Abstract
This paper reviews and comments on the recent case of Ellame Ford-Dunn, who caused her own death after being allowed to abscond from hospital. It then discusses some important issues relating to the case and makes some helpful suggestions that will help prevent or reduce the incidence of absconding from hospitals, especially, where compulsorily detained patients are concerned. This paper shows the need for effective measures to be taken to prevent mental patients from absconding from hospital because absconding can result in serious consequences for the absconder, etc. The paper has the following parts: (a) facts and decision, (b) the meaning of absconding, (c) consequences of absconding from hospital, (d) the civil law ramifications of the University Hospitals Sussex NHS Trust’s defective policy regarding absconders and consequent breach of duty under the Health and Social Care Act 2008 and (e) recommendations.
Keywords
Facts and decision
Ellame, a 16-year-old patient with severe mental health problems, detained under s.3 of the Mental Health Act 1983 (‘MHA 1983’), 1 absconded from Worthing Hospital on 20th March 2022. She caused her own death some minutes after absconding from hospital.
The The University Hospitals Sussex NHS Trust (“the Trust”), which was responsible for Worthing Hospital, was prosecuted by the Care Quality Commission (‘CQC’), the hospital regulator. On 27th October 2025 the Trust pleaded guilty to the offences of failing to provide safe care and treatment resulting in avoidable harm to Ellame, under regulations 12(2) and 22(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 2 On 26th November 2025 the Trust was sentenced at Brighton Magistrates Court. District Judge Tessa Szagun fined the Trust £200,000, along with the costs of the prosecution and a victim surcharge of £190. 3
Comment
According to INQUEST, this fine was the largest imposed on an NHS Trust following death in a mental health setting. It reflects failures in the Trusts’s policy re absconders at the time Ellame absconded.
It is difficult to understand and/or accept that in modern days a 16-year-old patient, detained under s.3, MHA 1983, was not only admitted to a children’s unit of a general hospital (rather than a psychiatric hospital) but also not prevented from absconding when there was an opportunity to stop her. Indeed, as the barrister for the Care Quality Commission (James Marsland) stated, the Trust’s policy on missing patients, then in operation, provided no meaningful guidance on what action should be taken when a vulnerable patient is seen to be absconding – the policy was so unclear that it created confusion among the hospital staff and resulted in the failure to control and protect Ellame.
Also, the Trust’s reason that there was a shortage of psychiatric beds, etc., is not acceptable, considering Ellame’s mental state and susceptibility to self-harm, all of which were known to the hospital. In fact, she had a long history of trauma, suicidal ideation and self-harm. Moreover, she was autistic and had ADHD and an eating disorder.
Because she was a patient detained under s.3, MHA 1983, the Trust should have done more to control her and protect her from harm or danger. The Trust had clear statutory authority (and, so, responsibility) to do so under s.6(2), MHA 1983. 4 It beggars belief, therefore, why the qualified nurse in charge of Ellame’s care at the time was not allowed by the Trust’s policy to stop her from absconding even though she was in hospital under s.3, MHA. So, better training for nurses and better Trust policies are required.
The Trust also, under Art, 2(1) of the European Convention for the Protection of Human Rights and Fundamental Freedoms 1950 (‘ECHR 1950’), 5 had a duty to do all they could do to protect Ellame’s life. This is discussed later (below).
Meaning of absconder
The term, ‘absconder’ refers to any compulsory or informal patient who leaves hospital without medical advice or without informing the staff. It also means any compulsorily detained patient who fails to return from leave at the appropriate time. Compulsorily detained patients who leave hospital unauthorisedly or fail to return from leave are statutorily described as ‘absent without leave’ (s.18(6), MHA 1983). 6 Ellame Ford-Dunn was such a patient as she was detained under s.3, MHA 1983 when she left Worthing hospital without medical permission.
The consequences of absconding from hospital
First, when a patient absconds from hospital, their treatment is interrupted and their mental condition is likely to deteriorate. Such a patient may, therefore, commit offences (e.g. in Carradine’s case in 1997, 7 while at large, the absconder bought a knife and stabbed a baby girl at random in front of her mother in a shopping centre) or cause self-harm in various ways (as in Savage v South Essex Partnership NHS Foundation Trust, 8 where, after absconding, the patient committed suicide). There are other consequences of absconding from mental hospitals: (a) for the absconder’s family, who may be attacked or subjected to fear, (b) for the absconder’s hospital in that, apart from the expense of returning absconders by taxi, etc., the absconding behaviour may be emulated by other patients, (c) for members of the public (who may be in fear if they live near the hospital in question) and (d) for the police in terms of demands on their time and resources (Andoh9, pp. 70–92).
