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Long-term segregation and seclusion for people with an intellectual disability and/or autism in hospitals: critique of the current state of affairs

Part of: BJPsych Features: Segregation and Seclusion

Published online by Cambridge University Press:  04 December 2024

Samuel J. Tromans Open the ORCID record for Samuel J. Tromans [Opens in a new window] ,
Indermeet Sawhney ,
Mahesh Odiyoor ,
Jana de Villiers ,
Jane McCarthy ,
Harm Boer ,
Regi Alexander Open the ORCID record for Regi Alexander [Opens in a new window] ,
Ken Courtenay ,
Stuart Wallace  and
Satheesh Gangadharan Open the ORCID record for Satheesh Gangadharan [Opens in a new window]
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Samuel J. Tromans
Affiliation:
SAPPHIRE Group, Department of Population Health Sciences, University of Leicester, UK; and Adult Learning Disability Service, Leicestershire Partnership NHS Trust, Leicester, UK
Indermeet Sawhney
Affiliation:
Learning Disability Services, Hertfordshire Partnership NHS Foundation Trust, Hatfield, UK
Mahesh Odiyoor
Affiliation:
Centre for Autism, Neuro-Developmental Disorders, and Intellectual Disability (CANDDID), Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
Jana de Villiers
Affiliation:
High Secure Forensic Intellectual Disability Service for Scotland and Northern Ireland, The State Hospital, Lanark, UK
Jane McCarthy
Affiliation:
Learning Disability Service, Sussex Partnership NHS Foundation Trust, Worthing, UK
Harm Boer
Affiliation:
Psychiatry of Intellectual Disability Services, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
Regi Alexander
Affiliation:
Learning Disability Services, Hertfordshire Partnership NHS Foundation Trust, Hatfield, UK
Ken Courtenay
Affiliation:
Psychiatry of Intellectual Disability Services, Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK
Stuart Wallace
Affiliation:
Legal Directorate, St Andrew's Healthcare, Nottingham, UK
Satheesh Gangadharan
Affiliation:
Adult Learning Disability Service, Leicestershire Partnership NHS Trust, Leicester, UK
Ashok Roy
Affiliation:
Psychiatry of Intellectual Disability Services, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
Amy Blake
Affiliation:
Psychiatry of Intellectual Disability Services, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
Kiran Purandare
Affiliation:
The Learning Disabilities Directorate, Central and Northwest London NHS Foundation Trust, London, UK
Anupama Iyer
Affiliation:
Learning Disability and Autism Division, St Andrew's Healthcare, Nottingham, UK; and Adult Learning Disability Service, Leicestershire Partnership NHS Trust, Leicester, UK
Richard Laugharne
Affiliation:
Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, Truro, UK; and CIDER, Peninsula School of Medicine, University of Plymouth, UK
Vivien Weisner
Affiliation:
Carer, Coventry, UK
Rohit Shankar*
Affiliation:
Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, Truro, UK; and CIDER, Peninsula School of Medicine, University of Plymouth, UK
*
Correspondence: Rohit Shankar. Email: [email protected]
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Abstract

In November 2023, the Department of Health and Social Care published guidance, entitled ‘Baroness Hollins’ Final Report: My Heart Breaks – Solitary Confinement in Hospital Has no Therapeutic Benefit for People with a Learning Disability and Autistic People’. The report's commendable analysis of the problems and identification of the areas where practice should be improved is unfortunately not matched by many of its recommendations, which appear to be contrary to evidence-based approaches. The concerns are wide-ranging, from the use of the term ‘solitary confinement’ for current long-term segregation (LTS) and seclusion, to presumption that all LTS and seclusion is bad, to holding clinicians (mainly psychiatrists) responsible for events beyond their locus of control. Importantly, there is a no guidance on how to practically deliver the recommendations in an evidence-based manner. This Feature critically appraises the report, to provide a comprehensive summary outlining potential positive impacts, identifying specific concerns and reflecting on best practice going forward.

Keywords

In-patient treatmenthuman rightsintellectual disabilityneurodevelopmental disordersautism
Type
Feature
Information
The British Journal of Psychiatry , Volume 226 , Issue 1 , January 2025 , pp. 39 - 46
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Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press on behalf of Royal College of Psychiatrists

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