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Nov 24 2023
I just watched the channel 4 documentary on Autistic inpatients: thing need to change

On Channel 4 in the UK there is currently a documentary from their dispatches series called “Locked Away: Our autism scandal”. This is a very upsetting documentary, and it has made one thing very clear to me. Autistic people are suffering at the hands of an oppressive mental health regime; we need to push back. The contents of this article may be very triggering for some people.

How many Autistic people are on psychiatric wards?

As of January 2023, there were 1,280 Autistic people on psychiatric wards (National Autistic Society). This is 1,280 chances to provide meaningful care, and yet I would hazard a guess that this has happened with none of them. Among the general population, those who have been held as psychiatric inpatients are 191 times more likely to die by suicide in the following months (National Institute for Health and Care Research). This is all-the-more concerning when we consider that while Autistic people represent 1% of the population, they represent 11% of suicides (Royal College of Psychiatrists).

Is inpatient treatment helpful for Autistic people?

I have written previously about the mistreatment that goes on in inpatient settings. I am far from the pnly person who feels Inpatient settings are inappropriate for Autistic people. The National Institute for Health and Care Excellence themselves have documents on their website stating that inpatient facilities have “lots of scope for improvement in autism friendliness”. Simply put, no, as it stands inpatient services are not helpful, and may even be detrimental for Autistic people.

My own experiences of being an Autistic inpatient

I have been an inpatient twice, in two different hospitals. The atmosphere is prison-like and hostile. The sensory environment is unbearable. There is a constant feeling that things could erupt at any moment, and staff make this worse.

Contraband such as alcohol and drugs flowed freely on the ward along with razor blades and other harmful items. Staff would use physical and chemical restraint to punish patients, and speak to us as if we were an inconvenience.

When I had reached the end of my patience with the environment (on my second stretch on the ward) I attempted to leave. I was told that if I tried to leave police would be called and I would be changed from a voluntary admission to an involuntary one. I now know this is an abuse of the mental health act.

I left the psychiatric ward in a worse state than I arrived. My care co-ordinator at the time would go on to state in my care plan that I should never be hospitalised again if possible. A difficult thing to write in the care plan of an Autistic Schizophrenic. I am still dealing with the fallout of the sheer quantity of medication they gave to me now, 7 years later.

Why is the inpatient system like this (concluding thoughts)?

Autistic people, particularly those of us with mental health concerns, are seen as sub-human. The system we live within views us as disposable and burdensome. We may have moved into an era of “care in the community” in the post-asylum era, but the attitudes of the old Bedlams are still very much with us. It is assumed that we will never be meaningful contributors to the world, and as such are the victims of a system that uses our mistreatment as an incentive to remain a good, tax-paying, law abiding citizen.

I personally will not stand for the mistreatment of my neurokin, it is time we pushed back and dismantled the systems that mistreat us. We need to throw away the masters tools and dismantle the house with tools of our own design.

David Gray-Hammond 0 Comments
Jul 27 2023
I was an Autistic psychiatric inpatient: Here’s what I would change in the mental health system

Autistic people are exposed to inordinately high rates of trauma and mistreatment. It is unsurprising then that a large portion of us develop mental health struggles. Where there are concerns around mental health, there are also issues regarding inpatient treatment, both voluntary and involuntary, under the UK’s Mental Health Act. There are currently 1,310 Autistic people under inpatient care, with 93% of inpatients under 18 being Autistic (as of this report in June 2023). Inpatient mental health treatment is a significant issue not just because of our mental health, but also because many of us have been forced to remain in such facilities for months, if not years.

Why are there so many Autistic people in psychiatric facilities?

According to a document submitted to parliament. The following is a significant factor:

“The lack of appropriate community mental health care for autistic people means that some reach crisis-point and are admitted to mental health hospitals.”

National Autistic Society, Document submitted to parliament

This is not a new finding. Community mental health services in general for both adults and children are shockingly underfunded, under-resourced, and not skilled in working with Autistic service users. One might look towards the current CAMHS crisis to consider how a lack of accessibility to good quality and timely assessment and treatment in the community can result in a person reaching crisis point.

We also need to consider the lack of social care support from local authorities. Autistic people all over the country are often gatekept out of vital services that they are entitled to due to failure in the social care sector. Long waits for mental health and social care services are potentiating the the journey towards mental health crises.

What was my own experience as an Autistic inpatient?

