Learning Disabilities and Autism: Solitary Confinement in Hospital

Lord Addington Excerpts

Thursday 23rd November 2023 Lords Chamber

[Lord Addington (LD)]

My Lords, when you have been here a while and suddenly see a pairing of people coming up in front of you on a certain subject—and it is the noble Baroness, Lady Browning, and the noble Lord, Lord Touhig, on autism—the first thing you do is to listen hard. When you get a report that has been written with such authority, inspired by this subject, that is doubly the case.

Every time we hear about confinement and control—physical restraint, chemical coshes on groups—we are basically saying, “You have got a failure”. Why have we got to that? Often because in getting to that point, people have not understood this bit of their client base; the report refers to that. The noble Lord, Lord Touhig, just put his finger on it but from what I know of autism, that would be one person’s experience of it. There will be a series of traits gathered together that are complicated and different—never the same twice, so it is not easy.

It is difficult to tell a health professional, or any professional in any sphere, “By the way, your training doesn’t cover this properly”. We all have a series of reflex reactions which we go back to. We have to make sure that people on the way up to this point—or down, depending on how you want to look at it—have ideas about where they should have better interventions, or know whether they should make them or back off. If, as a mental health professional, you are confronted with somebody in an institution or in that process, unless you know not to behave as normal you will go into a pattern of behaviour because everybody does. You have put a reflex or bureaucratic pattern in place, so why would you break it? The only answer will be from the information about what you are dealing with.

Lots of things can go wrong in this process of identification and self-identification. I remember that once I managed to get myself into a totally unnecessary row with somebody who was on the autistic spectrum, because they accused me of not doing something in very aggressive terms. They probably did not mean to. I said, “Wait a minute—this is public”, and started to defend myself. Then they had a minor meltdown and left. I know more about this than most people but still do not know anywhere near enough to understand what that person was going through. Everybody can make these series of mistakes.

My question to the Government is: what are you doing to ensure that everybody in that process better understands that normal responses will get negative results on many occasions? How can we get that idea into the system quickly? Long training programmes, the fact that we are making progress through them and the fact that we have targets: those will all come out because they will be in the Minister’s brief—they always are. However, we need to know that an awareness that something will not respond correctly is required here.

Every time I have dealt with anything to do with autism, there has been this pattern of behaviour in the criminal justice system. To put it bluntly, autism is one of the most over-represented groups in society within the prison system. It can go horribly wrong everywhere. I take the example of the noble Lord, Lord Touhig, on the process of responding: when somebody is confronted with authority, suddenly there is a conflict there, without even trying.

How can people be trained and be made aware generally in society so that they can avoid getting as far as the medical facilities, and how can we make medical facilities aware that a different type of response will be required? I would like that big question to start to be answered. If we do not address that, we do not stand a chance of addressing it in the round because even if we train all the medical practitioners, they will still have a great flood of people coming to them—people who should not have been there.

The police in certain places have had a little more training, but usually after very bad episodes: some degree of conflict has taken place or somebody has been traumatised. We are asking the Government to give us a serious plan about building up a pattern of awareness within the institutions that people bump into. If there is a certain specialist pattern, you only get x number of people going into it. Somebody who is a high- functioning autistic or functions well with learning difficulties may bump into the system only occasionally. But if they do not have support and guidance, with somebody to say, “Yes, there is a different type of response required here”, those incidents will get bigger and more frequent, and we will have to deal with them at the acute level.

The same will apply to those who are discharged from hospital. There must be an entrance and a way down. Sometimes it will be specialist provision and sometimes it will be specially trained people, particularly when you are discharged having had some damage—let us face it, we have all had some damage. I would hope the Minister can give us some pattern for the first steps in making the institutions of government aware that a different way of responding is required. That is a necessary first step, meaning that people should at least ask others, “What do we do?”. If you have that, you will have a bit of hope, which is the least that we should take away from this debate.