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Care system for mental health patients needs overhaul

DHSC announces measures to improve care for people with autism and learning disabilities

Adrian O'Dowd

Tuesday, 21 May 2019

The main NHS regulator the Care Quality Commission (CQC) has called for significant changes to the current system of looking after people in mental health hospital wards.

The CQC has today published an interim report* which shares early findings from its review of restraint, prolonged seclusion and segregation for people with a mental health problem, a learning disability or autism.


The government has accepted all of the report’s recommendations and announced new measures.

Specifically, the CQC has called for an independent review of every person who is being held in segregation in mental health wards for children and young people and wards for people with a learning disability or autism.

These reviews should examine the quality of care, the safeguards to protect the person and the plans for discharge.

The review, which was commissioned by the government, also highlights the need for a better system of care for people with a learning disability or autism who are, or are at risk of, being hospitalised and segregated.

From an information request sent to providers, the CQC was told of 62 people who were in segregation. This included 42 adults and 20 children and young people – some as young as 11 years old.

Sixteen people had been in segregation for a year or more and one person had spent almost a decade in segregation.

The regulator has so far visited and assessed the care of 39 people in segregation, most of whom had an autism diagnosis.

Reasons for prolonged time in segregation included delayed discharge from hospital due to there being no suitable package of care available in a non-hospital setting.

The safety of other patients or staff and inability to tolerate living alongside others were the most common reasons providers gave for why people were in segregation. In some cases, staff believed that the person’s quality of life was better in segregation than in the less predictable environment of the open ward.

Some of the wards were not suitable environments for people with autism and many staff lacked the necessary training and skills to work with people with autism who also have complex needs and challenging behaviour.

Dr Paul Lelliott, deputy chief inspector of hospitals (lead for mental health), at the CQC, said: “We are calling for urgent action to strengthen the safeguards that protect the safety, welfare and human rights of people held in segregation. We think that independent advocates have an important role to play in this – if they are trained and supported to recognise what is good care and what is not.

“Given the severity and complexity of their problems, people held in segregation should be receiving expert care in an environment that is adapted to their specific needs. These people have been failed by the current ‘system of care’ and that system must be changed.”

The CQC will report its full findings in a final report in the spring of next year.

Health and social care secretary Matt Hancock, said: “I have been deeply moved and appalled by the distressing stories of some autistic people and people with learning disabilities spending years detained in mental health units. These vulnerable people are too often left alone, away from their families, friends and communities.

“At its best, the health and care system provides excellent support to people, backed by a dedicated workforce. But a small proportion of some of the most vulnerable in society are being failed by a broken system that doesn’t work for them.

“I commissioned the CQC to review the use of segregation in health and care settings to tackle this issue head on. Today I have accepted their recommendations in full. I hope this is a turning point so everyone receives the care they need.”


*Interim report: Review of restraint, prolonged seclusion and segregation for people with a mental health problem, a learning disability and or autism. Care Quality Commission (21 May 2019).

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