Psychiatric wards are intimidating places. I spent the first 48 hours under round the clock supervision. Every aspect of my day-to-day life was under the microscope. Something I witnessed regularly and experienced myself, was the use of restraint. For me, this took the form of chemical restraint, being given powerful tranquilisers that kept me quiet and sedentary. Staff would treat me as a nuisance in their workplace, forgetting that I did not want to be there anymore than they wanted me there.

The building was almost prison-like in its design, with doors that could be closed and locked at the touch of a button, and walls with wire fences on top of them. The beds had plastic mattresses with plastic pillows. Sleep was not an issue because of how sedated they kept me. Staff had no idea how to even identify an Autistic patient, let alone good practice for working with them.

Restraint in psychiatric wards

Autistic people are significantly more likely to be the victims of restraint and seclusion. The International Coalition Against Restraint and Seclusion recently published a report into the use of restraint in schools showing just how common this is in non-psychiatric settings. I assure you it is worse on psychiatric wards.

Chemical restraint is very commonly used in this setting, in fact, I would argue that every single one of us on the ward was chemically restrained. The Care Quality Commission found the following:

“The Mental Health Services Dataset published by NHS Digital for August 2021 shows that 2,465 people in a mental health inpatient setting were reported to have been subject to restrictive interventions in the month, and there were 17 restraints per 1,000 occupied bed days.The data also shows that in August 2021, 790 people were subject to chemical restraint. Among these people, chemical restraint was used on average 2.5 times per person”

Care Quality Commission, December 2021

“…providers did not always recognise how distressing the use of restraint and other restrictive practices could be for people. They also did not recognise the long-term impact of being in restrained, secluded or segregated.”

Care Quality Commission, updated March 2022

It is clear that restraint is used too frequently and in dangerous ways, and yet this continues. Despite the Code of Practice calling for use of least restrictive practices, this is an issue that is prevalent for many inpatients.

What does the code of practice say about Autistic people?

The most interesting part of the code of practice is the following:

“Compulsory treatment in a hospital setting is rarely likely to be helpful for a person with autism, who may be very distressed by even minor changes in routine and is likely to find detention in hospital anxiety provoking.”

Mental Health Act (1983) Code of Practice

Given this we have to consider that the concept of least restrictive practice and the code of practice itself are being failed by the lack of adequate community services. Autistic people are being locked away because there are no better options. That should not be a good reason to do such things.

The code of practice also states:

“If a person with a learning disability or autism is detained under the Act, a comprehensive assessment of their needs should be undertaken to ensure that reasonable adjustments required by the Equality Act are made”

Mental Health Act (1983) Code of Practice

In my experience, this requirement is rarely met, with Autistic people often being given the same treatments and approaches as every other inpatient.

What can we change?

First and foremost, we can change the lack of tailored community mental health support. We should be supporting Autistic people with their mental health within their community and following principles for least restrictive practice. If Autistic people had this they would be less likely to be sectioned under the mental health act. In particular I think of the 93% of inpatients under 18 who are Autistic. How many of them were turned away by CAMHS before finding themselves under section?

Staff need to be significantly up-skilled. This means training them in Autistic experience using competent Autistic trainers who can help to contextualise information. Services would be able to better support Autistic people if they understood the nuances and differences in our experiences. Staff who are better prepares are also less likely to resort to the use of restrictive practice.

Parents need better support. Parents of Autistic people are more likely to be socially isolated creating tension in the family environment that can decrease the mental wellbeing of the whole family unit. We must also remember that many Autistic children and young people have Autistic parents and carers.

We need service user involvement models to be implemented in service commissioning. When a service is designed and implemented, it should be mandatory for service users to be involved in the design and implementation of service provision and policy. A service without the input of service users is fundamentally flawed.

Finally, we need improvements to social care provision that would allow for services to implement support that reduces the psychological burden of being Autistic in an environment not designed to support you. Improvements in social care can make a big difference to the psychological wellbeing of Autistic people.

It is clear that Autistic people require a great deal more from the services that currently exist than what is available. The issues above are not an exhaustive list and until such time that issues within the mental health system are addressed, Autistic people will continue to be inappropriately help in inpatient settings.

What can you do now?

Visit the CAMHS Crisis page of this website.

Sign the petition to make CAMHS accept Autistic young people.

Learn about Autistic experience- this seminar on burnout I am giving with Tanya Adkin is free for Autistic Parents.

Share this article and similar articles.

