Two hard-hitting reports from the Care Quality Commission (CQC) and the Children’s Commissioner for England reveal the extent of the scandal of autistic people stuck in mental health hospitals. In this blog, Tim Nicholls (NAShead of policy), highlights the reports’ findings and argues for urgent and concerted action from the Government and NHS England.

The Children’s Commissioner reveals that:

• the number of children who are autistic or have a learning disability identified in mental health hospitals is increasing, despite Government promises
• children are being detained in hospital for too long – the average time spent in these institutions is 6 months

And the Care Quality Commission:

• finds serious over-use of seclusion on autistic people in mental health hospitals and poor levels of autism training
• says the whole system of care “has failed people”

Since the weekend, two shocking reports have further exposed the failures of Government attempts to move autistic people and people with a learning disability out of mental health hospitals. Further, these reports highlight how for autistic people in hospital, restraint, seclusion and segregation are too often a part of their experience. This is unacceptable and points to a system that is broken and must be fixed.

The Children’s Commissioner’s report

On Monday, Anne Longfield, the Children’s Commissioner for England, published a report called Far less than they deserve. She found that there are 250 autistic children or children with a learning disability in mental health hospitals in England and, on average, they had spent 6 months there. Many are far away from home, their friends and their families. And, shockingly, one in four hadn’t had their care plan reviewed within the last 6 months. These are very similar to our charity’s own findings in our Beyond Transforming Care report late last year, which identified how the system had failed autistic people.

Shockingly, the Children’s Commissioner also found that, despite the fact that restraint and seclusion should only ever be a last resort, many staff in mental health hospitals “speak of it almost as a matter of routine”.

The Care Quality Commission (CQC)

Late last year, the Health and Social Care Secretary, Matt Hancock MP, asked the CQC to carry out a review into the use of restraint and seclusion in mental health hospitals. This followed a number of high profile stories about young autistic people stuck in inappropriate units.

On Tuesday, the CQC published an interim report of its findings so far. The report uncovered a shocking situation, particularly about autistic people who were being held in “long-term segregation”:

• 31 of the 39 people they found in long-term segregation, whose case investigators assessed, were on the autism spectrum
• Some wards that autistic people were on didn’t have the appropriate environment
• Many staff lacked the training they need to support autistic people, particularly those with behaviour that is seen as ‘challenging’. The CQC said “staff were typically unqualified”
• In the case of two thirds of the people the CQC assessed, staff had stopped trying to reintegrate them back into the main ward
• One third of the people they assessed were experiencing a “delayed discharge” because there wasn’t a plan for appropriate care in the community.

These findings are extremely concerning. Wherever possible, autistic people should get the mental health support they need in their own community. If someone falls into crisis and is admitted to hospital, it is essential that this is delivered by staff who understand autism, in an environment that meet their needs, and for as short a time as possible.

Matt Hancock has announced that every case of segregation and long-term seclusion will be reviewed and that a new “independent body to speed up discharges” will be set up. This is a good step, but in order to address the failures of Transforming Care, the Government and NHS England must do more.

We are calling on the Government and NHS England to make sure that the right range of services are available in every area for autistic people, to support them and prevent them reaching crisis point. It is also vital for Government, NHS England and the CQC to identify and take action on bad practice. Finally, we believe that the Government needs to look again at the Mental Health Act and how it applies to autistic people, so that autistic people aren’t wrongly sectioned.

As the CQC points out, the problem is the system of care itself. It’s broken. It’s failed autistic people and it needs urgent reform.

Further information

Read more stories about autistic people who’ve been stuck in inpatient care in our Transforming Care: our stories report and find out about the extent of the scandal in our Beyond Transforming Care report.

For information about what to do if an autistic family member is at risk or has been admitted to or discharged from a mental health hospital, visit our page on autism and mental health.

Bringing us Together have produced this very useful Survival Guide for care and treatment reviews.

Read our recent news story, setting out what’s wrong with mental health hospitals and what we can all do to support the vital campaigns to change this unacceptable situation.