The Care Quality Commission (CQC) is calling for an independent review of every person who is being held in segregation in mental health wards for children and young people and wards for people with a learning disability or autism. These reviews should examine the quality of care, the safeguards to protect the person and the plans for discharge.
CQC makes the recommendation in the interim report published today; in which it shares early findings from its review of restraint, prolonged seclusion and segregation for people with a mental health problem, a learning disability or autism. The review, which was commissioned by the Secretary of State for Health and Social Care, also highlights the need for a better system of care for people with a learning disability or autism who are, or are at risk of, being hospitalised and segregated.
From an information request sent to providers CQC was told of 62 people who were in segregation. This included 42 adults and 20 children and young people – some as young as 11 years old. Sixteen people had been in segregation for a year or more - one person had spent almost a decade in segregation. The longest period spent in segregation by a child or young person was 2.4 years.
CQC has so far visited and assessed the care of 39 people in segregation, most of whom had an autism diagnosis. Reasons for prolonged time in segregation included delayed discharge from hospital due to there being no suitable package of care available in a non-hospital setting. For some, the commissioners had found it difficult to find a suitable placement.
The safety of other patients or staff and inability to tolerate living alongside others were the most common reasons providers gave for why people were in segregation. In some cases, staff believed that the person’s quality of life was better in segregation than in the less predictable environment of the open ward.
Some of the wards were not suitable environments for people with autism and many staff lacked the necessary training and skills to work with people with autism who also have complex needs and challenging behaviour.
Around half of the people in segregation were in wards managed by the independent sector and half were in the NHS. Twenty-four of the places were commissioned by a clinical commissioning group, 30 by NHS England specialised commissioning, three by local authority commissioning, two by Welsh commissioning and three did not specify the commissioning arrangements.
Source: Care Quality Commission, 21st May 2019