Restraints used on people with learning disabilities and autistic people in inpatient units through COVID-19 - an update

Summary

This blogpost updates a post I wrote about restrictive interventions in inpatient services used on people with learning disabilities and autistic people leading up to the first peak of COVID-19 in England. 

The last blogpost had information up to the end of March 2020 - this blogpost includes information up to the end of May 2020.

It is important to remember that these statistics on ‘restrictive interventions’ (restraints) seriously underestimate the true picture, because many independent sector inpatient services do not report into the MHSDS dataset where restraints are recorded.

From January to May 2020, the percentage of people with learning disabilities and/or autistic people in inpatient units who were subject to restraint increased as the overall number of people in inpatient units decreased. In January 2020, 11.3% of people in inpatient units were subject to some form of restraint, rising to 16.2% of people in May 2020. In total, 540 people in May 2020 were subject to restraint at least once in the month, with a total of 5,520 restraints reported.

Those people who did experience some form of restraint experienced restraint on average 9.6 times in January 2020 (almost once every 3 days), increasing to 10.2 restraints per person in May 2020.

There were increases in May 2020 in almost all types of restraint, with particularly stark increases in prone, supine and 'other' forms of physical restraint, chemical restraint in the forms of oral medication and injections of rapid tranquilisers, and seclusion.

As restrictions in inpatient services related to COVID-19 continue, these statistics show sharply increasing use of severe physical restraint, chemical restraint and seclusion on people with learning disabilities and autistic people in these services. 

Restraints in inpatient services

A couple of months ago, I wrote a short series of blogposts about what (if anything) the statistics could tell us about what happening to people with learning disabilities and autistic people in inpatient services leading up to and going through the first peak of COVID-19 in UK in April. This blogpost updates the previous post on restraints (restrictive interventions) that people were being subject to. The previous post (please have a look at that post for background on the statistics and their limitations, which I won't repeat here) only had information up to the end of March, before peak COVID-19. This update extends that information (supplied by NHS digital on a monthly basis) to the end of May, starting to look through the first COVID-19 peak when further restrictions on people in inpatient settings and changes to working practices were started to be imposed. 

From January to May 2020, the source of the information used here (the Mental Health Services Dataset, or MHSDS) reports a reduction in the number of people with learning disabilities and autistic people in inpatient services (including people in specialist learning disability inpatient services and people in mainstream mental health inpatient services), from 3,810 people at the end of January to 3,335 people at the end of May. Throughout this time, there have been particularly big reductions in the number of people with learning disabilities and autistic people in mainstream mental health inpatient services for very short (i.e. days or weeks rather than months or years) periods of time.

For those people who were in inpatient services at this time, what were they subjected to in terms of restraint?

 

The graph shows the number of people with learning disabilities and autistic people (in independent sector and NHS inpatient services) who were subject to at least one episode of restraint in each month, from January to May 2020. It also shows the total number of episodes of restraint that people were subject to in the same time period.

The pattern is similar for people in both independent sector and NHS inpatient services - a picture of general reductions from January to April (remember, the number of people in inpatient services is also decreasing), then in May an increase in the number of people being subject to restraint and particularly sharp increases in the number of restraints that people are being subject to.

In May 2020, overall 16.2% of all people with learning disabilities and autistic people were subject to at least one episode of restraint, with each person subject to restraint experiencing an average of 10.2 restraints (one every three days) during the month.

As the next graph shows, while the percentage of people subject to restraint increased in May amongst all age groups, younger people aged 18-24 were particularly likely to be subject to restraint throughout.

What particular types of restraint were people subject to, and how do they change over time? The two graphs below show information on the types of physical restraint recorded by inpatient services to the MHSDS, in terms of the number of people subject to restraint and the number of restraints people were subject to.

 

Both of these graphs show a consistent picture, of flat or gradually decreasing reported physical restraints from January to April 2020, then stark increases in many types of physical restraint in May, particularly prone restraint, supine restraint, and physical restraints reported as 'other' (a particualrly worrying trend given the alarming number of categories of physical restraint catalogued here). There were also reported increases in the number of times standing restraint, seated restraint and restrictive escorting were used, without big increases in the number of people subject to them.

 

The final two graphs report the same information for chemical restraint, mechanical restraint, seclusion and segregation. Again we see a similar pattern, with particularly sharp increases in reported chemical restraint in the forms of rapid tranquiilising injections and oral medication, and in reported seclusion.

I find these sharp increases in all sorts of heavy-duty restraints in May (when presumably lockdown restrictions and COVID-19-related working practices have been in place for some time) really, really worrying. Whether you're subject to these restraints yourself in an inpatient unit, or spending time in an inpatient unit where these restraints are being frequently used on people around you, it can't feel like you're in a place that is therapeutic and helping you to better physical and mental health.

Transparency and openness of these inpatient units to friends and family members of people within them (perfectly possible while managing COVID-19 infection risk), let alone any sign of a coherent strategy throughout COVID-19 for people in inpatient units, has been conspicuously lacking. To my mind, these statistics only reinforce the urgency of the need for scrutiny and action.