End solitary confinement for children and limit it for adults, review demands

Autistic children and those with a learning disability should never be subjected to long-term segregation in hospital – and its use should be “severely curtailed” for adults, a review has recommended.

An independent panel, chaired by Baroness Hollins, was announced in November 2019, to oversee a case review for those in long-term segregation to help with their discharge into the community as “quickly as possible”.

In her final report, published on Wednesday, she said the panel was unanimous in stating that all instances of enforced social isolation, including seclusion and long-term segregation, should be renamed “solitary confinement”.

She said such measures for under-18s “should be ended with immediate effect”, and time-limited to a maximum of 15 days for adults.

Baroness Hollins led a review into the care of people with learning disabilities and autism (Alamy/PA)
Baroness Hollins led a review into the care of autistic people and those with learning disabilities (Alamy/PA)

Learning disability charity Mencap said the report “shines a vital light on system wide failures”, while NHS Providers, which represents health trusts, said its findings were “deeply concerning and underline the urgent need for trusts to tackle high levels of long-term segregation”.

Baroness Hollins described the current situation in England as heartbreaking, warning that solitary confinement has no therapeutic benefit.

Baroness Hollins said outcomes remain “so poor” four years on from her appointment to look into the issue, as she described the use of solitary confinement as causing “what could be described as a ‘social death’”.

The review into the Department of Health and Social Care’s programme of independently chaired case reviews (IC(E)TRs) for people with a learning disability and autistic people detained in long-term segregation (LTS), was prompted by serious concerns about the use of long-term segregation.

Baroness Hollins has previously described the work as part of her review as “extremely harrowing”.

In her final report, she said: “My heart breaks that after such a long period of work, the care and outcomes for people with a learning disability and autistic people are still so poor, and the very initiatives which are improving their situations are yet to secure the essential funding required to continue this important work.”

The review considered the care and treatment of 191 people who were detained in long-term segregation between November 2019 and March 2023.

At the start programme’s second phase, there were 115 people in long-term segregation, with a similar number by the end.

Baroness Hollins said of the 114 people who received an IC(E)TR in the second phase, 48 had moved out of long-term segregation, including seven people who had been discharged from hospital.

Among the panel’s 13 recommendations, they called for long-term segregation to become “never events” for those under 18, where it does not meet minimum standards for adults, or where it lasts for longer than 15 days.

They also said health regulator the Care Quality Commission (CQC) should be notified within 72 hours of a person entering solitary confinement.

Other recommendations included staff using any restrictive practices to be delivering “therapeutic and human rights-based care”; good practice guidelines should be issued on the assessment and treatment of such patients in solitary confinement; and strengthened safeguarding processes around visits by family members and advocates who the review stated should be able to visit “at any time of day or night if they consider it necessary”.

Baroness Hollins’ report said: “The humanity of people in solitary confinement gets forgotten. Their life story remains unknown. The use of solitary confinement affects the person’s identity to such an extent it causes what could be described as a ‘social death’.

“The panel are unanimous in recommending that the use of solitary confinement should be severely curtailed for people with a learning disability and/or autistic people in the ways outlined above.”

Jackie O’Sullivan, from Mencap, said solitary confinement was being used “to ‘warehouse’ people with a learning disability and autistic people in mental health hospitals with devastating consequences”.

She added: “The Government must act with urgency and implement the recommendations she has set out to end this barbaric practice, and develop the community based services that are desperately needed to support people in crisis and avoid hospital admission.”

Saffron Cordery, deputy chief executive at NHS Providers said: “It is important to ensure the full range of services that people with a learning disability and autistic people rely on are properly resourced and prioritised across the country.

“This means having enough staff with the right skills and experience.

“Greater capital investment is also crucial for patients to get the care they need in environments that properly meet their needs.”

Mental health minister Maria Caulfield said “use of long-term segregation must be significantly and urgently reduced” and, where it is used, “should only ever be in a way that respects human rights, and all treatment plans should aim to end long-term segregation”.

She said work is “ongoing” on recommendations made in the report, including efforts to bring in changes changes, subject to Parliamentary approval, to CQC regulations on better reporting and notifications on the use of restrictive practices which “will provide a better flow of information and allow scrutiny of the care provided”.