Self-discharge from hospital: How does it work?

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Important takeaways:

Before you can self-discharge from hospital, you need to:

• Understand the risks associated with self-discharge
• Be assessed by medical staff at the hospital
• Write a self-discharge letter stating you understand self-discharge is contrary to medical advice

Understanding self-discharge

If you ever find yourself in hospital, waiting to be given the all clear to leave, you may be wondering, ‘Can I discharge myself from hospital?’ The answer is yes.

Choosing to leave hospital before being assessed as fit for discharge, and or against medical advice, is known as a self-discharge from hospital.

Before making a decision, the hospital will consider whether or not a patient has the mental capacity to self-discharge or if self-discharge could potentially put the patient at risk.

The process of self-discharging

How does self-discharging from hospital work? As a patient, you have the right to discharge yourself from hospital, however, hospitals recommend speaking with your Named Nurse or Doctor before making the decision to leave. This ensures you receive any necessary treatment and enables staff to arrange follow-up care you may need.

Hospital staff will assess you before agreeing to a self-discharge, and if they have concerns about you discharging yourself, they must arrange a further assessment. The outcome will be discussed with you (and your family or carer if you wish) and may result in you not being allowed to leave the ward.

If you wish to self-discharge against the advice of the Doctor or Nurse, you may be asked to sign a discharge AMA (against medical advice) form or self-discharge form before you leave. This letter states that you are aware self-discharge is contrary to medical advice. Self-discharge forms and their names vary across NHS trusts.

Mental capacity and self-discharge

If you choose to self-discharge from hospital against medical advice UK, or before being assessed as fit for discharge, the hospital or Trust will assess your mental capacity in line with the Mental Capacity Act 2005 (England) and the Adults with Incapacity Act 2000 (Scotland).

Following the assessment, if a patient is assessed as having capacity, they have the right to make the decision to leave the hospital (even if others think it is unwise). However, if a patient is assessed as lacking capacity to make a decision, they can be refused discharge if staff can demonstrate they are acting in the patient’s best interest.

Risks and consequences of self-discharging

Risks associated with self-discharging from hospital should be considered before making the decision to discharge yourself from hospital against medical advice.

For example:

• The management of medicines
• The provision of appropriate health and social care in the community
• Incomplete tests and scans
• The fitting and use of home adaptation
• The risk of falls, infections or sores 

A patient needs to be able to make an informed decision before choosing to self-discharge, this ensures they have a full understanding and appreciation of the risks, benefits and alternatives of the decision.

Support and advice services

PALS or PASS can help people in many ways, including resolving any questions or concerns when using an NHS service.

PALS can:

• Help you with health-related questions
• Help resolve concerns or problems when you’re using the NHS
• Tell you how to get more involved in your own healthcare
• Give you information about the NHS complaints procedure, including how to get independent help if you want to make a complaint

• Give information about support groups outside the NHS

You can find your nearest PALS office on the NHS website, or you can ask your GP surgery, hospital or phone NHS 111 for details.

PASS is delivered by Citizens Advice in Scotland; they provide information about your rights and responsibilities when using NHS services. It’s free, accessible and confidential and can be used by patients, their carers and their families.

PASS can help you provide feedback, comments, concerns or complaints about the NHS.

To contact PASS :

• Visit the PASS website and use webchat
• Phone the PASS national helpline 0800 917 2127
• Go to your local citizens advice bureau

As an NHS patient, these are some of your key rights:

• Not be discriminated against
• Be treated with dignity and respect
• Accept or refuse treatment and only be physically examined with consent
• Have access to your own records
• Privacy and confidentiality
• Have any complaint acknowledged within three days and properly investigated
• Compensation if harmed by negligent treatment

Writing a self-discharge letter

How do I write a self-discharge letter from the hospital? An important question to ask if you wish to self-discharge from hospital. A self-discharge letter should include:

• Your name
• Stating you take full responsibility for discharging yourself and the possible consequence have been explained by X Doctor and that action is contrary to medical advice
• Your signature
• Doctor’s signature and their name
• Witness signature and their name
• The date

Discharging a family member

Family members wanting to get their loved one home as quickly as possible have asked ‘Can you discharge a family member from hospital? No, it is the hospital’s decision to discharge a patient, unless the patient wishes to self-discharge.

Potential impacts on family and caregivers

Self-discharge can have an impact on the patient or their family or caregiver.

Patients may see negative effects on their health, and it could impact the ways in which families care for them. This in turn can lead to a deterioration in their health or even readmission to hospital.

Returning to hospital after self-discharge

Some people worry that if you discharge yourself from hospital can you go back? No hospital in the UK will refuse to treat you on the grounds you have previously discharged yourself, even if against medical advice.

The only circumstances where an NHS hospital will refuse to treat someone is if they are displaying aggressive/violent and/or abusive behaviour to staff. However, if it is a life-threatening emergency, they will still find a way to treat them.

Exploring positive aspects of self-discharge

Hospital staff have expressed sympathy for patients choosing to self-discharge from hospital, noting that it isn’t poor care that prompts a patient’s decision, but distress living on a hospital ward. 

A nurse said: “We are waking them up in the middle of the night to check their observations, we’ve got patients coming and going and monitors going off, you get why somebody would much rather be at home in their own bed using their own facilities.”

Some patients feel their leaving hospital reduces hospital staff workload, whereas healthcare staff see self-discharge as a patient’s response to the lack of control they feel they may be experiencing during their care. 

Lancaster University researchers say that viewing self-discharge in a more positive way enables staff to demonstrate compassion toward patients.

Frequently asked questions

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