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For the last two years, the Forensic Mental Health Service at South London & Maudsley NHS has been one of the pilot sites funded by the DSPD programme. In this paper we are reporting on one segment of the Personality Disorder Service. As of December 2006, the service will have been operating for two years. This is one of several Home Office‐funded forensic personality disorder treatment sites in the UK. It consists of a 15‐bed medium secure inpatient service, a community team and two hostels.We begin by describing briefly our treatment model and the theoretical underpinnings of our service. However, the bulk of this paper will report on the lessons we have learned.

Leave is an important part of life for both patients and clinicians in secure mental health and learning disability settings. Patients breaching leave conditions (i.e. absconding or failing to return) represent a small percentage of leave episodes; however when incidents occur there can be far reaching negative outcomes for potential victims, the patient and the service. The purpose of this paper is to devise a risk assessment specifically for leave decision making based on the literature available.

Using the approach followed in the violence risk assessment field, a literature review was carried out of papers relating to absconding. The results were used to develop the leave/abscond risk assessment (LARA).

There are a number of problems with the available literature: there is a dearth of research, definitions for absconding are varied (often including escape) making comparisons difficult and much of the literature focuses on psychiatric acute wards making it difficult to translate into secure environments. Characteristics of absconders vary and are not idiosyncratic enough from which to develop a risk assessment. Socio‐environmental factors are perhaps more important and so the LARA was devised around assessment of these.

The limitations of this paper are clear: a risk assessment tool is proposed that has not been evaluated or validated in any way. The authors feel that the process warrants publication and invite readers to use the tool for clinical and/or research purposes.

The LARA is proposed as a specific leave‐decision‐making risk assessment tool for teams working in secure environments.