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Improving the quality of mental health hospital treatment and support for autistic people
It is World Autism Acceptance Week and here, in the Improving Quality team in the national Learning Disability and Autism programme, we are again reflecting on the ways we can improve the quality of mental health treatment and support for autistic people in hospital.
We know that the care and treatment provided to autistic people in mental health services is not always of the quality we would want. This can be because of a lack of understanding about autism or a lack of understanding of how to adapt and tailor services for the individual. The need to be creative to ensure the way a service is delivered meets the individual need of that person is key to all NHS services.
This desire to hear the individual’s voice and preferences has progressed significantly this year through our work to review the way advocacy is provided to people in hospital. We have heard many examples of when advocacy works well, and examples of when it fails to meet the goal of actively progressing the plans of the person. Alongside this, we have been able to support the delivery of life planning and consider how this can help create a clear plan owned by the individual of what they want next in their life.
A lot of our work focuses on the care and treatment provided to people in the most restrictive settings, called long term segregation – which means that a person is nursed in isolation, not of their own choosing, and it lasts for longer than 48 hours. For people in this situation, it is recognised that staff teams can get really stuck as they struggle to see a different way to keep everyone safe.
Baroness Hollins was tasked with chairing an Independent Oversight Panel to oversee how people in this situation are supported and developed a series of recommendations to improve care. Her report gave several recommendations about ways to reduce restriction and help people get back to living near their family and friends which include the offer of an independent care (education) and treatment review (IC(E)TR).
We have been working with NHS regional teams to identify the people who should receive an IC(E)TR. We work in the IC(E)TR project team alongside the Care Quality Commission and the Department of Health and Social Care. These independent reviews deliver real scrutiny from fresh, and skilled eyes, focused on how restrictions can be reduced.
We know that in some cases, that person may be ready to move out and there is a need for a creative way of thinking about that next move to a home in the community. Our pilot establishing senior intervenors focuses on this, with senior intervenors looking into situations where progress is not being made and there is concern for the individual’s wellbeing. The senior intervenor works to find solutions to barriers that may be preventing the individual from moving to less restrictive settings or into a home in the community.
Lastly, we are excited about the development of the HOPE(S) model. This is an ambitious human rights-based approach to working with people in long term segregation developed from research and clinical practice. In partnership with Mersey Care Foundation Trust, NHS England and NHS Improvement is funding the roll out of this positive model across all of England. All the new recruits for this model are being trained next week and we can’t wait for them to get out across the hospitals in England to think about solutions when people are stuck.
I hope this has given you a flavour of the exciting work we are focused on to improve hospital care for autistic people, so much is happening but we remain very aware we are not yet where we need to be.
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