David Gray-Hammond 1 Comments
Jul 22 2023
The NHS wants to put surveillance equipment in psychiatric wards: Here’s what’s wrong with that

Psychiatric wards are a challenging environment for patients. Staff often forget that they work where a person is very often forced to live for an extended period of time. At the best of times, patients on psychiatric wards can feel very restricted, with some being monitored on a one-to-one basis 24 hours a day. It’s also no secret that a number of abuses have been brought to light in the last few years. In particular there was the abuse taking place at the Edenfield Centre, one of the UK’s largest psychiatric facilities.

As if abuse of patients’ rights is not already a significant enough issue, the NHS is now seeking to roll out something called Oxevision in all inpatient psychiatric facilities. Oxevision uses cameras and infrared detection to measure vital signs, monitor a patients movements with their room, and alert staff to anything unusual. It can even tell staff how long a patient has been in the toilet. More information from the people who designed this can be found here.

The first counterpoint to any resistance against this technology is likely to be that patients have to consent to monitoring. My response to this would be that consent only works if you can trust staff. Between the frequent stories of abuse, and the mature of the types of distress patients in psych wards experience, I believe consent is meaningless.

As an Autistic and Schizophrenic individual who has been a psychiatric inpatient, I can tell you that I would not trust staff to honour my consent or lack thereof. The use of oxevision has the potential to make patients feel incredibly unsafe in an environment that is meant to help them.

We also need to consider a patients rights. Both the Mental Health Act and Mental Capacity Act require staff to use the least restrictive option. The use of Oxevision restricts a patients human right to privacy, and thus, their liberty by allowing staff to intervene whenever they see fit. There is a fine line between patient safety and deprivation of liberty.

It is fundamentally wrong for patients to be under 24-hour surveillance in their private space. Patient liberty is already heavily restricted in psychiatric settings. How does the NHS justify this?

This is a flagrant abuse of patient rights, and as with many of the abuses in the psychiatric system, it’s being sold with a helpful smile.

Please sign this petition calling to stop the rollout of Oxevision.

David Gray-Hammond 0 Comments
May 29 2023
Creating Autistic Suffering: CAMHS kills kids

This article was co-authored by David Gray-Hammond and Tanya Adkin

This article includes exerts from interviews conducted by David, all interviewee’s gave their permission for quotes to be used.

Tanya has demand avoided weighing in on this topic for quite some time. Not for no good reason. Tanya has felt torn with this topic and the potential outcome of the petition that has been circulating and included in David’s previous articles on CAMHS. This petition has been signed by nearly 190,000 people as we type this. The number is climbing. The petition shines a light on the routine refusal of services such as CAMHS to provide mental health support for Autistic children and young people.

Neither of us have ever been quiet about our opinions on statutory services for Autistic young people, Tanya especially is a firm proponent of the phrase “CAMHS kills kids”. This might sound extreme, but in our lines of work we have seen their lack of competence have life altering/ending consequences.

If this petition succeeds to its fullest extent, and the doors are flung open as tens of thousands of Autistic children across the country flood into CAMHS departments (unlikely to happen quite like this, but bare with us), what awaits us on the other side of those shiny doors? Doors that Autistic people very rarely get to see the other side of.

You’d be forgiven for assuming “support” might be found there. That’s what CAMHS is there for, right? Our biggest fear is that we are just waiting to be disappointed at best, and at worst, the mental health of tens of thousands of Autistic young people is going to get significantly worse.

What might CAMHS offer?

“Services are still being designed without the involvement of the people using them. There is chronic under-funding and under-staffing which is undoubtedly having a huge negative impact on outcomes.”

Charlotte, CAMHS Professional

CAMHS may offer:

