Learning Disability Today
Supporting professionals working in learning disability and autism services

Government response to report on long-term segregation “insulting”

Campaigners have described the government’s response to Baroness Hollins’ report on the use of long-term segregation for autistic people and people with learning disabilities as “ineffective” and “insulting”.

Rightful Lives says the response has proved that the government “really don’t care”, and it has “given permission to hospitals, practitioners and commissioners to carry on as normal.”

Jackie O’Sullivan, Acting CEO at Mencap, says it is “bitterly disappointing” that this report has been published at a time when the government has failed to commit to reforming the Mental Health Act, and she urges the government to urgently implement the recommendations in the report which set out to end this “barbaric practice”.

Serious concerns about the use of long-term segregation in hospitals

This comes following a report from Baroness Hollins who chaired the Oversight Panel in its review of the Independent Care (Education) and Treatment Review (ICETR) programme for people in long-term segregation (which is also referred to as 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.

The programme was established because of serious concerns about the use of long-term segregation in hospitals, and in particular about lengthy stays and difficulties in discharging people.

The aim was to identify the blocks to discharge and to assess whether independently chaired Care (Education) and Treatment Reviews would be more in developing the right support for each person detained in long-term segregation.

The Department of Health and Social Care (DHSC) says ICETRs have helped to make a difference for some people, with 48 out of the 114 people who had an ICETR in the second phase having moved out of long-term segregation by the end of May.

Care should be community-based wherever possible

Baroness Hollins’ report, My heart breaks – solitary confinement in hospital has no therapeutic benefit for people with a learning disability and autistic people, concluded: “The care and outcomes for people with a learning disability and autistic people are still so poor, and the very initiatives which are improving their situations are yet to secure the essential funding required to continue this important work.”

The report made 13 recommendations for the Department of Health and Social Care, and urged the Department to end the practice of long-term segregation, as there is “no therapeutic benefit” from solitary confinement.

The report also demanded that solitary confinement should be outlawed for children and limited for adults, with the majority of care taking place in the community.

Baroness Hollins says there are three key principles underlining these recommendations. These are:

  1. All support needs to be based in relationships, as currently, professional risk assessments and risk plans do not meet people’s needs.
  2. Care needs to be community-based, as trying to mend environmental pressures in hospitals “never works”.
  3. Care environment’s must be “trauma-informed” to ensure that hospital admission and solitary confinement is avoided wherever possible.

Some recommendations need “further work before they can be delivered”

The Department of Health and Social Care has responded to all 13 of the recommendations made by Baroness Hollins, and while they have agreed to some of the recommendations, Maria Caufield MP said several of the recommendations laid out in the report need “further work before they can be delivered.”

In her letter to Baroness Hollins, Caufield said she agreed that long-term segregation is often “overused” and that she was “appalled by the poor and unacceptable outcomes that were found for a number of people.”

Caufield says there is now a “continued need to focus on reducing restrictive practices through learning and culture change.”

“I am absolutely clear that we must significantly reduce the use of long-term segregation and if used, it should only ever be in a way that respects human rights, where the environment is of the standard set out in the Mental Health Act 1983 and is no more restrictive than is necessary for people’s safety.

“All care and treatment plans should aim to end long-term segregation as soon as possible and patients must have access to therapeutic interventions, with regular review of their wellbeing. Urgent action should be taken when this does not happen to protect the people in long-term segregation,” she wrote.

“No guarantee” that autistic people and people with learning disabilities will be protected from solitary confinement

In response to the government’s reply, the campaign group Rightful Lives said there is now “no guarantee” that powerful initiatives that were drawn up during the programme will continue. “It seems that things that work are just abandoned,” they said.

“Not for one minute had we envisaged that the Government’s response would be as ineffective and insulting as it has been. We were led to believe that the Department of Health and Social Care was taking this issue seriously.”

Rightful Lives said their concern remains with all the people in solitary confinement and they are disappointed that the recommendations outlined in the report have not been taken seriously.

“Not only has the government proved that they really don’t care, their response has merely given permission to hospitals, practitioners and commissioners to carry on as normal. All of this is so unfathomable when we know that care in the community is so much more cost effective and rights respecting.”

“Solitary confinement is toxic, inhuman and degrading and frequently in breach of international and domestic law and guidance. There is little or no accountability when services fail people. Quite frankly, we are furious that, with more people than ever subject to enforced isolation, the Government doesn’t appear to be in the least bit invested in doing what works,” they said.

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