Anna’s Blog- Overreliance on Restraint and Segregation in care
Restrictive practices, including physical or chemical restraint and segregation, have been a topic of concern in the health and social care sector for a long time. The Secretary of State for Health and Social Care asked the Care Quality Commission (CQC) to begin an investigation into the use of restraint, seclusion, and segregation in care settings in 2019. This culminated in the damning 2020 report ‘Out of Sight- who cares?’ which reviewed the excessive use of restrictive practices for people with autism, learning disabilities and mental health conditions. They found many instances of undignified and inhumane care, in which people were not treated as individuals but instead as conditions, where the response has too often been to restrain, seclude, or segregate them.
The CQC also found people were admitted to hospital with no assessment, treatment, or discharge plan in place. This has led to many people being held in hospital without a diagnosis, and subsequently a lack of correct support. It has also delayed their ability to move on from hospital, despite alternatives being proposed by their families or other care providers. Many people have found themselves stuck inside a system which is negatively impacting their quality of life and their physical and mental health.
This report featured a case study of a gentleman named Erik. Erik has autism and is sensitive to loud noises, yet was placed into a busy ward with 11 other people. He couldn’t cope with the noise and threw a chair, which resulted in him being placed into long-term segregation. He wasn’t allowed access to things that made him happy, such as his computer or his guitar, and his mental and physical health deteriorated. He wasn’t allowed to leave the room, and was instead told to lie on the bed when staff entered, as they found him “too difficult to deal with him when he was distressed.” Erik became so used to this treatment that he didn’t want to be near people or come out of segregation, as he believed he was dangerous. He had become institutionalised by the setting and poor level of care.
Sadly, as the CQC report shows, Erik’s story is not unusual. The length of time people spent in prolonged seclusion ranged from two days to seven months, and long-term segregation was used from periods from three days up to 13 years. Shockingly, around 70% of the people whose care the CQC reviewed had been segregated for three months or longer, and in certain cases had even been in hospital for over 25 years. In 81% of the wards for children, autistic people or people with a learning disability, physical restraint had been used in the prior month, showing this overreliance in stark terms.
In March 2022, the CQC published a review on progress against their initial recommendations. They found that none had been fully met, and only four had been partially met. Their findings showed that there was instead an increase in the number of people being subjected to long-term segregation. They said: “There is a continued over-reliance on restrictive interventions. People are too frequently subjected to practices that are about containment and are not therapeutic.” Data in the updated report also shows that more people are known to be in long-term segregation now than when it was originally published in 2020.
The lack of process in the past two years has of course been hindered by the pandemic and the overwhelming pressure placed on the health and social care sector. However, the stagnation in the progress towards improving support for people and reliance on these unnecessary and traumatic practices will continue to blight the lives of individuals going forwards. The publication of this latest report is a stain on the sector, but it is our hope that it helps to fuel a movement towards much less restrictive and person-centred practices, based on respect and appreciation for each unique person, their needs, wishes and human rights.
Ultimately, the recommendations that the CQC have laid out will take time to fully implement, but there are immediate changes that can be made to remove restrictive practices from the culture of support in clinical settings. This includes a renewed focus on attracting and retaining compassionate staff and ensuring that they are all trained in alternative methods of support, with a move away from restraint and segregation as the immediate response.
What needs to be at the forefront of care is always the individual and the tailored support they should receive. The overreliance on cruel practices such as unnecessary restraint and segregation continues to have a real-life impact on people across the country, and much more must be done to protect them from unnecessary suffering and long-term trauma.
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