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Once upon a time there were three blokes. One was blind, one had autism, all three had learning disabilities. The odds on ‘living happily ever after’ might have been better if the labels stopped there. All three had mental health and challenging behaviour labels. And all three had a reputation, shaped by words like ‘forensic’ and ‘dangerous’, the stickiest labels of all. All three were in-patients in NHS funded assessment and treatment units – like the infamous Castlebeck’s Winterbourne View – and/or equivalent secure residential units.
Eleven people might have been prosecuted for abuse at Winterbourne View, but the whole NHS funded in-patient deal is awful and, some say, unlawful. If I (no learning disabilities, no autism) were stuck in a local hospital ward with no treatment for days and weeks, my family would notice and do something. My stay could not turn into months and years – much less, as reported by the CQC, the six years average stay of people in assessment and treatment units or the scandalous 17 year long detention of one in-patient.
If I had no family and no advocate – or I was detained too far away for them to visit more than twice a year – I can guess fairly graphically how my mental health would fare. Desperate, desolate, I could not vouch for my behaviour. If I expressed distress at my situation, railed against the futility of my detention, self-harmed – and in so doing attracted regular restraint, a bucket of medication and serial sectioning under the Mental Health Act – who could blame me for lashing out? Well, everyone around me probably. My case notes would describe me as dangerous; no-one would know or remember me as any different.
You don’t have to be a professional to appreciate the vicious circle of detention without treatment, deteriorating mental health and behaviour that challenges. So how is it that, in the 21st century, when we know so much more than we did when we put people in lunatic asylums, 3400 people with learning disabilities are still so detained? Even in those instances where mental health diagnoses have currency and cause beyond detention, where is the ‘recovery model of mental health’, the ‘life beyond illness’, the ‘staying well’ plan, any stab at supporting people to deal with trauma and have a life worth living?
Amongst the answers, two fatally combine. One: we still do not respect the full human and civil rights of people with learning disabilities. Two: detention is big business. The average price of one of these placements is £3500 per week, with the top 200 people priced at £68 million a year. Retaining customers is good for business, recovery and resettlement is not. Some such companies employ the services of consultant psychiatrists involved in serial sectioning – or generating repeat custom as they say in the trade.
Once upon a time, there were three blokes. One was blind, one had autism, all three had learning disabilities. Unlike the 3400 people still detained, four good things came together to change the course of their lives. Firstly, their families or advocates knew them, believed in them, stuck by them. Secondly, Lewisham commissioned community support and sourced local housing. Thirdly, as provider, Three Cs and its staff were prepared to share the risks to focus on recovery and inclusion. Fourthly, and critically, the local Behaviour Support Team learned from and passed their know-how on to Three Cs staff, the families, and the multi-disciplinary team.
Three blokes have been living lives well worth living for the last seven years. And the price of happiness? At between one third and half the price of misery, what is the argument again for retaining even one bed space in NHS-funded, detention-based care?