Out of Sight – Who Cares A review of restraint seclusion and segregation for autistic people, people with learning disabilities and / or mental health condition


This CQC report was publish on the 21st October and paints a horrific picture of the systems failure to deliver quality support for some of the most vulnerable individuals in society.  This failure impacts all ages and reflects a long-term lack of investment in developing quality, person centred services at a community level, resulting in individuals experiencing inappropriate long term stays in hospitals, where they too often are subject to restraint, seclusion and segregation.  People get ‘stuck in the system’ because the right support isn’t available in their community, close to family and friends.

The group of people impacted by this situation often have complex needs that require careful consideration and understanding of how best to support them, yet too often they find themselves in unsuitable environments, that are noisy, chaotic and overwhelming.  This lack of a therapeutic approach inevitably triggers behaviour that challenges, and the report states individuals become seen "as a condition or a collection of negative behaviours".

The CQC report can be read here https://www.cqc.org.uk/publications/themed-work/rssreview

This situation is sadly not a new one and while not enough has been done, work under the Transforming Care Programme, now called the Learning Disability and Autism Programme, has started to address some of these failings.  In Shropshire, PACC has recently joined the local Learning Disability and Autism Programme board and is pushing for early intervention at a community level, so that families and young people receive the support they need before they reach crisis point.  We are also working to improve transparency in the system so that families know where to go when they need help, as well as ensuring that services are responsive to them.  The Shropshire Written Statement of Action identified the failings of the local Autism / ADHD pathway and ensuring that this is addressed is a key priority in Shropshire. 

One of the major issues is that too often young people fall through the gaps of a failing system and opportunities to intervene early are lost. Local areas are now required to maintain a Dynamic Support Register, which should record any young person with a Learning Disability and/or Autism who is at risk of going into crisis, which may result in a hospital admission or an out of county placement.  You can find out more about the DSR here https://www.england.nhs.uk/learning-disabilities/dynamic-registers-and-dynamic-systems/

If a young person with a learning disability and / or Autism goes into crisis then a Care Education and Treatment Review should be considered.  This is a meeting that brings all those involved in a young person’s care together, with a person-centred focus on the needs of the young person and their family.  Data shows that where a CETR takes place in the community, then in over 80% of cases an admission to hospital is avoided.  You can read about CETR’s here https://www.england.nhs.uk/learning-disabilities/care/ctr/care-education-and-treatment-reviews/

In addition to the CQC review the Government has recently responded to the ‘Joint Committee on Human Rights reports on the Detention of Young People with Learning Disabilities and/or Autism and Human Rights and the implications of the Government's COVID-19 response’.  In this response the Government accepts numerous recommendations made in the report. You can read the response here https://questions-statements.parliament.uk/written-statements/detail/2020-10-22/hcws530?s=03

This work will be a major area of activity for PACC over the next 12 months and we will keep you up to date on progress and any new proposals.  If you would like to know more about any of the above please do get in touch.  If you have experienced any of the above and are struggling to secure the right support please also contact PACC and we will do our best to help.


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