  1. Medication–
    • This has it’s place, but 9 times out of 10, in our experience, Autistic people present with mental health issues (especially young people that have been subject to the trauma that comes from an education system not fit for purpose, and woefully underfunded) due to unmet needs. There is no amount of medication that can fill the space where education falls short. It’s akin to sticking a plaster on a stab wound.
  2. Talking Therapy–
    • If an Autistic young person has experienced enough trauma to feel they need to access mental health services, it’s highly likely that they will be alexithymic. The first thing to suffer when a child is traumatised is their interoception. If they can not express how they feel, talking therapies (usually based in CBT) are likely to reinforce the medical model view that they are broken and can not be fixed. Furthermore, they’ll mask through it. Masking is a leading predictor of suicidality in Autistic people (Higgins et al, 2021; Adkin, 2023).
    • Neuronormativity is another factor to consider, if the person who is helping the child or young person comes from a neuronormative perspective that “neurotypical” is the gold standard of being that everyone should strive for, then you’ve given a young person something else to fail at (Gray-Hammond and Adkin, 2022).
  3. Parenting Courses–
    • You can’t parent away Autistic trauma (Gray-Hammond and Adkin, 2021) or burnout, or really any other mental health concern for that matter. Not only is it extremely patronising, it also risks parents being taught harmful, outdated methods based on the lack of competence of those designing and delivering said courses. This leads nicely onto our last offering on the CAMHS shitlist.
  4. Parent Blame–
    • Institutionalised Parent/Carer Blame (IPCB) is a real phenomenon (Clements and Aiello, 2021), and the NHS is an institution. The thing about IPCB is that it covers the lack of professional competence and protects their egos by shifting the onus of responsibility onto the parent and subsequently social care. It’s also a fantastic cost-saving tool. Unfortunately, it often has devastating consequences. It’s not only the young person not getting their needs met, it’s the trauma of parents believing they are responsible for their young person’s mental health difficulties. The trauma accrued from social care involvement. The worst but not uncommon occurrence of an accusation of fabricated and induced illness (Gray-Hammond and Adkin, 2022).

” I worry about staff knowledge levels regarding up-to-date autism practice and the nature of the interventions offered”

Jenny, Parent of child under CAMHS

What do Autistic children and young people with mental health concerns actually need?

“Practitioners need to be better equipped to recognise the differences between treatable mental health difficulties, and challenges within the context of autism”

Charlotte, CAMHS Professional

They need:

  1. Sensory Integration trained Occupational Therapists
    • This is absolutely essential to understand the sensory profile of an Autistic person. It allows us to make provision and adjust the environments they exist in accordingly. This in turn reduces the impact of sensory trauma (Fulton et al, 2020). This also affords the young person and the people around them understanding of their needs. It reduces anxiety and builds self-advocacy, while simultaneously helping develop coping strategies.
    • There’s one problem with this, there are not enough qualified OT’s. There is a workforce crisis across social care and the NHS (Brexit doesn’t seem like such a bright idea after all…). This is just for regular OT’s. To become a sensory integration OT you need approximately two years extra post-graduate study (Can’t see the government finding a magic OT tree at the bottom of the garden any time soon).
  2. Mental Health professionals that will call out the school system for the trauma they cause
    • Unfortunately, it’s not considered “professional” to call out other statutory services. Health professionals are often told that they can not comment on education because it is outside of their remit. Tanya would argue that safeguarding is everyone’s remit (David agrees). We would remind professionals that physical and mental health have legal parity (Baker and Gheera, 2020). If a teacher willfully broke a child’s leg, it would be on national news. Yet, routinely restraining an Autistic child into a traumatic environment is the norm (Gray-Hammond, 2023). Or even worse, threatening parents with either social care (safeguarding) or financial penalties for non-attendance.
  3. Competence
    • As previously mentioned, we need professionals that fully understand Autistic experience and culture. Everything from masking to monotropism, burnout to community-connectedness (Botha, 2020). Without competence, you can’t have safety because the person will not be aware of their own neuronormative viewpoints. The cycle will continue.

“I remember one clinician telling me, ‘there’s not much you can do with them’ as in therapy for autistic children.”

Jane, former CAMHS Professional

Where does this leave us?

We are pretty much stuck between a rock and a hard place. On the one hand, it’s a question of supply and demand. If we demand, theoretically they should supply. In reality, how many of our children do we need to throw under the CAMHS bus until they get the message? This doesn’t stop at a petition. As any SEND parent will already be aware, this is just one rung on a never ending ladder of fighting, advocating, and holding professionals, services, and our government to account. So please sign this petition and help us place our Autistic feet on the proverbial ladder.

References

Adkin, T (2023) Mask on, Mask Off: How the common understanding of Autistic masking is creating another mask. Emergent Divergence.

Baker, C. and Gheera, M. (2020) Mental health: Achieving ‘parity of esteem’. HM UK Government.

Botha, M. (2020). Autistic community connectedness as a buffer against the effects of minority stress (Doctoral dissertation, University of Surrey).

Clements, L., & Aiello, A. L. (2021). Institutionalising parent carer blame. The Experiences of Families with Disabled Children in Their Interactions with English Local Authority Children’s Services Departments. Cerebra. University of Leeds.

Crane, L., Adams, F., Harper, G., Welch, J., & Pellicano, E. (2019). ‘Something needs to change’: Mental health experiences of young autistic adults in England. Autism, 23(2), 477-493.

