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Restraint Reduction Network responds to Baroness Hollins’ thematic review and recommendations into long-term segregation (LTS)

The Restraint Reduction Network calls for the immediate safety and protection of vulnerable people in LTS.

The Restraint Reduction Network (RRN) has today (21 July 2021) welcomed recommendations made by Baroness Hollins, Chair of the Independent Care (Education) and Treatment Review into the long-term segregation (LTS) of people with a learning disability and autistic people in inpatient settings[1] calling for ‘immediate and urgent action for the people still being subject to this inhumane practice in this country’.

The thematic review and interim report into LTS, supported by an independent Oversight Panel[2], has highlighted important, distressing and disturbing insights into the quality of life for those detained, described by RRN as being the ‘the most inhumane, lonely and traumatic experience of all restrictive practices’.

RRN is pleased that support for all immediate actions outlined in the interim report have been strongly welcomed by Helen Whatley MP, Minister of State for Care who has expressed her support for the Oversight Panel’s recommendations to improve the circumstances of people in LTS. This is particularly important given the marked lack of progress that has been made to date to release people from LTS, despite numerous Independent Care and Treatment Reviews.

Baroness Hollins’ thematic review shows that over half of those subject to long-term segregation are diagnosed as autistic. Autistic people are disproportionately impacted by inpatient care. Highlighted in the thematic review was how distressing inpatient life can be as it aggravates autistics’ sensory systems. Communication can be difficult for both staff and the person receiving care, often as a result of a lack of training, understanding and knowledge of how to support individuals. This means that autistic people are left unsupported and made vulnerable to restrictive practices which can and does result in LTS.

Alexis Quinn, Manager of RRN and representative on the independent Oversight Panel – who was herself subjected to Long Term Segregation in care – said:

“Let’s be absolutely clear, if someone reaches the point where others feel they need to be isolated from humanity, the care system has utterly failed them. This is a fundamental human rights issue and at RRN we passionately believe that long-term segregation is never appropriate and has no basis in modern health care”.

“It is a harsh reality that for most autistic people in segregation, it is being used in response to challenging behaviour, when we should be addressing the fact that we do not have the right therapeutic care and environment in place. We strongly welcome the Oversight Panel’s recommendation to substantially improve the quality of diagnosis, treatment and care in hospitals and wider settings. Excellent clinical leadership must be a standard and all staff must demonstrate the effects of a robust and integrated formulation and treatment plan. It is only then people can be enabled to progress and move on to life in the community.”

Person-centred care featured heavily in the interim report, however the report highlighted that hospital staff and commissioners demonstrated a lack of knowledge and experience about best practice in transitioning to community placements. This is directly hindering the transition for people into the community.

Alexis, who authored her memoir Unbroken detailing her three years locked inside various mental health hospitals and Assessment and Treatment Units (ATU) before finally escaping abroad, continued:

“Sadly, like me, many people in LTS are seen as a risk that need to be controlled and minimised. A lack of aspiration for people with learning disabilities and autistic people permeates at every level, despite the mantra on person-centred care.

“Given the lack of progress made to date, it is pleasing to see that Minister Helen Whately has supported Baroness Hollins’ call for the continuation of Independent Care and Treatment Reviews for all those in LTS, as well as extending the role of the Oversight Panel. This is critical for continued oversight and scrutiny. As such, we welcome the role of the senior intervenor and hope that these experts will be able to challenge the system in the right places and secure appropriate community provision. 

“While Baroness Hollins’ recommendations are enacted, the RRN is calling for the conditions that people are kept in whilst detained in long-term segregation to be improved immediately. It is not acceptable in our society to house people for any length of time in a bare room with nothing more than a mattress and a chair. When I was in LTS I had nothing but a mattress. I didn’t know whether it was night or day. I can’t describe in words how awful it was. Being fed on the floor like a dog. Such conditions are far from ok and we mustn’t wait any longer. I am aware of one young man who was kept in a 136 suite[3] designed for 24 hour care for over a year. This is clearly a breach of human rights and yet is somehow permissible.

“We are aware of numerous cases of physical, sexual and psychological abuse with patients and families not being listened to and where safeguarding procedures have failed. We urge the Department for Health and Social Care (DHSC) to implement feedback processes that ensure the immediate safety and protection of these vulnerable people. “

The RRN is a coalition of committed organisations and individuals who provide education, health and social care services, alongside experts by experience and families, all aiming to eliminate the use of unnecessary restrictive practices.

Further information is available at https://restraintreductionnetwork.org/ or by following RRN on Twitter @theRRNetwork.

To read the Independent Care (Education) and Treatment Reviews: government response, visit: https://www.gov.uk/government/publications/independent-care-education-and-treatment-reviews-government-response

Helen Whately MP’s letter to Baroness Hollins is available at: https://www.gov.uk/government/publications/independent-care-education-and-treatment-reviews-government-response/letter-from-helen-whately-mp-the-minister-of-state-for-care-to-baroness-hollins-chairperson-of-the-independent-care-education-and-treatment-review


Footnotes

[1] See notes to editors for further information on the overarching aims of the review. Further information is available at: https://www.gov.uk/government/publications/independent-care-education-and-treatment-reviews/the-oversight-panels-interim-conclusions-and-recommendations

[2] In November 2019, the Secretary of State for Health and Social Care announced that people with a learning disability and autistic people in long-term segregation would have their care independently reviewed. Baroness Hollins was appointed to oversee this process and to chair an independent Oversight Panel (https://www.gov.uk/government/publications/independent-care-education-and-treatment-reviews)

[3] A Section 136 suite is a facility for people who are detained by the Police under Section 136 of the Mental Health Act. It provides a ‘place of safety’ whilst potential mental health needs are assessed under the Mental Health Act and any necessary arrangements made for on-going care (https://www.cntw.nhs.uk/services/section-136-suites/)

Further Information 

For further information, or to interview Alexis Quinn, please contact Laura Smith at Consilium Communications via lsmith@consiliumcommunications.co.uk / 07467945848. 

The full press release, including notes to editors, can be downloaded here.