Absconding and missing patients — structured clinical viva

This is failure to return from authorised leave, a core abscond pathway. It is not a minor lateness if residual suicide risk and interpersonal crisis (argument, left alone) are present. Treat as a missing-patient incident with timed escalation.^[1]

Immediate plan: declare overdue/missing per policy; confirm leave form details (return time, destination, escort level); search ward/grounds in case she returned unseen; repeated phone attempts; contact sister for last location, mood, whether she mentioned suicide or went to get means; notify nurse-in-charge and duty consultant; build timeline. Risk is at least moderate-high given mixed depression, passive death wishes this morning, overdue leave after conflict, and voicemail — low threshold for police missing-person notification, especially if sister cannot locate her quickly or describes farewell acts/means access.^[1]

Legal frame: if detained, statutory AWOL/return powers apply (jurisdiction-specific — do not invent section numbers). If voluntary, still act on clinical risk. Lithium therapeutic status does not remove acute leave-risk duties.^[1]

Prevention teaching points: multi-element abscond reduction packages; Safewards conflict/containment framing; structured leave decisions with clear purpose, return time, contingency contacts, and dynamic MSE — forensic literature on structured decision-making is transferable in principle even on general adult wards.^[2][3][4]

Motives: argument and family stress are classic social drivers alongside mood symptoms; address alliance and leave purpose, not only restriction.^[5]

On return: medical check, MSE (ideation/intent/plan/means), observation review, consider leave step-down, means restriction at home with sister, therapeutic debrief, document who was informed and revised plan same shift.^[1]