Systematic review of therapeutic leave in inpatient mental health services

Aim: To identify, critically evaluate, and synthesise the empirical evidence about therapeutic leave from mental health inpatient settings. 

Background: “Leave” occurs when a mental health inpatient exits the hospital ward with the appropriate authorisation alone, or accompanied by staff, family, or friends. Limited research has previously addressed therapeutic as opposed to unauthorised leave, and the evidence-base has not been systematically evaluated. 

Design: Systematic review methodology following relevant Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidance. 

Data Sources: Multiple electronic databases (CINAHL; Criminal Justice database; PsycARTICLES; Scopus; OpenGrey; Cochrane; GoogleScholar) for papers published from January 1967 to July 2017. 

Review Methods: Information was extracted under the following headings: study, purpose/aims, sample, country, setting, design and data collection method(s), data collection instrument, and results. Papers were assessed, as per the hierarchy of scientific evidence, and where there was sufficient data, we calculated a range of standardised rates of leave incidence. 

Results: Standardised leave rates in forensic settings reflect security level. There was little meaningful information on which to base calculation of rates for civil settings. The strongest evidence supports leave used for supervised discharge; other forms of leave lack an evidence base and decisions appear to be made on the basis of heuristic rules and unsupported assumptions. Clinical decision making about therapeutic leave cannot claim to be evidence-based. 

Conclusion: Research is urgently needed to provide information about how leave is managed, the best ways to support leave, and what happens on leave.