Care Quality Commission (CQC) review on the use of restraint, seclusion and segregation

Inclusion London have submitted evidence to the CQC review on the use of restraint, seclusion and segregation.

Below is an overview of the evidence followed by our key recommendations.

Overview

Inclusion London believes that the UN Convention on the Rights of Persons with Disabilities (UNCRPD)[1] is the key to welfare of people who are subjected to restraint, prolonged seclusion or segregation.

The UK became a signatory to the UNCRPD in 2009. As a signatory the UK should:

“ensure and promote the full realization of the rights by adopting appropriate legislation and other measures…” and

“refrain from engaging in any act or practice that is inconsistent with the present Convention;”[2]

The Mental Health Act 1983, the Mental Health Act 2007 and the Mental Capacity Act and (Amendment) Bill breach the UNCRPD. In 2017 the UNCRPD Committee[3] confirmed that UK legislation does not comply with the UNCRPD principles.

The rights in the UNCRPD need to be urgently implemented in the UK to address the practices of restraint, seclusion and segregation.   In our evidence we will refer to the UNCRPD and the observations and recommendations of the UNCRPD committee in their most recent report regarding the UK.[4]

We recommend that the CQC uses the rights under the UNCRPD to inform their review of restraint, seclusion and segregation of people with lived experience of mental distress/trauma and people with learning difficulties and people on the autistic spectrum (LD/A).

We agree with the UNCRPD Committee that the practices of restraint should be eradicated and that all institutions should be closed. However, given that the practices of restraint persist in our evidence we look at why they occur and give recommendations to reduce their use as an initial stage, pending full implementation in law of the UNCRPD.

We also examine why people with LD/A or people with lived experience of mental distress/trauma reach the point of crisis so a detention in hospital where restrictive practices are used. Without tackling the root causes the practices of detention and restrain both will continue.

Many people with lived experience of mental distress/trauma and people with LD/A do not wish to be forcibly detained and treated miles from home, isolated from their support networks in institutions where the risk of abuse increases.  Care and Support urgently needs to be provided in the community with services co-designed by service users and user-led services with funding for user-led research also made available to provide the necessary evidence base for alternative services recommended by service users. The voice of those  with lived experience of mental distress/trauma or people with LD/A should be at the heart of designing services. Person centre care is a phrase that has been used all too glibly – it urgently needs to become a reality.

Summary of key recommendations

  • The Mental Health Acts and the Mental Capacity Act are replaced by legislation that complies with the UNCRPD standards.
  • Services are co-produced with people with lived experience of mental distress/trauma and people with Learn Difficulities or people on the autistic spectrum (LD/A).
  • There is also resource provision for services led by service users, together with the funding needed for user-led research into evidence bases for these.
  • NAVIGo’s RESPECT training used by Sheffield Health and Social Care Trust is rolled out nationwide[5], together with funding for user-led monitoring of effective implementation of the training
  • The National Survivor User Network (NSUN’s) National Involvement Standards are rolled out to all hospital trusts, again with funding for user-led monitoring of effective implementation of the Standards.
  • Advocacy can be accessed by all inpatients.

                                                           

[1] https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities/convention-on-the-rights-of-persons-with-disabilities-2.html

[2] See Article 4 ‘General Obligations’: https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html

[3] UNCRPD Committee concluding observations report on the United Kingdom re Living independently and being included in the community (art. 19): https://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRPD%2fC%2fGBR%2fCO%2f1&Lang=en  

General comment No. 5 (2017) on living independently and being included in the community: https://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRPD/C/GC/5&Lang=en

[4]https://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRPD%2fC%2fGBR%2fCO%2f1&Lang=en

[5] https://www.navigocare.co.uk/?s=respect+ttraining