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Care Quality Commission's report on segregation

The Care Quality Commission (CQC) which is the independent regulator of health and social care in England published their interim report about segregation on 21 May 2019.

The review was commissioned by the Secretary of State for Health and Social Care on the use of restraint, prolonged seclusion and segregation for people with a mental health problem, a learning disability or autism.

The interim report focuses only on the experience of those people cared for in segregation on a mental health ward for children and young people or on a ward for people with a learning disability or autism.

It recommends:

  • Over the next 12 months, there should be an independent and an in-depth review of the care provided to, and the discharge plan for, each person who is in segregation on a ward for children and young people or on a ward for people with a learning disability and/or autism
  • An expert group, that includes clinicians, people with lived experience and academics, should be convened to consider what would be the key features of a better system of care for this specific group of people (that is those with a learning disability and/or autism whose behaviour is so challenging that they are, or are at risk of, being cared for in segregation)
  • Urgent consideration should be given to how thesystem of safeguards can be strengthened, including the role of advocates and commissioners, and what additional safeguards might be needed to better identify closed and punitive cultures of care, or hospitals in which such a culture might develop
  • All parties involved in providing, commissioning or assuring the quality of care of people in segregation, or people at risk of being segregated, should explicitly consider the implications for the person's human rights
  • Informed by these interim findings, and the future work of the review, CQC should review and revise its approach to regulating and monitoring hospitals that use segregation

In the next phase of the review, they will look at the use of restrictive practices in a wider group of settings, including low secure and rehabilitation mental health wards and adult social care services.

They are going to work with Ofsted to consider the use of restrictive intervention in children's residential services and secure children's homes.

They will make further recommendations to the Department of Health and Social Care and the wider system in a report due to be published March 2020.

Our thoughts

We welcome the report which shines a light on the awful treatment faced by many people with learning disabilities, autism and mental health problems who are locked up in mental health hospitals – confirming what we've been hearing from families for a while now.

It's clear that many people are staying far too long in inappropriate settings often very far from home, sometimes locked in little more than cells, with no focus on their rehabilitation or reintegration into society.

We urgently need to see the Government and NHS commit to improving mental health wards, staffing and training for staff and respond to the Mental Health Act review which made recommendations to better support people who find themselves in mental health settings.

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