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Autism: In-patient Care in Mental Health Hospitals

Volume 834: debated on Tuesday 14 November 2023


Asked by

To ask His Majesty’s Government what provisions they are making to reduce the number of autistic people confined to in-patient care in mental health hospitals.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and declare an interest as a vice-president of the National Autistic Society.

My Lords, this year we are investing £121 million in community support for autistic people and people with a learning disability. This will support reductions in the numbers of autistic in-patients in mental health hospitals in line with the NHS long-term plan commitments. To ensure that autistic people receive quality care in these settings, we are rolling out a National Autism Trainer Programme and have published guidance on sensory adaptations in health environments.

The King’s Speech was an opportunity for the Government to introduce the mental health Bill, ending the scandal of autistic people being locked up in mental health hospitals, sometimes for decades. By shelving the Bill, the Government have failed thousands of autistic people and their families, who are devastated that there continues to be no legal protection against unnecessary detentions; I believe that is an attack on their human rights. The Minister is well respected across this House as a caring and compassionate individual, but I must press him on this. Will he please explain why His Majesty’s Government do not see the Bill as a priority, and as an opportunity to end a most evil practice?

I thank the noble Lord for his kind words about me; I understand the situation. The Government are committed to implementing those changes and we are looking for opportunities to introduce them. I understand his disappointment that the Bill is not in the current programme of legislation. What I am committed to doing is making sure that as many features as possible from the Bill are implemented through action on the ground; the care and treatment reviews are a vital part of that today. Following the report from the noble Baroness, Lady Hollins, we are also making sure that we have regular CQC reviews over the next few years. We are delivering good action in this space, but I understand his feelings.

My Lords, like the noble Lord, Lord Touhig, I am a vice-president of the National Autistic Society. I also remind the House of my interests in the register and my family interest in this subject. The reason why a lot of autistic people become in-patients in mental health hospitals is the lack of real understanding and training of healthcare professionals in that field. It is a lot better in the big conurbations than in the countryside. Autism is not a mental health condition but, as my noble friend the Minister will know, one of the problems that the Government will face if they are to help to get people out of these institutions is that, like the rest of us, people with autism can develop mental health conditions; autistic-related anxiety is a very common one. Psychologists—one finds more of them than psychiatrists out in the community—cannot prescribe; it has to be a psychiatrist who prescribes. Until you get the right number of trained professionals out in the community—namely, psychiatrists with a specialism in autism; it is no good having just your average jobbing psychiatrist—those people are doomed to stay. I urge my noble friend to look at the levels of availability for the right professionals, to release these people from the incarceration they should never have suffered in the first place.

I and the whole House would agree with my noble friend that having the right people making the right assessments on the right place for those people to be treated is key to all this. We are rolling out training through the National Autism Trainer Programme, in which we have invested £20 million to ensure improvements in autistic diagnostic pathways and people’s capability to achieve them. We are now rolling out the Oliver McGowan training to over 1 million people and looking at rolling out stage 2. However, I agree with her that these actions are vital.

My Lords, the tragedy is that so many admissions are due to failings in adult social care. Mencap’s analysis of the latest NHS Digital statistics shows that only 45% of ICSs have met the adult in-patient rate promised by March 2020 and that 26% of ICSs are going in the wrong direction. Can the Minister update the House on future plans for building the right support after March 2024? In the absence of mental health and adult social care Bills in the gracious Speech, what plans are there to fully implement the recommendations in my report, which he kindly mentioned, published by the Department of Health on 8 November? So many of those recommendations were dependent on a code of practice to the current Mental Health Act being reopened.

I thank the noble Baroness for her report and the meeting that we had to follow it up. Probably the best way forward on this is that a lot of things we are doing and can do can be done absent the Bill. I should be happy to sit down with her and talk through what we can do and where we can go further to make sure that everything that we were trying to put into legislation we can effectively make happen anyway, because we are all agreed as a House absolutely on the direction of travel in which we want to go.

My Lords, what is being done to change the commissioning systems and contracts that currently incentivise providers of medium and long- term secure accommodation to keep people in hospital, rather than equip them to go back into the community?

I will come back in more detail on the contractual arrangements, but the point that the noble Baroness raises on making sure that there are no perverse incentives to do that has to be right. The now CQC-led reviews that we have agreed to put in place as part of continuing the recommendations of the noble Baroness, Lady Hollins, happen frequently. In the case of adults, there is a review every six months, if appropriate, and, in the case of children, every three months to make sure that every step of the way we ask whether this is really the right place for them to be.

My Lords, these days, more and more parents would like to have purpose-built accommodation for their autistic children. At this moment, they are unable to have that because they cannot access an adaptation grant, also known as a disability facility grant. That needs to change so that parents can build independent self-contained accommodation for their autistic children, which can be done only through legislation and extra funding. Will the Government look into this?

I am aware of the point that the noble Lord makes. About 48% of the reasons why people are not discharged are because of a lack of suitable housing. It is something on which we are working closely with Homes England and DLUHC, to make sure that we can utilise as much of the affordable housing grant as possible. I was not aware that legislation needed to be changed but I will happily look into that to see if it is the case.

My Lords, is the Minister aware of the critical importance of early intensive education for severely autistic children? I hope so. I was involved in such an initiative some years ago and it is remarkable how a child with no speech and tremendous deficits can ultimately go to a normal school, and the prospects to then lead a reasonably normal life are enhanced enormously.

Yes, I have some personal experience here and I know how vital it is to find out early, so you can put together the tools. I have seen some really interesting things. The Bradford pilot looked at children’s scores and whether that was an early indicator. I was at Boston Children’s Hospital a few weeks ago, which is looking at the way that children play on apps and whether that can give indications of whether there is some neurodiversity. There is absolutely the intention of early diagnosis.

Thankfully, my Lords, understanding of and support for autism have changed substantially since the now 40 year-old Mental Health Act, especially about being clear on what an autism-friendly environment looks like and should be, although sadly that is not often found in mental health settings and ATUs. Did the Government’s decision to abandon the new mental health Bill this Session include an assessment of the impact this would have on patients? This is particularly urgent now that changes to the code of practice, recommended by the excellent report on long-term segregation by the noble Baroness, Lady Hollins, will not be considered until we deal with the Bill. How and when will the Government deliver the significant changes needed?

I think we are all agreed on the action; there was was an intensive and involved process by the whole House when it came to agreeing the action. That is why I am keen to ensure that we implement as much of it as possible that does not require legislation, which we are doing. I am happy for the noble Baroness to join me at the meeting with the noble Baroness, Lady Hollins, when we can look at the practical steps to see what is possible.