by Mollie Heywood
Assessment and treatment units (ATUs) were designed to offer short-term crisis interventions for people with learning disabilities and autism. The intention was to offer problem-solving support for bigger issues or short-term respite care.
However, research published this week by the Centre for Disability Research for the 7 Days of Action campaign shows that these ATUs are no longer short-term stopgaps. Instead, people are being forced to stay in these units for far longer than necessary and, in some cases, kept hundreds of miles away from their families and homes.
Why? According to an NHS report, one of the top five reasons people are admitted to a unit is because no community-based assessment and treatment services are available in their areas. Meanwhile a reason commonly given for admitting someone to a unit is that their “challenging” behaviour or a mental health issue has flared up.
Worrying
It seems obvious to me that moving someone away from their home, their family and known environments won’t do anything to help reduce challenging behaviour or improve mental health. So being sent hundreds of miles away means a person will potentially spend even longer in an ATU that they should never have been sent to in the first place.
Another worrying point raised by the 7 Days of Action research is the suggestion that the NHS’s contracting of private sector-run ATUs means profits are being valued over people. The report found a person who has been in a private unit for five years roughly produces £950,000 of income for the independent sector. Last year, there were over 1,290 people in these services.
The report concluded: “It is clear to us that the way in which the healthcare economy has been encouraged to develop by recent governments turns people into commodities and liabilities.”
How can it be right that there are hundreds, if not thousands, of people treated this way? A friend of a friend is about to be moved hundreds of miles away from their home to an ATU for a minimum of two years, moving from an NHS unit to a private one.
They’ll be losing the social networks and relationships they desperately rely on, including visits from friends and family members, and, put simply, the knowledge that they’re in an area that they know and are comfortable in.
Values
Online, private ATUs look like flashy, appealing prospects. Pictures show facilities that look like show homes or university halls. The reality can be very different. A 2012 report highlighted in the research found patients in the independent sector were 30% more likely to experience an assault and 60% more likely to be restrained than inpatients in NHS units.
Having studied the 7 Days of Action research and read many of the observations online of the descriptions of real peoples’ experiences, I just keep coming back to the same conclusions. I’m horrified and shocked that vulnerable people are being exploited, seemingly within the law, while profits are padded out.
I’m currently completing an MA in social work. One of the things that troubles me is where our profession fits into the ATU issue. The way they are used seems to defy so many of the principles that underpin social work. Yet social workers must be involved in the lives of many of the people sent to live in these units, whether it be in the referral or management of the placement.
It’s time our profession stood up against this scandal and fought to ensure community alternatives are available. Simply continuing to let the use of these ATUs continue goes against everything we should stand for.
Mollie Heywood is a social work masters student at Lancaster University. She tweets @mollieaheywood.
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Thank you Mollie and Community Care
As you will know, where children in these units are concerned – all roads lead back to the DfE
https://www.gov.uk/government/publications/lenehan-review-into-care-of-children-with-learning-disabilities
…who are resolutely sitting on their hands, hoping nobody notices that the party now in political power do not have the political will to dismantle a system they set up and the DfE itself does not have the competencies necessary to do so..
Mollie Heywood highlights and important issues. What though, would happen if a concern was raised was raised to safeguarding? Sadly in this country safeguarding does not work well. That is not the fault of practitioners but rather the system. Council employees being tasked with making judgments that often come down to lack of money. Its time we had an independent national safeguarding agency
I hope and pray that your fellow social workers take your concerns on board.
We desperately need to change the awful way we treat people with learning disabilities and their families.
Thank you for adding your support to families who are desperately in need of some empathy and understanding.
….this is where everything starts
https://www.youtube.com/watch?v=Tfn6vD4yyC4&rel=0
Social Workers should be at the forefront of articulating a vision of what ‘good’ looks like for disabled children/people with challenging behaviour so they do not end up in these awful places.
Whilst I agree with the majority of your post, there is a fundamental flaw within your opening paragraph- the term ATU correctly refers to services with the intention of short term assessment and treatment (and obviously the debate as to why they often fail to deliver upon that definition is right and proper)
However, the overall inpatient population quoted at approximately 2500 (based on most recent NHSE dataset) includes a significant proportion that have been correctly diverted, at Court, from custodial sentences (as per Bradley recommendations); this population are not admitted to hospital for short term assessment and treatment, but for longer term offence specific work that 1) is not available within the prison estate, and 2) is not deliverable in the community due to risk. This patient group are also considered a risk of harm to others and therefore there is a dual role for rehabilitation and public protection.
To bracket these patient groups together is misleading and dilutes the argument that you are trying to make
There needs to be a legal obligation for all local authorities to have a comprehensive local offer including help and support for people with LDs who present with VCB (violent and challenging behaviour), which is not caused by bad parenting I might add. It’s sick that parents and these cherished family members are being treated like this. And how long have we know about early intervention and how much does it happen in reality? This is an education, health and social care issue. Agencies need to work together and collaborate with the parents of the individual concerned. Parents have all the knowledge and are the experts on their son or daughter. They must be involved in the care of anyone ending up in an ATU or some other residential placement.
So right to ask the question – how is it that social workers involved in assessments and plans can have people arrive at these so inapropriate solutions? Assessments should be looking early and long-term. We usually know children who have complex needs – who’s looking at what is needed as tehy move towards adolescence and transition to adulthood? Whose assessments include considering what ifs? – like if the family get ill? like working with the person and families to consider their future needs and longer-term ones? What is the plan if they struggle? Do we introduce early a service support where they get to know and are known and can support additional needs/plan for longer-term adult needs….. How come social workers are colluding with short-term-ism that encourages not listening, not seeing other than immediate needs,. not asking the family how best they can support…..? Just buying for today won’t do it/ignoring the family’s needs…. And it’s their job to know their local services and identify deficits to ensure commissioners plan effectively and partner with the right local skills who care and go that extra mile… Social workers should be accountable for their professional pratice and it’s their job to tell their manager like it is – not pretend the emperor has got clothes!
The same kind of thing is happening to the elderly with dementia or some other mental disorder. It happened to my mother, she was removed from my care using the Mental Health (Scotland) Act, and died in hospital because she was denied sufficient exercise to remain healthy. Many others in her ward were likewise not given sufficient exercise and also died.
In such cases as mine, there is no excuse that private profit-taking is the driving motive. As you have realised, the practice is clearly being driven by those social workers/mental health officers whose motivation is to control and to impose their views on people, rather than to support their decisions as human rights legislation requires. The scandal is being caused by your profession.
You Molly seem to be in the 2nd camp of young idealists whose goal is to serve. Those who have been in the profession for some time are mostly in the former camp, although they would deny it. They say they are acting in the patient’s “best interests” – by which they mean that it is in the patient’s best interests to do what the social worker or health professional recommends, even to the extent of taking legal action to impose their views on others who have clearly said No and are acting as rationally as anyone without a mental disorder.