Fulton, R., Reardon, E., Kate, R., & Jones, R. (2020). Sensory trauma: Autism, sensory difference and the daily experience of fear. Autism Wellbeing CIC.

Gray-Hammond, D. (2023) Restraint and seclusion in England’s schools. Emergent Divergence.

Gray-Hammond, D. and Adkin, T. (2021) Creating Autistic Suffering: In the beginning there was trauma. Emergent Divergence.

Gray-Hammond, D. and Adkin, T. (2022) Creating Autistic Suffering: Fabricated or Induced Illness, state sanctioned bullying. Emergent Divergence.

Gray-Hammond, D. and Adkin, T. (2022) Creating Autistic Suffering: Neuronormativity in mental health treatment. Emergent Divergence.

Gray-Hammond, D. and Adkin, T. (2023) Creating Autistic Suffering: Autistic safety and neurodivergence competency. Emergent Divergence.

Higgins, J. M., Arnold, S. R., Weise, J., Pellicano, E., & Trollor, J. N. (2021). Defining autistic burnout through experts by lived experience: Grounded Delphi method investigating# AutisticBurnout. Autism, 25(8), 2356-2369.

David Gray-Hammond 16 Comments
May 20 2023
Failure by the NHS to adhere to the United Nations Convention on the Rights of Persons with Disabilities

This article was written by an anonymous guest author

This post references:

UN Special Rapporteur on Torture

UN Convention on the Rights of People with Disabilities

UK Mental Health Act (1983)

We are at a pivotal crossroads on our path towards a fairer society, faced with a monumental issue that, while hidden, carries unsettling implications.

The UK’s National Health Service (NHS) has repeatedly been implicated in serious violations of human rights, as outlined by the United Nations conventions on the rights of disabled persons. This is not merely an affront to international law; it’s a harsh, terrifying reflection of the suffering inflicted on people with disabilities under the pretext of health care provision.

The UK Government’s ratification of the UN Convention in 2008 was a potent commitment to protect disabled people’s rights, obligating domestic legislation to align with its principles. However, as we traverse through 2023, it’s distressingly apparent that the NHS has systematically breached this social contract, casually discarding the rights of the disabled.

The NHS’s Mental Health Act 1983 blatantly contravenes the UN Convention, notably:

• Article 12, Equal Recognition Before the Law: This Act permits restriction of legal capacity based on mental health status, infringing upon personal autonomy and decision-making rights.

• Article 14, Liberty and Security of the Person: This Act shockingly allows involuntary detention and treatment of people with mental health conditions based on their disability, violating their right to liberty and security.

• Article 15, Freedom from Torture or Cruel, Inhuman, or Degrading Treatment or Punishment: This Act neglects to shield individuals from non-consensual treatments such as electroconvulsive therapy and psychosurgery, which could amount to torture or inhumane treatment.

These issues have persisted for years. In 2013, the UN Special Rapporteur on Torture called for an outright ban on these reprehensible practices.

Regrettably, the proposed Mental Health Act reforms lack the depth needed to align the NHS fully with the United Nations Convention. A fragmented approach is grossly insufficient in addressing these grave infractions.

The field of psychiatry has largely remained reticent on this matter, often keeping these concerns concealed. The victims, who are often society’s most vulnerable, have their stories systematically suppressed.

Alarmingly, our media has mostly remained mute, a tacit accomplice to these profound human rights violations. The much-needed transparency is missing, replaced by a stifling silence that only magnifies the problem.

We must break this silence with knowledge, empathy, and decisive action. Disseminate this information broadly. Challenge the apathy that perpetuates these horrors.

We must unite and place collective pressure on the NHS to uphold its duty to protect the rights of disabled persons. The time for change is now. Let us stand together and navigate our society towards a future where health care is genuinely fair, and human rights are unreservedly respected.

David Gray-Hammond 1 Comments
May 9 2023
How many Autistic people are in inpatient units in the UK?

When we consider the world of inpatient psychiatric care, we often think about types of neurodiversity like schizophrenia and bipolar. While it is true that these individuals represent a considerable number of admissions, there is a darker side to admission to hospital. Detainment and admission is not solely the realm of traditional psychiatric “conditions”; Autistic people are being locked away for months or even years.

This issue has become so prevalent that the government has had to commission inquiries and reports into the matter. Still, there are a disturbing number of Autistic people locked away in these institutions.

