RRN responds to Baroness Hollins’ report on solitary confinement and Government response

Restraint Reduction Network welcomes Baroness Hollins’ report, ‘My Heart Breaks – Solitary confinement in hospital has no therapeutic benefit for people with a learning disability and autistic people’

The Restraint Reduction Network (RRN) welcomes the recommendations made by Baroness Sheila Hollins, Chair of the Independent Care (Education) and Treatment Review, in her latest report into long-term segregation (LTS) of people with learning disabilities and autistic people in inpatient settings.

Of particular note is the change in terminology to ‘solitary confinement’ used throughout the report when referring to practices of “enforced isolation from meaningful human contact.” Having an umbrella term that captures the harmful nature of toxic isolation common to both seclusion and long-term segregation makes clear that regardless of duration, the harms can be significant.

Undeniable harms

Damningly, the review demonstrated that little progress has been made in reducing the number of autistic people and people with learning disabilities detained in solitary confinement. The ICETR programme reviewed the care and treatment of 191 people who were detained in long-term segregation between November 2019 and March 2023. Four years later, around the same number of people remain forcibly isolated from their peers, despite the success of initiatives including senior intervenors, ICETRs and the HOPE(s) programme in moving people out of the isolation. It seems that as soon a person left the solitary confinement facility, another entered.

The report demonstrated particular concern from the oversight panel about the lack of therapeutic benefit associated with the practice which is instead used for containment, resulting in sensory and social isolation. The RRN shares the concern that this is invariably harmful and results in lifelong trauma. Too often family and friends were denied access to those held in solitary confinement and excluded from care and treatment decisions.  The report further detailed that, alongside solitary confinement, other restrictive practices including chemical restraint, surveillance and blanket restrictions were used excessively and inappropriately.

The need for minimum standards

Where solitary confinement is used, the RRN welcomes Baroness Hollins’ recommendations that minimum standards of accommodation are introduced to ensure that at least some of people’s basic human needs are met including separate toilet facilities; access to natural light and access to fresh air. People must also be given meaningful activity and access to their friends and family. An environment that does not meet basic human needs is fundamentally unsuitable for therapeutic care and support and is a breach of people’s human rights.

The RRN strongly supports that the practice of solitary confinement should be curtailed in the following ways:

• That solitary confinement should not be used for longer than 15 days
• That solitary confinement should not be used on people under the age of 18
• That solitary confinement should not be used where it may exacerbate a person’s disability or mental state

While we are concerned about any ongoing use of solitary confinement, these minimum standards would represent a step forward in limiting this harmful practice.

Department for Health and Social Care response

The Department for Health and Social Care’s response is disheartening, particularly the refusal to include solitary confinement of people with learning disabilities and autistic people within NHS England’s Never Event policy. This omission leaves the protections short of meeting international standards for prisoners, as per the UN Nelson Mandela Rules. It is unacceptable that healthcare systems in the United Kingdom fall short of such standards.

We are in a position where the lack of robust, human-rights informed guidance on solitary confinement, combined with a lack of changes to the outdated Mental Health Act mean there will continue to be unacceptable inequalities in mental health provision and a continued lack of sufficient protection for the rights of people with disabilities.

The RRN calls on the DHSC to reconsider and enact the recommendations with a view to severely curtailing the practice and where the practice is used, that minimum standards of accommodation are introduced so that people’s basic human needs are met. While some progress in discharge rates has been made, the near constant numbers of people held in solitary confinement show that further change is needed to prevent its use and diminish the harms experienced. Better models of support and robust policies that end solitary confinement are essential and doable.

Frameworks such as the Six Core Strategies to reduce restrictive practices should be adopted and embedded within services, alongside a focus on promoting positive cultures and relational working. This is essential to protect the rights of people with learning disabilities and autistic people in hospital and prevent the continued use of unacceptably harmful practices that result in a legacy of trauma.

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The RRN has created resources helping people understand the harmful effects of solitary confinement and helping practitioners understand how best to support people who are currently confined.

The RRN will host a free webinar to explore the impact of solitary confinement and recommendations from report in early 2024.

Register for the webinar taking place 28 February at 12.30pm here.