Sam SlySam Sly explains why she feels assessment and treatment units do not work, and the importance of ‘the good things in life’:

I have been tweeting (@samsly2) recently as part of the #107days campaign for Connor Sparrowhawk, who died last year in an assessment and treatment unit (ATU). I have tweeted about the many things I have learned about ATUs in the years I have been helping people leave them to return to a real life and home of their own in the communities they came from. Most things I have learned lead me to conclude that ATUs do not have a place in the rehabilitation – if that is even the right word to use – of people who have been labelled by others as having ‘challenging behaviour’.

Taking someone out of the environment that has become problematic to ‘treat’ them elsewhere does not, nor ever will, help them in the long-term. Instead, it transfers the person to a new, often more challenging environment where they have to learn a new set of expectations, rules and behaviours that will not apply when they go home.

Throughout my career I have often reflected back to where the fire within me to fight the injustice that people with learning disabilities experience on a day-to-day basis first started and what continues to drive me to fight to help people stay in their communities and sort out issues and not go to ATUs. I conclude that my passion for this crystallised when I came across Wolf Wolfensberger’s work as a young social worker. His theory of Social Role Valorization (SRV) has as much relevance now as it did when he formulated it in 1983.

SRV not only helps us identify what methods we in services and society use to devalue people with learning disabilities, but also in our work, giving us tools to counteract the effects. Social devaluation has long-term effects on people, and those in ATUs experience the most extreme wounds – emotional, psychological and physical – and devaluation. Wounds can wreak havoc not only on the person but those closest and committed to them – family and friends – as they become devalued by association.

Further reading: Tragic death of Connor Sparrowhawk again highlights urgent need for reform

The labels given by the powerful – professionals and services – to people like ‘challenging’, ‘forensic’, ‘criminal’, ‘deviant’, ‘lacking capacity’ and ‘patient’ all serve to differentiate them from the norm in a negative way and keep them separated and controlled; reiterating the destructive roles in life that have been assigned to them over and over again. A very sad business. These labels never get forgotten and cannot be erased for as long as people are treated by services as their labels and this is reinforced throughout a person’s life in the professional reports that follow them around.

Wounded people are relegated to the status linked to their label and they are continually rejected by their communities, society and services. This can lead to people taking on the roles they are assigned – deviant, child-like, criminal and outcast – and they may become scapegoated. They are likely to be segregated and congregated with other labelled deviant people, for example in ATUs, and lose control of everything including their autonomy and freedom. This leads to people losing their home and place in the community and then family and relationships. Natural freely given relationships are replaced with artificial/bought ones and deindividualisation starts to happen, which leads to material poverty, impoverished experiences and exclusion from the knowledge that gives meaning and direction to life and provides community. Ultimately their life becomes ‘wasted’ and in extreme situations, as happened to Connor Sparrowhawk and countless others in ATUs over the years, people become objects of brutalisation.

What everyone, valued or devalued, needs to flourish is to have what Wolfensberger describes as the ‘good things in life’. This is why planning around people’s gifts, talents, hopes and dreams and not around their deficits is so important. I think this is one of the reasons ATUs don’t work: ‘treatment’ is targeted at deficits – a person’s challenging behaviour – and not on achieving the good things in life. These are:
• Family or to belong and be loved
• A transcendental belief system
• Not to always be scared of the imminent threat of hardship
• To be viewed as a human and treated with respect
• To be treated justly
• Friends
• Meaningful work
• Opportunities and expectations to discover and develop skills, abilities, gifts and talents
• To be dealt with honestly
• To be treated as an individual
• Access to the ‘sites of everyday life’
• Being able to contribute and having one’s contributions recognised as valuable.

It is worth reflecting on which of these you have and why they are so important in making life worthwhile and fulfilling. Then consider them again through the eyes of a person who is stuck in the hospital system and ask yourself how impoverished a life they are probably living?

About the author
Sam Sly is a freelance consultant and director of Beyond Limits: She has worked as a social worker, an inspector as part of the Change Team following the investigation into Cornwall NHS Partnership Trust, managed the campus closure in Bournemouth and had a senior position in a large domiciliary care agency before doing consultancy work. Email:

This article first appeared in the July/August 2014 issue of Learning Disability Today. For more information on the magazine, and how to subscribe, go to: