Last Monday’s BBC Scotland Disclosure programme (https://www.bbc.co.uk/iplayer/episode/m001b8qg/disclosure-series-5-locked-in-the-hospital 15.08.22) shone a powerful light on the plight of a number of men with learning disability and autism inappropriately placed in both the State Hospital at Carstairs and in other mental health hospital settings.
The documentary provided strong evidence of these individuals having being admitted to an NHS facility at a time of personal and family crisis but failing to re-emerge into community life despite the passage of the intervening years. Many of those taking part in the programme, including the former chief executive of the Mental Welfare Commission for Scotland, provided evidence that the environments in which they are being held are not conducive to their health and wellbeing. Their own families spoke of the psychological distance inevitably imposed between them and their sons – a distance of course cruelly exacerbated by covid – and of the labyrinthine processes of future planning and decision-making lacking clarity, urgency or transparency.
One of the agencies responsible for the management of one of the places used to detain people in this way – the NHS Ayrshire & Arran and North Ayrshire Health and Social Care Partnership (HSCP) – has now issued a statement in response to the programme, but without specifically referencing it. It describes its facility – comprising 136 mental health inpatient beds and 10 beds for learning disability assessment and treatment, as well as 60 beds for general physical health long-term conditions – as a “bespoke mental health and learning disability inpatient service” and suggests that it is a national exemplar of good professional practice.
The statement goes on to acknowledge that “where individuals have complex needs………….discharge from hospital can take a longer time than we would normally expect” and attributes this to “challenges in identifying and commissioning services that will meet the person’s needs” but without indicating what these challenges might be.
Statement such as this cannot be allowed to pass without challenge, not least on the basis that we appear to have forgotten our own relatively recent history. (As Milan Kundera wrote, “the struggle of man against power is the struggle of memory against forgetting”.)
For we seem to have forgotten that almost thirty-years the Mansell Report (1993; revised 2007) set the UK policy context for the development of services for “people with learning disabilities and challenging behaviour or mental health needs”:
- recommending that “commissioners should stop using services which are too large to provide individualised support; serve people too far from their homes; and do not provide people with a good quality life in the home or as part of the local community, in favour of developing more individualised, local solutions which provide a good quality of life.”
- Identifying that “the appropriate role for psychiatric hospital services for people with learning disabilities lies in short-term, highly focused assessment and treatment of mental illness. This implies a small service offering very specifically, closely defined, time-limited services.”
We seem to have forgotten that it’s at least twenty-five years since health and social work professionals in Scotland began to square up to, and to successfully overcome, the challenge of commissioning services for even the “most complex” men and women living in the long-stay learning disability hospitals of that day.
We seem to have forgotten also that it’s twenty-two years since the Scottish Parliament endorsed a national learning disability and autism policy, “The Same As You”, which required all long-stay learning disability hospitals to close.
A statute of limitations should surely be imposed therefore under which it is simply inadmissible for any of us to continue to state that – despite all the positive examples of its implementation, person-by-person, throughout the hospital discharge programmes, and elsewhere – we are still trying to get our heads round the difficulties of implementing this thirty-year-old policy, and that therefore allowances must be made whenever a short-term mental health intervention morphs into long-term segregated detention.
If you are interested in examining this issue further please join us at our next Radical Visions for Social Care seminar at 12 noon on Monday 12th September. We can’t afford to wait any longer. Everyone has a right to their own home.