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Anne Longfield, the Children’s Commissioner for England, is today publishing a new report, ‘Far less than they deserve: Children with learning disabilities or autism living in mental health hospitals. The report shows how too many children are being admitted to secure hospitals unnecessarily – in some cases are spending months and years of their childhood in institutions when they should be in their community. It warns that the current system of support for those with learning disabilities or autism is letting down some of the most vulnerable children in the country.

The report also finds shocking evidence of poor and restrictive practices and sedation, with some children telling the Children’s Commissioner of how their stay in mental health hospital has been traumatic, and parents too often left feeling powerless to do anything to intervene.

Some of the main findings in today’s report include:

Today’s report also shines a light on the use of restraint and seclusion. While data on restraint needs to be treated with caution because of issues with how restraints are recorded by hospitals, 75 children with a learning disability and/or autism in hospital were recorded as having been restrained in December 2018. This group received a reported total of 820 incidents of restraint in that month – nearly 11 incidents of restraint per restrained child, on average.

The most common type of restraint was “Physical restraint – Excluding prone (face down)” which accounted for 3 in 5 restrictive interventions in December 2018. One girl told the Children’s Commissioner’s Office: “I don’t like being restrained … it’s not very good. I don’t like leg holds When I said I don’t feel comfortable they let go. They didn’t immediately, but they did when I persuaded them. I don’t like when they restrain me in my room … when there’s more than 2 people in my room … I got restrained with an arm round my back … it strained my wrist and it felt numb and had lumps”.

The report says there is some evidence from children of seclusion being used not as a last resort but as a threat.

The report also reveals:

The Children’s Commissioner’s Office made a series of visits to mental health care hospitals and spoke to children in these units as well as some families of children.

A mother of a teenage girl in hospital: “She’s been in for two years and she’s got to stay there until they find her a place. She doesn’t need to be in the hospital any more but she’s not allowed to come home. We would like her to be somewhere close to home that we can see her whenever we want and that she’ll be safe, where no one can take advantage of her. In crisis situations nobody should have to feel like nobody’s there for them. There’s no support in the community where people can go”.

One boy in a unit said: “Right now I’ve been here for 10 months or so and when I leave it’ll be more than a year. [When he first arrived they said he’d be there for 3 months.] That 3 months turned into six months and then 9 months. About 7 months ago I could have been out of here. It made me a lot worse having to wait for a school and every week they kept saying they’d find me a school and then it was wait another month”.

A hospital clinician told us that by the time a child is admitted to hospital: “A lot of them have had really abusive, failed histories. They’ve been bounced around the system. There have been multiple failures… they’ll have had 10 or more placements”. Another clinician told us he felt that “society turns a blind eye to these children”.

The Children’s Commissioner makes a number of conclusions including:

Anne Longfield, the Children’s Commissioner for England, said:

“There around 250 children with a learning disability and/or autism in England living in children’s mental health wards. They are some of the most vulnerable children of all, with very complex needs, growing up in institutions often far away from their family home. For many of them this is a frightening and overwhelming experience. For many of their families it is a nightmare.

“I will never forget the stories I heard, and the tears of frustration and anger, from mums and dads of these children at a meeting I arranged for them. Some of them have a child who has been locked away in a series of rooms for months. Others have to listen as they are told by institutions that their children have had to be restrained or forcibly injected with sedatives. They feel powerless and, frankly, at their wits end as to what to do.

“A national strategy is needed to address the values and culture of the wider system across the NHS, education and local government so that a failure to provide earlier help is unacceptable, and admission to hospital or a residential special school is no longer seen as almost inevitable for some children. There has been report after report and promise after promise to address this issue and yet the number of children in hospital remains stubbornly high.

“We know more about the lives of these children and the impact it is having on their families, than we did. The onus is now on Ministers, the NHS, the CQC, Ofsted and local authorities to make sure that these most vulnerable of children are not locked out of sight for years on end simply because the system is not designed to meet their needs. Hospital admission must always be in a child’s best interests and as part of a managed process, with clear timescales and a focus on keeping the length of stay as short as possible. This is clearly not happening at the moment and instead we have a system which is letting these children down.”

Read the report

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