Autistics in English mental health hospitals

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The latest monthly Assuring Transformation NHS Digital data shows that in June 2022:

In total 2,005 autistic people and people with learning disabilities are in inpatient mental health hospitals in England
1,215‬ (60%) of these people are autistic
Around 190 of these are autistic people under 18.
This is the most up-to-date record of how many autistic people and people with learning disabilities, both adults and children, are currently in inpatient units in England. It also shows how long they have been in these units for, when their care and treatment is checked and what kind of unit they are in.

Collecting this information is important because it holds the Government to account on its commitment to reduce the number of people in these institutions.

Despite some progress moving people with a learning disability out of hospital and into the community, the number of autistic people in inpatient facilities has increased. In 2015, autistic people made up 38% of the number in hospital, now it is 60%.

It is widely recognised that for most autistic people, care in an inpatient unit is rarely helpful – in fact, it can be deeply damaging.

Wards can be noisy, bright and unpredictable. Without reasonable adjustments to the environment, and support from a professional who understands autism and how to adapt care, it can be completely overwhelming, particularly if you have an extreme sensitivity to sound, light or touch. It can increase someone’s level of distress, which can lead to further restrictions and make it even harder to move to support in the community. On top of this, there aren’t enough of the right type of mental health and social care services in the community for autistic people to move into.

The average length of stay is around five and a half years.And we continue to hear alarming cases of overmedication, seclusion and unnecessary restraint.

In 2011 shocking abuse was uncovered at Winterbourne View Hospital, an inpatient unit for people with learning disabilities. This scandal led to the acknowledgement that there is a significant number of autistic people, those with a learning disability or both, stuck inappropriately in inpatient settings – largely because services to support them in the community simply do not exist.

The Government’s response came in the form of the Transforming Care programme which aimed to close up to half of the inpatient mental health beds and move people back to their local communities by 1 June 2014. This did not happen.

In 2015, NHS England published a three-year closure programme and national plan called Building the Right Support. This set out how the NHS and local authorities in England propose to improve the lives of autistic people and those with a learning disability or both in inpatient settings.

The key promises they aimed to achieve by the end of May 2019 included:

Closing 35-50% of inpatient beds for autistic people with or without a learning disability.
The right support would be developed in communities to support these people.
Alongside this, NHS England published a ‘service model’ setting out all the local support that should be available in each area by March 2019.

But this is still not the case. There is simply not enough of the right type of community services, which is a key reason why autistic people are still being admitted to inpatient care and why it’s often so hard for them to move back to the community.

The Government recently published a ‘Building the Right Support Action Plan.’ This proposes some changes to the way that autistic people and people with a learning disability get care in the community and in hospitals, as well as the training that medical professionals will receive.

NHS England’s Long-Term Plan reinstates its pledge to reduce the number of autistic people or people with a learning disability in mental health hospitals.

It has also pledged to:

transform mental health care so more people can access treatment
continue to develop services in the community and hospitals.

The overwhelming majority (90%) of autistic people who are detained in hospital are put there using the Mental Health Act 1983. We and hundreds of thousands of campaigners have been calling for changes to mental health law for years, so it respects autistic people’s rights.

If someone is admitted into hospital, it’s essential that this is for as short a time as possible, that they’re supported by people who understand autism, and in an environment that reflects their needs.

In January 2021 the Government first announced promising proposals for change to mental health law and in June 2022 a draft bill to reform the Mental Health Act was published. The bill could stop people being sectioned just because they’re autistic and make it easier for autistic people in hospitals to leave. This is a big step forward.

But it’s important to remember that these changes will take years to come into force. To reach its target to reduce the number of people in hospital, the Government needs to do more to stop autistic people reaching crisis. This means investing in better social care and mental health services that meet the needs of autistic children and adults. Without a fully funded social care system that provides the support autistic really people need, the scandal of autistic people being wrongfully held in mental health hospitals won’t change.