According to the National Autistic Society, as of January 2022 there were 1,185 Autistic people held within the inpatient psychiatric system. Of this, around 1 in 7 (165) were under 18 years of age. It’s not just Autistic adults being detained, it’s our children too. This represents a stark departure from the so-called schemes of “care in the community” that promised to empty asylums and create a community culture of caring for our most vulnerable.

Instead what has happened is the systematic incarceration of Autistic adults and young people for no other reason than not having the correct services in place to support them in their independence. This becomes even more concerning when you consider the current rate at which care home and inpatient units are experiencing scandals around the mistreatment and abuse of those they are supposed to care for.

Autistic people are being abused daily in these settings, despite evidence to suggest that inpatient units are inappropriate settings for Autistic people. What we are seeing is the systematic practice of locking away people because our society is unwilling and unable to give them meaningful support at home. To my mind this is against the Mental Capacity Act (2005), in particular principles 4 and 5 of the Code of Practice:

“An act done, or decision made, under this Act for or
on behalf of a person who lacks capacity must be done, or made, in his best interests”

Principle 4, Mental Capacity Act Code of Practice

“Before the act is done, or the decision is made,
regard must be had to whether the purpose for which it is
needed can be as effectively achieved in a way that is less
restrictive of the person’s rights and freedom of action.”

Principle 5, Mental Capacity Act Code of Practice

Given that inpatient treatment does not improve outcomes for purely being Autistic, there is a significant and unresolved risk of abuse, and the overt removal of a person’s freedom, I would argue that both principles 4 and 5 have been failed. One might argue that the Mental Health Act (1983) should take precedence which allows for the detention of people who are at risk to themselves or others.

First I would bring your attention to this section of the Code of Practice:

“The MCA should be central to the approach professionals take to patients who lack
capacity in all health and care settings (including psychiatric and general hospitals).
The starting point should always be that the MCA should be applied wherever
possible to individuals who lack capacity and are detained under the Act.”

Section 13.11, Mental Health Act Code of Practice

We have to consider what is being classed as risk, and whether the deprivation of a person’s liberty is necessary. I posit that in most cases, Autistic people remain in inpatient settings because services have no resources to appropriately address their dysregulation in the community.

An Autistic person’s freedom should not be decided by government funding.

To boot, the prinicples of the act itself state that professionals should use the:

“Least restrictive option and maximising independence”

SWLSTG NHS Trust

In what world is indefinite detention in an institution the least restrictive option? Since when does detention be decided by community resources? This is a dangerous precedent to set, it opens up the entire neurodivergent community to facing detention.

When we consider the Royal College of Psychiatrists disturbing statistic that Autistic people are nine times more likely to die by suicide, and combine that with the fact that according to The Nuffield Trust there were 1,357 suicdes in 2019 amongst people who had been in contact with mental health services. Something is going very wrong, and I suspect that, in part, it is the number of Autistic people being detained wrongfully under The Mental Health Act.

It is clear that this situation is out of control. Autistic people should be supported to freely live their lives, not spend years locked in seclusion rooms suffering chemical and physical restraint as a daily practice. Sadly, until such time that our government supplies appropriate funding and resources to services, we are going to continue to witness the systemic mistreatment and killing of Autistic people.

We are Autistic, not monsters to be hidden away from society.

Make sure you check out the CAMHS crisis resource page.

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David Gray-Hammond 2 Comments
May 3 2023
Children are being seriously injured for displaying “challenging behaviour”

All statistics mentioned in this article are taken from The ICARS Report into the use of restrictive practice in England, information take from The Equality and Human Rights Commission, Human Rights as detailed by the United Nations, and The Royal College of Psychiatrists.

There is a growing belief in the world that the use of corporal punishment, ranging from smacking a child through to more archaic forms of punishment, are unacceptable. While this is a good thing, to me it shines a light on the hypocrisy that is currently at play.

While remaining a global phenomenon, restrictive practice is still widely used, and in particular it can be found in specialist settings where people work with disabled students who more likely than not have experienced a great deal of trauma. Autistic people in particular are likely to be traumatised, this is because of the way that the world is designed. There are myriad ways that the world does harm to us.

This becomes deeply problematic when we consider the way that restrictive practice takes place. While used as an intervention for perceived “challenging behaviour”, it would be more accurate to view restrictive practice as an intensive intervention for dysregulation.

