Page 21 - Community Living Magazine 34-3

assessment and treatment units

The precept of no torture, inhumane or Matthew Garnett,
degrading treatment (article 2) was “Liverpool’s best fan
challenged with injurious use of physical ever,” as he says, was
restraint, resulting in injuries including a restrained and
broken arm and broken clavicle, solitary forcibly medicated
confinement in small cells for long – “treatment” he
does not need back in
periods, disrespect for people’s clothes the community
and possessions, no support for personal
care, no privacy when using the toilet,
caged transport for a child and concerns
about starvation.
A harmful model of care is an inarguable
paradox, makes no clinical sense and is
unethical. Many ATUs are the antithesis of
a place of safety, with an untenably high
incidence of distress, injury caused by a
combination of detention, seclusion,
physical and chemical restraint, abuse and If this is largely absent, as it was in our detention. This is money that could so
neglect of basic healthcare, the last leading study, it explains why patients receive obviously be spent on an ordinary life and
to deaths from manageable conditions inferior physical healthcare and are at risk more effective treatment in the
such as epilepsy and constipation. of dying from treatable conditions. It also community, instantly ending the
Short periods of assessment turn into an calls into question how mental illness can “nowhere else to go” argument.
average of 5.4 years detention, according to ever be accurately diagnosed or excluded On this basis, this is potentially a
Mencap; for our research cohort, this was in this group of patients. guaranteed £1.4 billion per annum
an average of two years and nine months. Detention with open-ended assessment industry for detaining 2,000 people still
It is hard to imagine how such a and no effective treatment was stranded in inpatient settings at the end of
calamitous intervention passes the experienced as punishment akin to the failed Transforming Care programme.
NHS threshold for funding imprisonment, with seclusion and While my back-of-an-envelope financial
evidence-based treatment. segregation the equivalent of solitary assumptions may be challenged, the
confinement. This was compounded in business model is clear: serial sectioning
some institutions with small prison-like is effectively repeat business and there is
Next time there is a scandal, cells, dark airless wards and a complete a perverse, pecuniary incentive to detain

look towards the top of the absence of personalisation and people – and to keep detaining them.
home comforts.
Next time there is a scandal in the
food chain, at the business Placing people hundreds of miles away private or not-for-profit sector, instead of
model and structure that holds from their friends and families, regularly focusing just on the reprehensible actions
cancelling family visits and section 17
of criminal staff, look towards the top of
this culture of abuse in place leave all compromise article 8 – the right the food chain, at the business model and
to a private and family life. structure that holds this culture of abuse
If people with learning disabilities and/or in place and at a government that appears
Treatment of no therapeutic value autism are subjected to detention in such happy to aid and abet it by its inaction.
While ATUs are intended to assess and treat places when they have no treatable mental Better surveillance? Better training?
people, their primary methods – detention, health conditions, when assessment is Safer methods of restraint? Such
segregation, seclusion and restraint – have obscured by behaviours of concern, when continuous improvement fixes are a shoal
no therapeutic value whatsoever. treatment has no therapeutic value, this is of dazzling red herrings, distracting us
As well as being liable to cause injury surely a state-sponsored subversion of not from the wreck of this model, obscuring
and distress, they deprive patients of the only article 5 (the right to liberty) but also the sharks lurking in the murky,
psychosocial aspects of existence (sleeping article 6 (the right to a fair hearing) and mendacious depths below.
well, eating well, meaningful activity, article 7 (no punishment without law). Instead, let us shine a light on
exercising and spending time with friends vested interests like dividends to
and family) that are known to keep children Financial incentives shareholders, remuneration of executives
and adults healthy and mentally well. The second big paradox is economic. The and non-executives, fees of consultant
Since psychosocial deprivation is known study found cost shunting and funding psychiatrists, lawyers, lobbyists and the
to be among the primary triggers for battles between health and social care whole panoply of defensive and offensive
so-called “challenging behaviour”, it is not were frequently implicated in delays tactics that some providers use to defend
surprising that ATUs can cause or intensify that caused or exacerbated crises, their share of this lucrative market.
the mental health conditions and behaviour defeated successful discharge and If ATUs trash the rights and trade in the
they are intended to assess and treat. delayed resettlement. lives and liberty of children and adults with
If communication and understanding Yet money and repeat funding appear learning disabilities and/or autism, they
patient needs are at the heart of the to be no object when someone is in the must surely be stopped, not improved. n
inpatient experience, then understanding system. If an ATU charges £13,500 per l Less than the Sum of its Parts is
an individual’s experience of autism and week, as was the case for one of our available at https://tinyurl.com/y42t875y;
their highly persona style of witnesses, it is set to bring in £3.8 million the easy read version is at https://tinyurl.
communication is critical. per person over the average 5.4 years’ com/yawbjcyv

www.cl-initiatives.co.uk Community Living Vol 34 No 3 | Spring 2021 21