042

Poster: Supporting unpaid carers around hospital leave
- The poster showcases the 10 items of the S.17 Leave Standard and can serve as a reminder to staff about ways they could be including unpaid carers before, during and after s.17 leave.

Poster: Supporting unpaid carers around hospital leave (PDF , 7,477kb)

Tucker, L., Moran, N., Webber, M., Naughton-Doe, R., Wakeman, E. and Wilberforce, M. (2024) S.17 Standard - Poster: Supporting unpaid carers around hospital leave. University of York. DOI: doi.org/10.15124/yao-w66r-va83

Business card: Supporting unpaid carers around hospital leave
- These small business cards are designed to fit inside a staff lanyard and act as a mobile reminder of the 10 items of the S.17 Leave Standard to help staff remember to include unpaid carers before, during and after periods of s.17 leave. These can be printed or a small number can be posted out on request (please contact Nicola.Moran@york.ac.uk)

Business card: Supporting unpaid carers around hospital leave (PDF , 2,403kb)

Tucker, L., Naughton-Doe, R., Moran, N., Wakeman, E., Wilberforce, M. and Webber, M. (2024) S.17 Standard - Business card: Supporting unpaid carers around hospital leave. University of York. DOI: doi.org/10.15124/yao-qyjh-5344

Training/information videos for inpatient mental health staff: Supporting carers around hospital leave

A series of short film clips have also been produced to explain the different elements of the S.17 Leave Standard as they apply at different points in the admission, namely before s.17 leave, during s.17 leave, and after s.17 leave. These short films can be watched together or individually as and when practitioners are at a particular point in the s.17 leave journey. Lots of the information and suggestions are also applicable to patients who are in hospital voluntarily:

Trailer

(42 second overview of the film clips)

Webber, M., Moran, N., Tucker, L. and Wakeman, E. (2024) S.17 Standard - 0. Trailer: Training videos for inpatient mental health staff: Supporting unpaid carers around hospital leave. University of York. DOI: doi.org/10.15124/yao-ncdc-pq77

Introduction to the S.17 Standard

(5:26 minute overview of the 10 items in the Standard, and the benefits to practitioners, carers and patients of practitioners working with and supporting carers)

Moran, N., Tucker, L., Webber, M. and Wakeman, E. (2024) S.17 Standard - 1. Introduction to the S.17 Standard: Training videos for inpatient mental health staff: Supporting unpaid carers around hospital leave. University of York. DOI: doi.org/10.15124/yao-d8sz-sw84

Before leave from hospital

(4:31 minute review of involving unpaid carers before leave occurs)

Tucker, L., Moran, N., Wakeman, E. and Webber, M. (2024) S.17 Standard - 2. Before Leave From Hospital: Training videos for inpatient mental health staff: Supporting unpaid carers around hospital leave. University of York. DOI: doi.org/10.15124/yao-a889-wq14

Planning and undertaking hospital leave

(4:27 minute insight into how practitioners can work with unpaid carers in the planning stage and at the start of the leave)

Moran, N., Tucker, L., Wakeman, E. and Webber, M. (2024) S.17 Standard - 3. Planning and Undertaking Hospital Leave: Training videos for inpatient mental health staff: Supporting unpaid carers around hospital leave. University of York. DOI: doi.org/10.15124/yao-jkqx-xv42

After leave from hospital

(2:53 minute review of involving and supporting carers following hospital leave)

Tucker, L., Moran, N., Wakeman, E. and Webber, M. (2024) S.17 Standard - 4. After Leave From Hospital: Training videos for inpatient mental health staff: Supporting unpaid carers around hospital leave. University of York. DOI: doi.org/10.15124/yao-wkp7-9w97

Publications from the project

Moran, N., Naughton-Doe, R., Wilberforce, M., Wakeman, E. and Webber, M. (2024) Supporting unpaid carers around hospital leave for people detained under the Mental Health Act (1983) in England: carer and practitioner perspectives. BMC Psychiatry 24, 160 (2024). https://doi.org/10.1186/s12888-024-05602-9

Naughton-Doe, R., Moran, N., Wakeman, E., Wilberforce, M., Bennett, L. & Webber, M. (2022) Interventions that support unpaid carers of adult mental health inpatients: a scoping review, Journal of Mental Health, doi: 10.1080/09638237.2022.2069702

Co-Investigators

Professor Martin Webber - School for Business and Society, University of York
Dr Nicola Moran - School for Business and Society, University of York
Dr Mark Wilberforce - School for Business and Society, University of York
Mrs Emma Wakeman - Senior Social Worker, St Andrew's Healthcare

The information shared on this webpage presents independent research funded by the National Institute for Health Research (NIHR) School for Social Care Research (SSCR), grant RE20-032-290398. The views expressed are those of the authors and not necessarily those of the NIHR SSCR, the NIHR or the Department of Health and Social Care.

Principal Investigator

Professor Martin Webber

Learn more

Funder

NIHR SSCR