Allow me to take a step back and consider the nature of such practice. Restraint is the use of techniques that restrict a person’s ability to act freely. Often when we consider such techniques, we imagine people being held to the floor, but we can see not just the use of mechanical restraints, but also chemical restraints in healthcare settings. Such restraints are employed by the use of drugs that inhibit a person’s ability to act freely.

As you can see from the off set, restrictive practice represents a significant issue in the human rights and ethics of working with disabled people. The hypocrisy lies with the people who speak out against corporal punishments while employing the use of restraint. While such practices are supposed to be “last resort”, 78% of those included in the ICARS report reported that their child had been a victim of restraint prior to the age of 10 years old.

Another concerning statistic is the number of children who were harmed by restraint. The ICARS report found that 97% of respondents were harmed, while restraint was only recorded 59% of the time (breakdown of statistics below). My interpretation of this data is that restraint is being performed dangerously, in a punitive context, and improperly recorded.

Taken from The ICARS Report into the use of restraint in English schools

The implication of children experiencing punitive restraint flies in the face of a society that is trying to move away from corporal punishment. Such brazen abuse of the position of trust and power that schools are privileged to have is simply unacceptable. Children have died and been significantly traumatised by restraint. This is, quite simply, not a practice that should be occurring in this day and age.

We must also consider the fact that restrictive practice feeds into a self-perpetuating loop, in which the child is constantly being exposed and re-exposed to the trauma of restraint. Dysregulation creates challenges, which are approached with restraint, causing trauma that once again results in dysregulation. It is a self-fulfilling prophecy of sorts that is fueled by societies pervasive desire to assimilate children’s behaviour into an “acceptable” standard.

Taken from Centre for Mental Health

According to the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), the UK has made a commitment to create an inclusive education environment and protect disabled people from all forms of violence and abuse. I would challenge our governments commitment to this convention on the grounds that the punitive and improper use of restraint is a direct violation of both of these commitments.

According to a report made in 2018 for the UNCRPD, 75% of Autistic students, and 70% of those with a physical disability reported bullying in school, compared with 50% of those with no disability. How can we reduce interpersonal bullying among students peers in an environment where adults are actively harming children with restrictive practice? We have, in effect, normalised the mistreatment of disabled children on the grounds that disabled embodiment is a challenge to be intervened on rather than addressing issues with the wider environment that are creating traumatised and dysregulated children.

The Universal Human Rights Index specifically mentions concerns over the UK’s use of restraint on children, stating;

“The Committee is concerned that the State party is still using techniques of restraint that aim to inflict deliberate pain on children in young offender institutions, including to maintain good order and discipline“

UHRI (Accessed May 3rd, 2023)

This indicates that the UK government is failing in it’s duty to prevent torture and ill-treatment of it’s citizens. This raises further questions about the fact that this failure specifically pertains to disabled children, a notably marginalised group in our current society.

The truth of the matter is that children’s lives are being endangered, if not by the restraint itself, then quite possibly due to it’s correlation with the 9x increase in suicide risk seen amongst Autistic people (RCPSYCH, 2018) and the significant over-representation of Autistic people in demographics that have been victims of restraint.

Disabled people deserve compassion and equal access to the world. All of the time that we are holding the threat of dangerous restrictive practice over their heads, this has not been achieved. we need to create a world in which disabled people thrive, are not met with the threat of pain and violence. Restrictive practice needs to be seen for the toruturous practice that it is, and not normalised as a means of forcing the behaviour that institutions arbitrarily believe is acceptable.

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David Gray-Hammond 0 Comments
Apr 5 2023
Restraint and Seclusion in England’s Schools

The International Coalition Against Restraint and Seclusion have just published their report into the use of restraint and seclusion in English schools and the results are terrifying. With Autistic children being the most likely to be the victims of inappropriate restrictive practice, it is clear that normative violence is taking far more overt forms than the micro-aggressions we are used to. For this reason, I am going to explore the findings of the report, using screen shots taken directly from the summary deck.

You can access the full ICARS report by clicking here.

What is restraint?

Ask this question to the layperson and you will receive different takes depending on the person’s career and privilege. I however feel it’s necessary to highlight the definition within the report, which itself is quoted from the Equality & Human Rights Commission 2019.

So, restraint is an act carried out with the purpose of restricting and individual’s movement, liberty and/or freedom to act independently.

This can be done in a number of ways. Most common is the use of holds and mechanical restraints that physically restrict movement of the body. One can also be chemically restrained. Most common in hospital inpatient settings, this involves administering sedative and/or tranquiliser drugs with the purpose of subduing a person into a state where they can no longer exhibit the behaviour that is being modified.