There are several other reported incidents illustrating the consequences of absconding from hospitals such as the following:
(a) Darren Harkin absconded from Hayes Hospital near Bristol and raped a 14-year-old girl twice at knife point. 10
(b) John Barrett, a violent and paranoid schizophrenic, repeatedly stabbed a 50-year-old cyclist after absconding from a south London mental hospital’s secure unit. 11
(c) In Lambert v West Sussex H.A. 12 the patient absconded and went on to jump from an overhead bridge, thereby sustaining spinal injuries.
(d) In D v South Tyneside Health Care NHS Trust, 13 after absconding from hospital, the patient went home and took her mother’s heart-condition tablets.
Ramifications in the civil law of the trust’s failure
The Trust’s incompetence may result in an action for negligence and violation of Art. 2(1), ECHR 1950.
(i) Negligence: The Trust can be sued for negligence, that is, breach of duty of care causing foreseeable harm/loss (see, e.g. Paul and another v Royal Wolverhampton NHS Trust 14 (2024) UKSC1 – regarding claims by secondary victims). Here the Trust’s pleading guilty to the charge of failing to provide safe care and treatment to Ellame under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 can, according to s.11(1), Civil Evidence Act 1968, 15 be relied on as proof of negligence on their part.
(ii) Violation of Ellame’s right to life under Art. 2(1) of the ECHR 1950 – the duty of hospitals/NHS Trusts, as public bodies, under Art. 2(1), ECHR 1950, as embodied in the Human Rights Act 1998. 16 On this point Savage v South Essex Partnership NHS Foundation Trust is nearly on all fours with Ellame’s case. In 2004 Mrs. Savage absconded from Runwell hospital where she was detained under section 3, MHA 1983 and being treated in an acute psychiatric ward. She committed suicide while at large. Her daughter brought an action claiming that, by allowing her mother to escape, the hospital, which was a public authority, had failed to protect the right to life under Art. 2(1), ECHR 1950. Art. 2 imposes a positive obligation on the state and public authorities to take adequate steps to protect life. The claim succeeded. The House of Lords held that Art. 2 put health authorities under an overarching obligation to protect the lives of patients, especially those compulsorily detained, in their hospitals. Art. 2 also required them to employ competent staff and to adopt systems of work which would protect the lives of patients. Moreover, according to the House, that obligation imposed a further ‘operational’ obligation on health authorities and their staff.
So, just as in Savage, Ellame’s parents may wish to sue the Trust for failure to protect Ellame’s life in accordance with Art. 2(1) of the European Convention. She was a compulsorily detained patient like Mrs. Savage and, so, the operational duty in Art. 2(1) was engaged: given her legal status (a patient under s.3, MHA 1983), and other circumstances (diagnosis, history of suicidal ideation and attempts to abscond) that the Trust knew of, the Trust should have done much more than they did to protect her, to prevent her from absconding and thereby preventing her from causing her own death.
Some recommendations will now be made to help reduce and/or prevent absconding from hospitals.
Recommendations
The recommendations are as follows:
(a) Better training of nurses and other hospital staff on how to deal with the problem of absconding (as was implied by the statement to the Magistrates Court made by the barrister for the Care Quality Commission when the Trust was prosecuted);
(b) Hospital policies on absconding or missing patients generally must be clear and comprehensive; this should include tighter control of hospital ward exits (e.g. Hunt et al.17, p.14) and
(c) Other measures suggested solely by the author:
(i) the atmosphere in hospital wards needs to be such that the patients feel reasonably happy and independent, safe, wanted and not bored; (ii) relatives and friends need to be encouraged to visit the patients and to be discreetly advised not to incite, or exert any pressure on them to abscond; (iii) the ward staff should do their best to adopt a warm and flexible attitude towards their patients; (iv) patients should be regularly counselled so that they feel they are getting the right sort of help; (v) there should be better channels of communication between members of staff and between staff and patients so that patients may not feel their care is being negatively affected in any way; (vi) patients should be encouraged as much as possible to be more concerned about each other’s welfare and to tell the staff about any unusual event/s in the ward, for example, a patient’s plan to abscond; (vii) there should be more vigilance by staff in the admission wards and more observation of patients considered more likely to abscond; (viii) there should be careful supervision and counselling of patients considered most likely to influence other patients to abscond; and (ix) in order that patients may not feel bored and choose to abscond as a result, existing recreational, occupational and other activities in hospital must be made, as far as financial limits permit, more exciting and appealing to the patients.
Conclusion
Ellame’s story is a sad one. Her absconding from hospital and subsequent death could have been prevented had the Trust not failed in its duty to take proper care and control of her. As the foregoing shows, that failure by the Trust has had ramifications in the criminal law. It has also exposed the Trust to possible legal action in the civil courts in the future. As discussed above, absconding from hospitals can have serious consequences, as evidenced recently by Ellame’s case. Accordingly, some recommendations are suggested to help prevent and/or reduce the incidence of absconding from hospitals.
Footnotes
Declaration of conflicting interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
