“The Health and Social Committee is right to describe the inpatient treatment of learning disabled and autistic people as shocking. Despite countless reports and action plans in the decade since Winterbourne View, fundamental structural issues remain. There’s a critical shortage of community based crisis resources to prevent admissions in the first place. Patients are admitted without subsequent discharge plans. Funding arrangements further disincentivise discharging patients. And there is still no consequence for those responsible for this ongoing failure – in stark contrast to those failed so desperately by our system.” Steve Scown, CEO
The Health and Social Care Select Committee’s report on the treatment of people who have a learning disability and autism underlines the fundamental need to invest in the right support so that people can lead better lives.
Yesterday’s report is welcome, above all, because it recognises that long term detention is fundamentally a human rights issue and it sets out that – no matter how well managed or supportive inpatient settings might be – community support is the only model of support that empowers people to lead independent, free and fulfilled lives.
We have long underlined the perverse incentives that arise in the system of inpatient detention. Current funding arrangements retain funding in the wrong parts of health and care services, making it difficult to provide the much needed services into which people should be discharged. Furthermore, there are limited safeguards in relation to the independence of clinicians making decisions about discharge from services that ultimately derive their income from the admission of people into their care. The Committee rightly recommends new measures to reverse these incentives and create obligations that pay due regard to the rights of people detained.
Dimensions supports the underpinning principles of the Trieste Model cited by the Select Committee, particularly reform to ensure that inpatient detention can only ever be used as a necessity and to introduce safeguards to reduce an individual’s length of stay to an absolute minimum. The recommendation for weekly reviews of the appropriateness of admission for people who have been detained for longer than 3 months would support ongoing scrutiny by families of clinical decision making and the introduction of a duty to establish community support within 8 weeks of admission no longer being appropriate, or pay compensation for a breach of human rights, would create much needed accountability within the system.
Whilst we have always recognised that, for a small number of people, a limited admission to a specialist inpatient service might support better outcomes, we have an enduring commitment to providing high quality support to people in their communities, where they can be active citizens and lead the lives they want to lead. Llong term detention is not just an affront in itself, but also sustains wider inequalities and lack of inclusion for people who have a learning disability and autism more generally. We therefore welcome the Committee’s reference to research carried out by Dimensions in relation to the experience of people who have a learning disability and autism in primary care and the need for training and development to ensure that people can have their health and wellbeing needs met with the right adjustments and an inclusive approach within their communities.
In our response to the Government’s White Paper on reforming the Mental Health Act we have consistently underlined that legislative reform will not succeed unless it is accompanied by investment in the right support – most importantly services that prevent people from reaching a level of crisis that might necessitate detention. Securing better lives for more people who have a learning disability and autism demands that housing and support are consistently available, close to people’s loved ones. We will continue to emphasise the importance of this investment as the Government introduces legislation to reform inpatient detention for people who have a learning disability and autism.