Restraint, seclusion and segregation in hospitals and care homes: an update on our work from Dr Paul Lelliott, Deputy Chief Inspector of Hospitals and lead for mental health.

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Dr Paul Lelliott

As part of our commitment to share findings and thoughts as they emerge, I am updating you on progress since last month’s blog. We have now visited 39 people who are in segregation or seclusion in a ward for people with a learning disability or autism or in a mental health ward for children and young people. We will be looking at other mental health wards, residential social care services and secure children’s homes in phase two.

We shared our very initial thoughts with our expert advisory group a week or two ago. The question that we posed there was whether, for people with the most complex needs and behaviour that challenges— and especially for those with autism — ending up in segregation is an almost inevitable outcome of the current system of care? If this is the case, simply asking the current system to ‘try harder’ would not be a helpful recommendation — we would need to think about what a better system would look like.

Many of the people we have visited have had very troubled childhoods and difficult interactions with children’s services that struggled to meet their complex needs or to respond to behaviour that challenges. At some point, admission to a hospital ward became the only possible option. Once in hospital, people with autism may find it difficult to cope with the unpredictability of the open ward and react in ways that put themselves or others at risk. Faced with this situation, staff, who may not have had specialist training in autism, may see no other option than to separate the person from others.

Once in segregation, the person may then not be re-integrated into the open ward and may not begin making progress down the path that leads to discharge.

During the remainder of the review, we will be checking whether this initial formulation is correct and, if so, what are the implications for those bodies that have some role in the care of this group of people.

We will say more about our initial findings in our interim report due in late May and hope that this will start the conversation about whether we are right to suggest that we need to rethink the whole system for care for those with the most complex needs and behaviour that challenges.


If you have information you’d like to share, or would like to speak to someone about this work, please email

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