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

Why are we still just talking about in-patient abuse?

More than two thousand autistic people and people with a learning disability are currently in in-patient mental health hospitals in England and the average length of stay is around five and a half years.

Charities have long campaigned against in-patient care as it is widely recognised that for most autistic people, care in an in-patient unit is rarely helpful. In addition, most are locked up due to the lack of the right community support, skilled social care, and suitable housing – not because of a mental health problem.

In 2015, NHS England published a three-year closure programme and national plan called Building the Right Support. This set out how the NHS and local authorities in England propose to improve the lives of autistic people and those with a learning disability or both in in-patient settings.

Yet in the past 12 years since the Winterbourne View abuse scandal, the government have repeatedly missed their own deadlines. The latest commitment was to reduce the number of by 50% by March 2024. It is estimated the government will miss this target by at least four years.

Mencap stats on in-patient abuse. Source: Mencap
Source: Mencap

Shockingly, it is not only lengthy stays and missed targets that make this a human rights scandal, but there are also consistent reports of serious abuse from a number of these settings.

One scandal should have been one too many, but this hasn’t been the case. Most recently, confidential reports obtained by the BBC have revealed more appalling abuse at care homes belonging to the Hesley Group.

This is why it was widely welcomed this week when MP Barbara Keeley led a debate in the House of Commons asking the government to urgently rectify the situation.

A national scandal that needs urgent action

Barbara Keeley began the debate by describing the experiences of two young autistic women whose stories were recently told in a Channel 4 “Dispatches” programme. This showed autistic people being locked away in seclusion and subjected to abuse in mental health hospitals.

The first was Amy, a 22-year-old autistic woman who was, until recently, detained at the Breightmet Centre for Autism in Bolton, run by ASC Healthcare. She reported that staff members used daily restraint and that the threat of violence was used to make patients conform.

The second was Danielle who has spent 13 years detained in in-patient units, one of which was 320 miles away from her family. While she was held at the Littlebrook Hospital in Dartford, Danielle was placed in solitary confinement for 551 days—more than 18 months.

Her mother Andrea told the “Dispatches” programme that during her stay at Littlebrook Hospital, Danielle was taken by staff members to areas away from cameras. She was then molested and raped. Further investigation by the “Dispatches” team found that 18 reports of sexual assault and 24 reports of rape at Littlebrook Hospital were made to the police between 2020 and 2023. Yet no charges have been brought in any of those cases to date, including Danielle’s case.

Keeley said that these abuses have been mirrored in similar scandals across the country.

“The criticisms reported in the CQC’s inquiry into Winterbourne View all that time ago are as true today as they were 12 years ago: there is a systemic failure to protect people or to investigate allegations of abuse.”

She added: “All those reports were preceded by the scandal at Winterbourne View, revealed by BBC “Panorama” in 2011. Members will remember the scale of the outcry when that programme was broadcast. There was a feeling then that something might change. I remind the Minister that the coalition government actually committed to closing all inappropriate in-patient beds for autistic people and people with learning disabilities by 2014.

“At one time, reports and investigations into the scandals gave rise to the hope of change, but despite the relentless efforts of journalists, charities and activists, the criticisms reported in the CQC’s inquiry into Winterbourne View all that time ago are as true today as they were 12 years ago: there is a systemic failure to protect people or to investigate allegations of abuse.”

A phase of total apathy

Keeley said the government seems to have entered a phase of total apathy and as calls to address repeated failed targets grow more desperate, less and less appears to be happening to rectify the situation.

She referred to the recent NHS England report analysing 1,770 individual reviews of the care of autistic people and people with learning disabilities, including children, who were detained in in-patient services. The report was commissioned following the tragic deaths of Joanna, Jon and Ben at Cawston Park. It found evidence of high levels of restrictive practice, that people’s medication was not always reviewed in a timely way and that more than half the people were being detained a long way from home.

“Most concerningly, the report found that 41% of people did not need to be in hospital at all. NHS England stated that many people could not be discharged because there was no adequate care provision in the community and because staff did not always have the training necessary to support people’s transfer from hospital. These findings are a deplorable indictment of the government’s failure to act,” she said.

Keeley went on to say that while the draft Mental Health Bill includes some provisions to address the detention of autistic people and people with learning disabilities, concerns have been raised by charities that the Bill must be significantly strengthened if it is to achieve its aims. There are also concerns that the Bill will take years to come into force and will not end the scandal on its own, without urgent investment in both social care and mental health services.

She ended by saying the government’s Building the Right Support action plan was woefully inadequate and unambitious.

“After so many years of allowing mistreatment to continue, it seems pathetic that the best system of accountability the government can come up with is a delivery board that I have discovered has met for only six hours in the 22 months since it was established,” she said.

Abuse cannot and will not be tolerated

The Parliamentary Under-Secretary of State for Health and Social Care, Maria Caulfield, responded by saying it was appalling to see reports of the care and treatment that some autistic people have experienced, and that the government takes this issue very seriously.

She said: “When in-patient care is absolutely necessary, it needs to provide a therapeutic benefit. It should be high quality, it should be close to home, and it should be as unrestrictive and for as short a time as possible—we have been very clear about that. Abuse cannot and will not be tolerated. That is why we are committed to taking steps at a national level to prevent the abuse and poor treatment of people with a learning disability and of autistic people in in-patient settings.

“NHS England has established a three-year quality improvement programme which seeks to tackle the root causes of unsafe, poor-quality in-patient care. We all acknowledge that there has been practice that has caused harm to patients. We want to see the picture across the country, and then look at specific trusts that are not providing the standard of care that patients and their families expect. Baroness Hollins is overseeing independent care and treatment reviews relating to people in long-term segregation, and a senior intervener pilot has been undertaken to help individuals in the most restrictive settings to be moved towards discharge. Work is being done to examine the specific units about which we have concerns.”

She added that she does not want anyone to be in an in-patient setting unless they absolutely have to be, and if they are in such a setting, they should be receiving good-quality, safe care, so that family members and friends can be reassured that their loved one is being looked after well.

“No one wants that more than me,” she said.

Further debate focused on funding, housing and the Building the Right Support action plan. This can be accessed here.

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