This week we have seen shocking and disturbing evidence of the experiences of people with learning disabilities and autism of mental health inpatient services in England.
The Panorama report on Whorlton Hall, the Children’s Commissioner’s report and the CQC interim review of restraint, seclusion and segregation all offer disturbing evidence of the damaging impact of institutional care for both children and adults.
The use of mental health services, and application of the Mental Health Act, to care for people with learning disabilities and autism is problematic. We know that people with learning disabilities and autism have very high levels of poor mental health, much of which goes unnoticed and untreated. Yet some people, whose needs are most challenging for local schools, health and care services, find themselves placed in institutions that are often far from home, under the powers of the Mental Health Act, sometimes for many months and years.
We know that people with learning disabilities and autism have very high levels of poor mental health, much of which goes unnoticed and untreated.
The scenes witnessed by Panorama, of abuse and violence, were especially troubling and traumatic. But we also know that the use of restraint, seclusion and segregation can traumatise people and often bring back past traumas. For people who have experienced trauma throughout their lives, being locked up, far from home, powerless and without hope for the future, is both psychologically harmful and undermines their chances of building a life for themselves on their own terms.
Long-term institutional care, in units far from a person’s home and family, creates conditions in which neglect and abuse can occur. It creates a fundamental imbalance in power between staff and patients which in some instances can lead to the abuse of power.
Too often, people placed out of area for long periods become isolated, lose touch with home and get forgotten by the local services that are responsible for their care. We have also seen this in the case of ‘locked rehabilitation’ for people with long-term mental health conditions.
For people who have experienced trauma throughout their lives, being locked up, far from home, powerless and without hope for the future, is both psychologically harmful and undermines their chances of building a life for themselves on their own terms
We know that this can and must change. We need to take action now to prevent the conditions in which neglect and abuse can happen. And we need action on different levels to bring about the necessary change so that we do not need another Winterbourne View or Whorlton Hall scandal to prod us into action.
First, we need to re-think society’s attitudes towards children and adults with learning disabilities and autism. Schools in particular need more support to offer children whose behaviour they struggle to manage a better experience. They cannot do this alone.
Second, we need to ensure that the mental health needs of people with learning disabilities and autism (and of their families) are fully met. That means seeking to promote good mental health and prevent mental ill health as well as treating problems when they occur. A report next month from the Children and Young People’s Mental Health Coalition will explore this critical and often forgotten issue.
Long-term institutional care, in units far from a person’s home and family creates a fundamental imbalance in power between staff and patients which in some instances can lead to the abuse of power
Third, we must think again about the use of the Mental Health Act for people with learning disabilities and autism. The Mental Health Act Review made a number of important recommendations about this and they need urgent government attention.
And fourth, we need to invest in a range of locally-based services for people who do need longer-term support, be it for their mental health, learning disability or autism. The Government’s Spending Review could make an immediate impact by setting aside sufficient funding to enable every local health and care system to review its services and work with the people it seeks to serve to meet their needs better. Just as NHS England has said that no one should be admitted out of area to hospital in a mental health crisis, so we should hold the same standard for someone with a long-term mental illness or a learning disability or autism.
There are no easy to answers and no quick fixes to the abuses we have witnessed this week, which for too long individuals and their families have told us about without an effective response. But that makes it all the more important that the change starts today.