That is what restraint is. It is behaviour modification through the use of force. Where the more insidious behavioural interventions are not successful, the use of restraint gives a person no choice but to comply in order to have some semblance of liberty. Something I find most concerning is that legislation such as The Mental Health Act (1983) and The Mental Capacity Act (2005) incorporate the use of “least restrictive options” in their code of practice, and yet in the schools of England, children are being exposed to unnecessary and traumatic uses of physical restraint that are far from being “the last resort”.

Statistics found by the report

This report had a sample size of 560 respondents. The following are the statistics arising from the experiences of the participants.

  • 81% of those experiencing restraint were Autistic
  • 34% were ADHD
  • 17% had a diagnoses of Sensory Processing Disorder
  • 15% had anxiety
  • 13% were PDA
  • 13% had a Specific Learning Difficulty
  • 47% of children were psychologically harmed by the use of restrictive practice.
  • 43% were physically and psychologically harmed.
  • 5% were physically harmed
  • 2% of respondents disclosed harm of an unknown nature
  • 3% did not note any harm

This means that of the respondents, 81% of children experiencing restraint were Autistic, and 97% of them experienced some kind of harm. This begins to raise questions around why Autistic people are over-represented in this sample, and why we feel it is okay to expose them to harm without good monitoring or reason.

On the topic of whether or not restraint was necessary in its use, we have the following statistics.

  • 3% of respondents said that restraint was necessary
  • 86% Said it was not necessary
  • 8% were unsure if it was necessary
  • 3% said it was sometimes necessary

Again, 97% of cases of restraint did not have a clear rationale or were a situation where restraint was not always necessary. 97% of the time, the hugely over-represented Autistic students were being exposed to restraint that could have been handled differently.

Restraint has a tendency of occurring in situations of dysregulation. The primary factor in Autistic dysregulation is an environment that does not meet the needs of the Autistic person. In the context of Children and Young People, this is very often a school environment that is under-resourced within it’s own SEN provision. In support of this, I give you this data from the ICARS report.

  • 2% of respondents said that, Yes, their child’s needs were being met.
  • 91% said that there child’s needs were not being met.
  • 6% said their child’s needs were somewhat being met.

This means that in 98% of cases, the needs of the child were not being met appropriately enough for the parent/carer to give a solid “Yes” as a response. Where we have unmet needs, we have dysregulation, which in turn raises the risk of restrictive practices being used. Rather than adjust the environment to the child, the child is being forcibly coerced into “appropriate behaviour” through the deprivation of their physical liberty.

Where restraint is used on a child, caregivers should always be informed. This leads me onto the last couple of statistics I will share, these are perhaps the most troubling statistics in my opinion.

  • 52% of respondents had not been notified about the use of restraint on their child.
  • 20% were sometimes notified.
  • 28% were notified.

72% of the time, schools could not be trusted to accurately report the use of restraint on children. This represents significant issues in accountability for schools and the scrutiny that they may face if all uses of restraint were made known to caregivers.

So perhaps you are wondering why parents don’t just withhold permission for the use of restraint?

6.3% of respondents were told that if they did not give permission, their child would not be afforded a place at the school. This is in direct conflict with a child’s right to education, and highlights a belief among staff that restraint is a necessary weapon of forced compliance.

Commentary

This statistics are horrifying. They represent a discourse around Autistic and learning disabled children that implies a lack of humanity, and the use of physical restraint to coerce them into normative standards of behaviour. I myself have written about neuroqueering education, and this report highlights to me the distinct importance of decentering normative values, and instead placing the rights of children centre place.

Children deserve space to work through difficult feelings and dysregulation without the fear of coming to physical harm. As you will see in the report, some of the restraint used has restricted children’s breathing and caused significant psychological harm. I am very much of the opinion the the use of restraint outside of preventing serious injury or death is child abuse. If it would be illegal to do it to an adult or romantic partner, then why is it okay to do to a child?

Children do not exist to serve pre-existing power structures and institutions. None of us were born to be boxed into idea’s of normality and acceptability. While I recognise that dysregulation can lead to a significant risk of harm, restraint needs to truly be a last resort. Where restraint has to be used, it needs to be documented in a way that allows for public scrutiny.

If having your use of restraint on public display makes you worry that people will not send their children to your school, the issue is not the child, it is the culture you have developed as an educational institute.

David Gray-Hammond 1 Comments
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