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 | May 2019 | Interim report: Review of restraint, prolonged seclusion and segregation for people with a mental health problem, a learning disability and or autism

This report from the Care Quality Commission (CQC) gives the interim findings from our review of the use of restrictive interventions in places that provide care for people with mental health problems, a learning disability and/or autism.

cqc.org.uk
Image source: cqc.org.uk

The interim report shares findings from the CQC’s visits to 35 wards (assessing the care of 39 people), alongside information gathered from a request sent to 92 registered providers of services for people with a mental health problem, a learning disability and or autism. The report outlines the CQC’s preliminary findings.

What the CQC found on their visits:

  • Many people the CQC visited had been communicating their distress and needs in a way that people may find challenging since childhood, and services were unable to meet their needs.
  • A high proportion of people in segregation had autism.
  • Some of the wards did not have a built environment that was suitable for people with autism.
  • Many staff lacked the necessary training and skills.
  • Several people that we have visited were not receiving high quality care and treatment.
  • In the case of 26 of the 39 people, staff had stopped attempting to reintegrate them back onto the main ward. This was usually because of concerns about violence and aggression.
  • Some people were experiencing delayed discharge from hospital, and so prolonged time in segregation, due to there being no suitable package of care available in a non-hospital setting.

The interim report focuses exclusively on the experience of those people cared for in segregation on a mental health ward for children and young people or on a ward for people with a learning disability or autism. It makes a number of recommendations for the health and care system, including CQC.

OverviewAt the end of 2018, Matt Hancock, the Secretary of State for Health and Social Care, asked us to look at the use of restrictive interventions.

This interim report focuses on 39 people who are cared for in segregation on a learning disability ward or a mental health ward for children and young people (Source: CQC).

Full details from CQC

[Interim report] Segregation in mental health wards for children and young people and in wards for people with a learning disability or autism

[Interim report easy read] How hospitals separate children and young people
who have a mental health problem or a learning disability or autism 

See also:

CQC [press release] CQC calls for action to fix the closed system that leads to people with a learning disability or autism being segregated in hospital

Children’s Commissioner Report: Children with learning disabilities or autism living in mental health hospitals

Children’s Commissioner | May 2019 | Children with learning disabilities or autism living in mental health hospitals

A new report from the Children’s Commissioner finds that children with learning disabilities or autism living in mental health hospitals. Far less than they deserve find shocking evidence of poor and restrictive practices and sedation, with some children telling the Children’s Commissioner of how their stay in mental health hospital has been traumatic, and parents too often left feeling powerless to do anything to intervene.

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Image source: childrenscommissioner.gov.uk

Key statistics:

  • 250 children with a learning disability or autism in a mental health hospital in England
  • 6 months is the average time children with autism and/or a learning disability had spent in their current hospital
  •  95 children were staying in a ward 31 miles away from home
  • A quarter of children did not appear to have had a formal review of their care plan within the last 26 weeks

Far less than they deserve 

See also:

Children’s Commissioner [press release] Many vulnerable children with learning disabilities are stuck in mental health hospitals for too long in poor conditions

Psychotropic drugs and people with learning disabilities or autism

Public Health England | March 2019 |Psychotropic drugs and people with learning disabilities or autism

Guidance from Public Health England (PHE) describes a system to track prescribing of antipsychotics, antidepressants and other psychotropics for people with learning disabilities, autism or both.

NHS England commissioned the study by NHS England to devise a method to report the impact of their programme to stop overmedication for people with learning disabilities, autism or both (STOMP). It provides data about the extent and trends in the use of psychotropic drugs between January 2010 and December 2017 (Source: Public Health England).

Further information about the study is available from PHE 

The guidance can be read online at PHE

Beyond the high fence

NHS England |February 2019 | Beyond the high fence from the unheard voices of  people with a learning disability, autism or both

Beyond the high fence from the unheard voices of  people with a learning disability, autism or both is a joint publication by NHS England and Pathways Associates. It was co-produced with people with a learning disability and autistic people who are, or have been, in hospital and offers their views on what more needs to happen to improve quality of care and support people to make a successful return to their communities (Source: NHS England).

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Image source: england.nhs.uk

Beyond the high fence from the unheard voices of  people with a learning disability, autism or both

[NICE Consultation] Service model for people with learning disabilities and behaviour that challenges In development [GID-QS10072

NICE | February 2019 | Service model for people with learning disabilities and behaviour that challenges In development [GID-QS10072

NICE is holding a consultation on Service model for people with learning disabilities and behaviour that challenges In development [GID-QS10072. The closing date for comments is Monday 18 March 2019 at 5pm.

Full details from NICE 

A Fair, Supportive Society: Summary Report

Institute of Health Equity | November 2018 | A Fair, Supportive Society: Summary Report

The Institute of Health Equity (IHE) report A Fair, Supportive Society highlights that some of the most vulnerable people in society – those with learning disabilities – will die 15-20 years sooner on average than the general population – that’s 1,200 people every year.

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Image source: A Fair, Supportive Society: Summary Report

The report commissioned by NHS England highlights key facts, stats, and interventions. Much of the government action needed to improve life expectancy for people with disabilities is likely to reduce health inequalities for everyone. Action should focus on the ‘social determinants of health’, particularly addressing poverty, poor housing, discrimination and bullying.

 

Shocking new report on children with learning disabilities: Half aren’t diagnosed in
childhood; those who are won’t collect their pension [press release]

Living together in a fair way [easy read]

Are we failing people with learning disabilities? A fair, supportive society: summary report

University College London | November 2018 |Are we failing people with learning disabilities?

A new report published by UCL’s Institute of Health Equity (IHE) highlights that  40 per cent of children with a learning disability remain undiagnosed and that adults with learning disabilities will die 15-20 years earlier (on average) than the general population which is 1,200 premature deaths each year.

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Responding to the findings Sir Michael Marmot , director of IHE said:

“This is a direct result of a political choice that destines this vulnerable group to experience some of the worst of what society has to offer: low incomes, no work, poor housing, social isolation and loneliness, bullying and abuse.

“A staggering 40% of people with learning difficulties aren’t even diagnosed in childhood. This is an avoidable sign of a society failing to be fair and supportive to its most vulnerable members. We need to change this. The time to act is now.”

The IHE makes a number of actions and 11 recommendations to improve life expectancy for people with disabilities.  (Source: UCL)

Read the IHE paper 

Easy read version 
In the media:

Guardian Two in five people with learning disabilities not diagnosed in childhood