Developing the leave/abscond risk assessment (LARA) from the absconding literature: an aide to risk management in secure services

Purpose

Leave is an important part of life for both patients and clinicians in secure mental health and learning disability settings. Patients breaching leave conditions (i.e. absconding or failing to return) represent a small percentage of leave episodes; however when incidents occur there can be far reaching negative outcomes for potential victims, the patient and the service. The purpose of this paper is to devise a risk assessment specifically for leave decision making based on the literature available.

Design/methodology/approach

Using the approach followed in the violence risk assessment field, a literature review was carried out of papers relating to absconding. The results were used to develop the leave/abscond risk assessment (LARA).

Findings

There are a number of problems with the available literature: there is a dearth of research, definitions for absconding are varied (often including escape) making comparisons difficult and much of the literature focuses on psychiatric acute wards making it difficult to translate into secure environments. Characteristics of absconders vary and are not idiosyncratic enough from which to develop a risk assessment. Socio‐environmental factors are perhaps more important and so the LARA was devised around assessment of these.

Research limitations/implications

The limitations of this paper are clear: a risk assessment tool is proposed that has not been evaluated or validated in any way. The authors feel that the process warrants publication and invite readers to use the tool for clinical and/or research purposes.

Originality/value
The LARA is proposed as a specific leave‐decision‐making risk assessment tool for teams working in secure environments.