Learning Disabilities and Autism: Solitary Confinement in Hospital

Baroness Wheeler Excerpts

Thursday 23rd November 2023 Lords Chamber

[Baroness Wheeler (Lab)]

I too congratulate the noble Baroness, Lady Hollins, on securing this debate, which is a welcome opportunity to listen to the detail of her excellent report, following on from this morning’s wider mental health discussions, and to the hear the Minister’s full response to the report itself. It is also a good opportunity to focus on the long-term segregation of autistic people and people with learning difficulties, with help from the usual important and insightful contributions from my noble friend Lord Touhig and the noble Baroness, Lady Browning, who are always such strong advocates for improved services for this vulnerable group of people.

It is worth noting that some of the speakers today, including myself, were all participants in the then Mental Capacity (Amendment) Bill 2019, which replaced deprivation of liberty order with liberty protection orders, and along with it all expressing many concerns and reservations about how any new system would operate or could lead to substantial change. As we know, implementation of LPOs was subsequently deferred earlier this year, presumably because of the expectation that even the Government had then that a new mental health Act would be in place this year or next.

I welcome the Minister’s promise in last week’s Oral Question to meet on this matter with the noble Baroness, Lady Hollins, and others, including myself, from these Benches. An urgent meeting is certainly much needed. He mentioned in the earlier debate a round table on mental health. My understanding was that there would also be a separate, smaller meeting specifically on the report from the noble Baroness, Lady Hollins, so perhaps the Minister can clarify this.

The noble Baroness, Lady Hollins, has spoken powerfully about how the 40 year-old Mental Health Act results in autistic people, with often misunderstood and challenging behaviour, remaining stuck in mental health settings and assessment treatment units for long periods of time, where approaches do not fit their individual needs for care and support, including their sensory and communications needs. Understanding and support for autism has thankfully changed substantially since 1983, especially on being clear about what an autism-friendly environment looks like and should be. It is certainly not one that is often found in the mental health settings that autistic people are mostly currently held in. Can the Minister tell the House whether the Government’s decision to abandon the new mental health Bill in this Session of Parliament included an assessment of the impact this would have on patients and patient safety?

The report from the panel of experts led by the noble Baroness, Lady Hollins, highlights deep concerns, including a lack of any therapeutic or rehabilitative benefit from the use of long-term segregation for autistic adults and those with learning difficulties. It calls for the introduction of rules which would radically reduce and place a time limit on the use of long-term segregation and to ban it for children and young people as a serious “never event” that prompts an investigation. These and other key changes are proposed to the existing Mental Health Act code of practice, which will now not be considered until the Bill is before us.

To repeat what I said in the previous debate, it is very hard to understand how the Government envisage that the care and treatment of people detained under the current Act is going to be improved by non-legislative commitments, as promised by Ministers in last week’s King’s Speech debate and ever since. I am not sure whether the Minister covered the issue in the previous debate, but can he explain exactly which significant changes can be implemented in the absence of the framework of the new Bill and with the continued constraints, approaches and outdated attitudes contained in the current Act and the code of practice that the Government have no plans to review, or how the real accountability that the noble Baroness, Lady Hollins, has called for can actually happen?

The report’s description of long-term segregation as one part of a four-stage failure forcefully underlines this, as was stressed by the noble Lord, Lord Allan. The first failure is a lack of community-based support, which prevents a person being taken out of school or away from their family and admitted to hospital. These are major failings in adult social care. The second is the hospital’s failure to provide the learning disability and autism-friendly support that is needed, meaning more trauma, disorientation and restrictions for the patient. The third is the use of restrictive practices, including solitary confinement, and the fourth is a lack of clarity about responsibilities for commissioning and funding the skilled support and case management needed in the community, which goes back to the accountability issue.

The treatment of people with autism and learning disabilities under the current outdated and discriminatory legislation disgraces our society. The need for mental health reform is why Labour, if elected, has pledged to reform the Mental Health Act in our first King’s Speech. It is an urgent priority for us. The current law is not fit for purpose and must change. We want to see the Act updated following the excellent work undertaken by the mental health Joint Committee. The code must also be updated to meet the aspirations outlined today and to reflect the learning and culture change we all want to see in how autistic people and those with learning difficulties are viewed.

I have a quick question, finally, on the timetable for the CQC to commence delivery of ICETRs on long-term segregation. When will the guidance on their role and responsibilities be available? The aim is noted—to make sure that, within 48 hours of a person being put into segregation, the CQC is ready to start an investigation of its suitability—but the process needs a great deal of thought and preparation, and the minimum standards criteria of the place need to be clear. How is Parliament going to be involved and what is the process to review the CQC’s role?