CQC to probe restraint and seclusion of people with mental health problems and learning disabilities

Government-commissioned review follows BBC investigation which showed sharp rise in restrictive practices in inpatient settings amid ongoing concerns around care for this group


The government has asked the Care Quality Commission (CQC) to review the use of restrictive interventions on those with mental health problems and learning disabilities and/or autism in hospitals and care homes.

It will review and make recommendations on the use of physical restraint, prolonged seclusion and segregation in settings that provide inpatient or residential care for people with mental health problems and a learning disability and/or autism.

The announcement follows longstanding concerns about the care and treatment of this group, including excessive use of restraint, institutional abuse, poor care and people being placed in inappropriate settings, often far from home.

The ongoing Transforming Care programme, set up in the wake of the 2011 Winterbourne View scandal, is designed to address these problems. However, an investigation by the BBC’s File on 4 programme broadcast last month found a substantial increase from 2016 to 2017 in the use of restrictive practices in inpatient settings for this group.

Assessing a variety of settings 

The review will first look at specialist NHS and independent hospital wards for adults and children, including assessment and treatment units, where problems are believed to be greatest, before moving on to consider mental health rehabilitation and low secure wards.

It will then carry out exploratory work to identify whether and how restrictive interventions are used in specialist care homes and children’s homes, and secure children’s homes.

Section 6 of the Mental Capacity Act 2005 (MCA) defines restraint as when someone “uses, or threatens to use, force to secure the doing of an act which the person resists or restricts a person’s liberty whether or not they are resisting”. Restraint can be physical, including controversial prone restraints that involve holding a person chest down, chemical, involving medication, or mechanical, involving some kind of device such as a belt or cuff.

Meanwhile, seclusion and segregation are ways to manage the threat or actual use of violence by confining or isolating a person, for example in a locked room or one the person is otherwise prevented from leaving.

The CQC review will include visits to services, interviews with people who have been subject to segregation or prolonged seclusion and with families and carers, in addition to analysis of relevant data, guidance and reseach.

NHS England, NHS Improvement and Ofsted will work with the CQC on the review, which is scheduled to report back to the government in March 2020, with interim findings expected in May 2019.

However, there has been some criticism over the 15-month timescale of the review.

‘Woeful’ report timescale

Sara Ryan, the mother of Connor Sparrowhawk, who died preventably in an NHS Trust unit in 2013, said: “The timescale is woeful and reflects a layer of indifference to this issue that is symptomatic of the sustained impoverished treatment of certain people in our society.”

“I would like the CQC to actually think about the people and children who will experience restraint, prolonged exclusion and segregation for a further fourteen months. These people are human and should not be subjected to such barbaric practices,” added Ryan, who is also a disability academic and a campaigner for the rights of people with learning disabilities.

Public concern surrounding use of restraint

CQC deputy chief inspector of hospitals (lead for mental health) Dr Paul Lelliot acknowledged there was “public concern” over the use of restraint and other restrictive techniques used on people with learning disabilities, he said:

“It is vital that services minimise the use of all forms of restrictive practice and that providers and commissioners work together to find alternative, and less restrictive, care arrangements for people who are currently subject to seclusion or segregation. Failure to do this has the potential to amount to inhuman and degrading treatment of some of the most vulnerable people in our society.

“The experience and perspective of the people affected by these practices, either as a patient or as a carer, will be central to this work. It is vital that society protects the rights, welfare and safety of children and adults with a mental illness, learning disability or autism and that they receive the safe, high quality care that they deserve.”

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7 Responses to CQC to probe restraint and seclusion of people with mental health problems and learning disabilities

  1. Sunday seymour December 5, 2018 at 5:44 am #

    Autism is always added on as an afterthought..yet there are now more with autism than LD in some areas..It is also not an LD nor mental health and as such if no co occurring MH problems no mess are ever needed..and the last thing EVER when in meltdown is any sort of restraint ..touch and talk escalates an already overloaded nervous system with adrenalin and toxins..people should never ever be given drugs to calm down especially if it’s against their will..A meltdown will end in harm bruised head from banging etc. But it’s time society learned to make more reasonable adjustments to stop us going into crisis in first place..and those with MH and or LD may need different interventions d pending on individual circumstances .but with autism especially those without LD that are intelligent to social norms and are temporarily out of control and very often say they want to end it when in meltdown are to be watched from eight feet or so away but never touched or spoken to .It will run its course may sustain injuries..that’s part of our life. Once subsided we have full capacity..and locking somewhere secure is also worst thing u can do for someone with autism and hen in distress as everything and everybody becomes a fear magnified and the worst thing is no escape route or being hemmed in whereby u can’t get away from whatever fear has triggered you..and despite lack of control over a meltdown we can hear and feel intense fear ..don’t add to it through ignorance and lobbing us in with LD and or MH when completely difference strategies are needed ..its time there was a completely separate part under social services for autism not shove us under LD ..would Physical disabilities be happy being shoved under MH ..no don’t think so..so don’t shove us under LD where we are not able to have the specialised support resources or understanding we need when under S’s ..I have at times and am being treated appallingly by service providers due to lack of listening to the individual how autism really is..my health wellbeing and disability mean I have no happiness or quality of life.. when I could so easily be enabled and meltdowns that take years off your life reduced..I have no voice no choice ..talk to me …

  2. SB December 5, 2018 at 3:32 pm #

    Can the investigation include assaults and injuries on staff as they too have the right to be protected.

    • Pam Hickmott December 7, 2018 at 1:55 am #

      Assaults on staff are caused by Young untrained staff on basic pay with no understanding Autism shouting at them verbally abusing and swearing g a d aggressive they hit because frightened of staff holding them down 6 plus staff prone restraint and injecting them with medication for minor incidents and big factor of this short staffing no care plan locked in daily Noise Alarms going off could go on and on in my sons case 18years of this in a cold uncaring lack of basic needs environment .also my son over years has received a broken arm 3 places every part of his body cuts bruises wrist burns fingers stood on Black eyes caused by staff who have been dismissed no police action taken against staff members

  3. Aleksander Angelov December 6, 2018 at 6:20 pm #

    In our days staff are only blamed for everything that’s why people leave social care settings. You can see shortages every where.

  4. Pam Hickmott December 7, 2018 at 2:00 am #

    Staff should be paid a better rate of pay also have proper training and be supported by managers who are not hands on sit in offices or meetings also staff are always working short staffing . Expect to do washing cleaning food as well as looking after challenging Adults who need a proper service and care plan

  5. SB December 11, 2018 at 10:10 am #

    There should be more opportunities for the above type of comments to be made to an audience that want to listen and want to make changes for the better.

  6. Jim January 3, 2019 at 12:23 pm #

    Autism provision in the UK is indeed a national disgrace and shame on the government.Most of the practical autism help which does exist is provided either by charities or the state funding other private operators to run projects, as to provide it in-house is much more expensive. So the Government using value for money shifts its statutory responsibilities onto low paid staff in cheaper to run poorly resourced charities or private businesses.

    Autism where it is the primary diagnosis should not be lumped as an after thought under the umbrella of LD and Mental Health. The state does this as it knows that to have properly resourced and specialised autism residential, daycare and short break provision would be very expensive if done properly. So, much of the autism provision from Councils or Health Trusts is confined to assessment, diagnosis and so called ”early intervention” with nothing much beyond this in terms of life long real everyday practical follow up. When autistic kids get to 18 they are dumped into adult LD and Mental Health Services, many of them ending up going in and out of LD psychiatric care especially those with co-morbid diagnoses of learning disabilities and bi-polar.