Learning Disabilities and Autism: Solitary Confinement in Hospital

Baroness Browning Excerpts

Thursday 23rd November 2023 Lords Chamber

[Baroness Browning (Con)]

My Lords, I refer to my autism interests as listed in the register and to the fact that, as your Lordships know, I have a family interest in autism. I very much welcome the fact that the noble Baroness, Lady Hollins, has brought her report to the Floor of the House today. We are very fortunate in this House to have her expertise that she shares with us on this and on many other occasions.

As the noble Baroness has said, the report describes statutory confinement as being used to “warehouse” adults and children with a learning disability and/or autism. If I may, I would like to set the scene a bit on autism. It is of course a spectrum—a communication disorder that covers a wide range of intelligence, but because of the complexity of the condition, the report we are discussing can capture any of them. Failure in the community to provide appropriate support raises the risk that any one of them may be admitted and subject to all the horrors that this report exposes, particularly solitary confinement, which in every other context would be regarded as a punishment.

For many adults and children, autism-related anxiety is common. It can often be helped with medication, but that is complex. There is no one quick-fix pill. The advance of personalised medication will certainly benefit this group, but we do not have it yet. We need it. The anxiety can cause meltdowns and challenging behaviour. It is usually triggered by a build-up of anxiety. Of course, it is difficult to deal with, but it is not a psychotic episode. The triggers that create these meltdowns in autistic adults and children need to be understood. They will vary from person to person, from changing environments and many quite obscure changes. It takes time and experience to manage and support somebody who is having a meltdown. I know that it is not a psychiatric term as such, but I think we all understand, know and have probably witnessed what that means. Whatever the cause of a meltdown, to be met with solitary confinement will compound the anxiety driver, and too often, the use of the chemical cosh on top just puts off a repeat event until the next time. For many autistic people, just being physically touched will trigger a challenging behaviour.

In over 31 years in Parliament, I have been involved with medical practitioners in order to extricate autistic people from mental institutions, and I can certainly relate to the title of the report that is the subject of today’s debate, which begins with the words, “My heart breaks”. My heart has broken many times over some of the cases I have personally observed. One would have hoped to have seen more progress. Over the years there have been high-profile cases, but the Government have made promises that have not been kept and targets have been widely missed.

In reading the response of the DHSC to the recommendations in the report by the noble Baroness, Lady Hollins, I would like to focus the Minister’s attention on the scale of the problem. In particular, their response to recommendation 6 says:

“Solitary confinement should become a notifiable event to CQC as well as to the ICB executive lead for learning disability and autism and the provider board. The notification should be made within 72 hours of a person entering solitary confinement”.


The Government’s response to recommendation 8 mentions the CQC. Although I support the training mentioned in that response, if there were notification of such confinement straightaway, or certainly within 48 hours, the CQC would not have to play “catch me if you can” in its ad hoc investigations of and attendances at these institutions. There is an urgent need for these cases to be identified when they happen and to explain why an action is taken. There is such a need for more action that the Government have a role to play here, rather than just saying, “Well, these are independent bodies who make day-to-day decisions”. That may be true, but what is behind this report is all the recommendation the Government need to make sure that the action in the field meets what we in this House would regard as humanitarian standards for this group of people.

I conclude by quoting a briefing that many of us have had from Mencap, which has great experience in this area. It says that the Government

“promised to reduce the number of people with a learning disability and/or autism in mental health hospitals by 50% by March 2024. Our analysis of latest NHS Digital Assuring figures … estimates that the Government won’t hit their own target until 2029”.

It says that, of the 5,025 reported cases, in August 2023—just three months ago—the use of restrictive interventions in this one month included 1,140 reported uses of restrictive interventions on children. I say to my noble friend the Minister: surely, this is urgent.