Psych CASC / OSCE · Emergency psychiatry — absconding and missing patients
Explain abscond response and engage family — CASC communication station
MRCPsych/FRANZCP-style CASC: calm transparent communication about a missing inpatient, collateral for location and risk, police threshold explanation, avoid false reassurance, invite questions, plan for return contact.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar on the acute ward. [1]
Candidate instructions. The examiner plays the missing patient's partner. Explain that the patient is currently unaccounted for, what the team is doing, and why. Obtain collateral about likely locations, recent stressors, suicide or violence risk, substances, and phone contacts. Agree how you will keep the partner informed. Avoid false reassurance ("they always come back") and avoid blaming the partner. Do not invent precise local statute numbers. [1][2]
Candidate scenario
Your patient is 34, detained for schizophrenia with recent suicidal ideation. They were last seen 40 minutes ago near the main exit. Search of the ward is underway. The partner has just arrived for visiting hour and is angry and frightened. [1]
Marking domains
- Empathy, calm pace, clear structure without jargon overload
- Honest explanation of missing status and active search
- Collateral: destinations, phone, means, farewell acts, substances, who else might help
- Explains police involvement threshold without panic or minimisation
- Collaborative plan for communication updates
- Avoids false reassurance and blame; checks understanding
- Mentions post-return review and prevention without over-promising [1][3]
Reveal assessor key
Open. Introduce role; acknowledge how frightening this is; explain you take missing patients seriously because of safety risks including self-harm away from the ward. [1]
Explain actions. Ward and grounds search; staff checking last seen time, clothing, exits; trying the patient's phone; senior doctors informed; decision about police based on risk (suicidality, vulnerability, time missing). Invite partner to share any recent texts or known places (friend's house, park, pub, family home). [1][2]
Collateral. "Has anything been more stressful this week?" "Have they talked about ending their life or getting away to die?" "Any alcohol or drugs?" "Where would they go if frightened?" "Who else can we call?" Document answers. [2]
Plan. Agree callback frequency; ask partner to call if patient contacts them; explain return will include medical check and a calm conversation about what went wrong, aiming to prevent recurrence rather than pure punishment. [3]
Close. Summarise; check understanding; thank them for helping; do not promise a specific find-time. [1]
References
- [1]Hunt IM, Windfuhr K, Swinson N, et al. Suicide amongst psychiatric in-patients who abscond from the ward: a national clinical survey BMC Psychiatry, 2010.PMID 20128891
- [2]Bowers L, Jarrett M, Clark N, et al. Absconding: why patients leave J Psychiatr Ment Health Nurs, 1999.PMID 10633672
- [3]Bowers L, Simpson A, Alexander J Real world application of an intervention to reduce absconding J Psychiatr Ment Health Nurs, 2005.PMID 16164511