The care watchdog has called for ‘fundamental change’ in a report on the use of restraint, seclusion and segregation. In its latest report (here), the Care Quality Commission (CQC) visited 43 hospital wards as well as low secure mental health wards, 27 care homes, 11 children’s residential services and five of the 13 secure children’s homes in England.

The CQC described mental health hospitals as ‘not therapeutic environments’ but ‘noisy, chaotic and unpredictable’ which could add to people’s distress, particularly people with autism. It also found that the use of restraint varied across the different hospitals; in some places it was ‘rarely used’, but in others it was a ‘daily occurrence’. Such disparity between the hospitals was concerning the watchdog argued as there appears to be no national consensus as to when restraint was deemed reasonable and its use had become part of culture in some hospitals.

The CQC met with 66 individuals who were in segregation and felt ‘let down by the health and care system’. The individuals relayed traumatic incidents and many of them felt they had ‘fallen through the gaps’ as professionals at the care services found it too difficult to put a care plan in place that catered to their individual needs.

It reported that most people in the review were autistic – 42 out of the 66 had a formal diagnosis – and  more than two-thirds of people in long-term segregation were autistic (67%). It was also found that around seven out of 10 people whose care the CQC reviewed had been segregated or secluded for three months or longer (71%) and a number had been in hospital more than 25 years

The report comes after years of scandals and devastating failures concerning the very care services that are intended to protect the most vulnerable in our society. Following the Winterbourne view scandal, the government released their Transforming Care Report in 2014. Despite the report’s findings and promises of drastic change, the recent failings at Yewtrees Hospital and Whorlton Hall show that the state, who has responsibility for the welfare of individuals in care services, is not acting quick enough.

The conditions of many of the seclusion rooms were deemed ‘unacceptable’ by the CQC as they were often bare, lacking natural light and had limited access to fresh air. It is clear that prolonged time in such an environment could negatively impact individuals mental and physical health.

More often than not challenging behaviour  was reported to be a sign that the individual was struggling due to their own mental health, traumatic past experiences or an unmet need. Rather than trying to understand the reasons behind challenging behaviour or ensure individuals placements are tailored to their needs, the watchdog found that the care system relied heavily on the use of physical restraint, seclusion or segregation.

One of the individuals discussed in the report, Alexis, explained that the key to improving care services is ‘creating the right environment and treating psychological differences with dignity and respect’.

To improve care services, the CQC has recommended that:

• The use of restraint, seclusion and segregation must be reduced.
• Individuals with learning disabilities and autistic people need to be supported to live in their communities.
• Individuals who are being cared for in hospital must receive high-quality, specialised care.
• Increased oversight and accountability for people with a learning disability and or autistic people who may also have a mental health problem.

Care Minister Helen Whately has said the findings are ‘deeply concerning’. Dr Kevin Clearly, the CQC’s deputy chief inspector of hospitals, said that ‘seclusion and restraint should only be used in extreme cases’. He said that the CQC saw too many examples where people were subject to unnecessary restrictions and examples of people’s human rights at risk of being breached.