Assessment and Treatment Units – young people with learning difficulties and autism

The government has announced a one year long review of the Mental Health Act overseen by the chair Professor Sir Simon Wessely. The focus on provision for Black and Minority communities is much needed and welcome but this review should also focus on overuse and abuse of sectioning of Disabled people (including young people) with learning difficulties and autism. Whilst the government’s flagship Transforming Care for People with Learning Disabilities and Autism programme has had some success in moving Disabled people with learning difficulties and autism from hospital into the community nevertheless there is a hidden trend: rising numbers of children and young people entering the psychiatric system.

In 2011 young people made up 7.6% of all Disabled people detained under the Mental Health Act but by 2017 this had risen to 13%. Many of these are people with learning difficulties or autism who are admitted for short stays that then become long-stay placements. Young people end up in the psychiatric system because of local authorities’ and clinical commissioning groups’ systematic failure to fund well-co-ordinated education, health and care services.

Nine year old Paul, who is autistic, attended mainstream school where he did not feel accepted by the school staff and pupils. Instead of being himself, Paul’s coping methods were to mask his difficulties and “blend in” at school, causing extreme anxiety requiring compulsory psychiatric hospital treatment. As a result of his traumatic school experience he will not return to mainstream education and will need state-funded support costing in excess of £100k per year.

Fifteen year old Michael, who is also autistic, was detained under the Mental Health Act. It was the only way of securing state-funded assistance because of the “systemic” failure of education, health and care services. His mother goes on to say that:

“There’s no joined-up thinking, no transparency. You go to one person, one part and it’s just ‘no, not my station’…. If he’d have had the support in his local community, none of this would have happened. It was totally avoidable.”

These young disabled people’s and their families’ experiences of how harmful the lack of inclusive education can be are not isolated incidents. During 2016 the Justice Together Project held a family event to explore why their loved ones end up in assessment and treatment units (ATUs). The authors found that the Special Education Needs Framework of the Children and Families Act came in for a high level of criticism; the whole system failed Disabled children time and time again. In particular children’s educational needs were not being assessed properly, leading to schools failing to understand triggers of distress and being unable to support the child’s behaviour within their own environments and during secondary school transitions.

Austerity is no longer an excuse for not funding inclusive education provision. The government seems very content to allow local authorities and NHS England to fund individual residential special school placements and inpatient beds to the tune of £300,000 per year – no expense spared here for the institutionalisation of Disabled children and young adults.

The UNCRPD Disability Committee in its guidance on how government can achieve successful implementation of Disabled people’s rights to independent living as set out in Article 19 made it very clear there is a direct link between segregated education and institutionalisation, and that inclusive education has a central role in the deinstitutionalisation of Disabled people. So if we are going to reduce the numbers of Disabled children and young people entering the psychiatric system the Mental Health Act Review must recommend the following:

• Development of a fully funded inclusive education system with the aim of phasing out special schools and colleges is fundamental to creating a society that does not need or want ATUs.
• The Mental Health Act must be amended to prevent ATUs becoming the only route of securing state-funded “assistance” for Disabled people with Learning Difficulties and Autism with challenging behaviour. As long as ATUs exist, they become a different public body’s responsibility for providing state-funded assistance. And therefore there needs to be a plan to phase out ATUs. If disabled people have the support they need from birth, there will be no reason for the establishment and growth of ATUs.
• The Department for Education and local authorities must stop funding independent special schools run by Assessment and Treatment Units and all segregated education provision.
• The Government must implement the UNCRPD Committee’s recommendations on how their legislation and policies comply with the UNCRPD standards (see ALLFIE briefing).

By Simone Aspis (Changing Perspectives)

I am a disabled person who is acting as an advocate for detained inpatients with learning difficulties and autism wanting to live in the community, not in an ATU. I have over 20 years’ experience campaigning for disabled people’s human and civil rights, working for People First, United Kingdom Disabled People’s Council, the Alliance for Inclusive Education and Not Dead Yet.

Children’s and parents’ names have been changed.