The anatomy of elopement from an acute adolescent service: Escape from engagement

Summary and Conclusions

The phenomenon of elopement from an open acute adolescent psychiatric service, located in a general city hospital, is studied. The records of 19 patients who successfully eloped a total of 25 times over a six-month period were analyzed: There was a predominance of male patients: 40% of escapes involved more than one patient; 88% of the elopements ended with a return to the hospital, usually of the patient's own volition; a surprising percentage of adolescents (58%) had never attempted elopement before; 60% of the elopements occurred in the evenings or over weekends.

Various types of elopement, and elopers, are presented. The authors suggest that running away is a highly complex, multidetermined act, and that, as in other forms of disruptive phenomena encountered on adolescent wards, staff dysfunction can be of primary etiological significance. However, elopement itself may precipitate considerable staff tension in a previously well-functioning milieu.

While the disturbed adolescent may bolt from a community ridden by distorted communication, it is emphasized that even in a smoothly run milieu, the patient may elope to elude the threat of engagement with adults who truly care about him, as an anguished human being invested with dignity and the capacity for healthy growth. For some children, running away may actually be the first proof that the therapeutic effects of the hospital are operating. Accordingly, any elopement should be viewed as a signal worthy of appropriate interpretation and understanding, rather than thoughtless denunciation.