Evaluation of the National HOPE(S) Programme to end long-term segregation for children and young people, autistic adults and/or adults with a learning disability in inpatient hospital setting

Summary

The use of restrictive practices for people in mental health settings has 'significant adverse effects on the individual, their family, care providers and organisations' according to this report. In particular, long-term segregation (LTS) 'can result in prolonged and profound human rights violations'.

The report states that LTS is often implemented 'in environments ill-suited for therapeutic recovery - with unclean accommodation, minimal stimulation, and isolation lasting months or even years'. It has been associated with decline in physical and mental health; loss of sensory input, social contact and daily living skills; and feelings of shame, humiliation, powerlessness and institutional trauma.

The study examined the impact of long-term segregation in mental health settings and evaluated an intervention (the HOPES(S) programme) designed to reduce and prevent its use.

It concludes that 'LTS is not a therapeutic intervention, but a practice that strips people of their dignity, identity and hope'. There is, it says, 'an urgent imperative to prevent the use of LTS... and radically improve health outcomes for [people] who are at risk of being isolated within the very systems intended to support them'.

Even where LTS cannot immediately be avoided, 'services must be held to account for ensuring that individuals experience the highest possible quality of life, with access to meaningful activities, personal relationships and physical health care, alongside a clear, person-centred pathway out'.

The HOPE(S) programme enabled individuals who had come to believe they would remain in LTS indefinitely, to rebuild their sense of self, form meaningful connections, and, in many cases, move out of segregation entirely.

Crucially, say the authors, 'the HOPE(S) programme challenges a deeply embedded culture of fear-based, risk-averse practice, replacing it with a model rooted in human connection, hope, and ethical care'.

Further reading on the hub:

• CQC: Restrictive practice — a failure of person-centred care planning?
• Restraint Reduction Network: Supporting people with lived experience
• Patient Safety Spotlight Interview with Professor Joy Duxbury OBE, Chair of the Restraint Reduction Network