Restraints used on people with learning disabilities and autistic people in inpatient units - what do seven years of statistics tell us?

Before I start, a quick warning. Most of my blogposts these days run through official statistics to try and build a picture of what's happening for (to?) people with learning disabilities. Through the distancing veil of numbers and graphs, this picture is usually quite upsetting. I found putting together the graphs for this blogpost more upsetting than any I've done recently - just thought I'd let you know this in advance when you're deciding whether to read it or not.

This blogpost will run through what the publicly available statistics say about what restraints (or 'restrictive interventions') autistic people and people with learning disabilities in mental health inpatient services in England have been subject since this information became publicly available around 7 years ago. I haven't looked properly at this information for the best part of five years, and the picture, in becoming more comprehensive, has become even more grim.

The dataset I used in that blogpost and in this one is the Mental Health Services Data Set (MHSDS) - this is a large dataset collected by all NHS-commissioned mental health services in England, and includes information on people flagged in these services as an autistic person or a person with learning disabilities. NHS England/DHSC extracts the information specifically related to people with learning disabilities and autistic people in any mental health inpatient service every month, including both the 'specialist' inpatient services that were largely the focus of Transforming Care/Building The Right Support, and general mental health inpatient services. Providing information for the MHSDS is mandatory for NHS funded service providers, including independent sector providers. The number of people with learning disabilities and autistic people in inpatient services according to the MHSDS is much higher than the number of people recorded in the Assuring Transformation dataset, which the government prefers to use when quoting how well it's doing.

There are going to be a lot of graphs. When going through them, I think there are at least three big things that have had an impact on the number of restraints reported in these mandatory statistics:

1) The Covid-19 pandemic. For reasons that will become clear later, it's hard to be completely confident in trends over time in the restraints data, but it looks like during the Covid-19 pandemic (at its peak in 2020-2021) there were fewer people being admitted to inpatient units and those people who were there were more likely to be subject to some types of restraint.

2) In 2022 and 2023, a reported cyber attack had an impact on the quantity and quality of data reported in the MHSDS, with some national information not reported for around a year. This means there are some gaps in what is reported, and some of the numbers might be less reliable than usual.

3) The completeness of reporting. When I first started looking at this information in 2020 and 2021, it was clear that many big inpatient service providers (including some very big independent sector inpatient providers) were routinely not reporting any restraints at all. The Mental Health Units (Use of Force) Act 2018 was passed into law in 2018 to improve this state of affairs, but statutory guidance from DHSC was not issued until December 2021. This means that, if reporting becomes more comprehensive, we should see this reflected in the restraint statistics. 

How many people with learning disabilities and autistic people are in inpatient services?

For pretty much all the graphs in this blogpost, I'll be sharing information from the MHSDS for every six months over a seven-year period, from March 2019 to March 2026. The first graph below shows information on the number of people with learning disabilities and autistic people in inpatient services at the end of the month in question, divided into people in independent sector services (the light blue line), NHS services (the dark blue line), and finally the total number of people in inpatient services (the black line).

The numbers here (typically 3,500-4,000 people) are much higher than those reported retrospectively by commissioners in the Assuring Transformation dataset (typically 2,000-2,500 people), possibly because the MHSDS is much better at identifying those flagged as a person with learning disabilities or an autistic person across the whole range of mental health inpatient services.

As I mentioned above, there seems to be a slight dip during the peak of the Covid-19 pandemic, then there is a year (where there is a gap in the black line) where the cyber attack makes the numbers a little unreliable. The introduction of the 2021 statutory guidance for the Mental Health Units (Use of Force) Act (2018) should not have an impact on the reporting of the number of people in inpatient services. However, there does seem to be a recent trend upwards in the number of people with learning disabilities and autistic people in both independent sector and NHS inpatient units, possibly partly due to the gradual demise of Transforming Care/Building The Right Support policy attention. At the end of March 2024 there were 3,540 people in inpatient units, rising to 3,930 people at the end of March 2026. This increase is in both independent sector inpatient services (from 1,070 people to 1,220 people) and in NHS inpatient services (from 2,425 people to 2,645 people).

What does the MHSDS say about restrictive interventions?

The MHSDS includes information on both the number of people subject to any restrictive intervention in any single month, and the number of restrictive interventions people have been subject to in any single month. It also provides information on a range of specific types of physical restraint, and on mechanical restraint, chemical restraints, seclusion and segregation.

What do the MHSDS statistics say about restrictive interventions overall? The graph below shows the number of people with learning disabilities and autistic people in inpatient units who have been subject to at least one restrictive intervention in that month, from March 2019 to March 2026. The figures for the total number of people subject to restrictive interventions (the black line) is again broken down into independent sector inpatient services (the light blue line) and NHS inpatient services (the dark blue line). 

During the Covid-19 pandemic, the number of people subject to restrictive interventions was reported by independent sector services to have dipped, while there was an increase reported in NHS inpatient services. Was this a 'real' difference, or were independent sector services less likely to be reporting restrictive interventions to the MHSDS than NHS services?

A clue to answering this question is in what happened to reported numbers of people subject to restrictive interventions in relation to the statutory guidance for the Mental Health Units (Use of Force) Act, issued in December 2021. The graph below shows that from September 2021 to September 2022 there were big increases reported by independent sector services but not by NHS services. The cyber attack in 2022-23 makes interpretation over time difficult, but there are clear upward trends over the last few years in the number of people subject to restrictive interventions in both independent sector and NHS inpatient services.

By March 2026, within that one month 855 people with learning disabilities or autistic people in inpatient services were subject to at least one restrictive intervention - 250 people in independent sector inpatient services and 580 people in NHS inpatient services.

Because the number of people reported to be in inpatient services also fluctuates over this time period, we can also look at what percentage of people in inpatient units in each month are subject to at least one restrictive intervention. The graph below shows these percentages for people in independent sector services, people in NHS services, and everyone combined. Even given patchy reporting (the change in the percentage of people reported to be subject to restrictive interventions in independent sector inpatient services increased by over 500% in a year from September 2021 to September 2022, with the introduction of the statutory guidance) and patchy data due to cyber attacks, the overall trend is clearly upwards. What looked like a discrepancy between the independent sector and the NHS early on seems highly likely to be a function of incomplete reporting by independent sector providers, with recent data being similar for both sectors.

I just want to take a moment to reflect on what this graph is saying - in the month of March 2026, 21.8% (more than 1 in 5) of people with learning disabilities and autistic people in an inpatient service were subject to restraint at least once.

As well as the number of people subject to restrictive interventions, we know that people can be subject to multiple restraints, so the graph below shows the total number of restrictive interventions that autistic people and people with learning disabilities in inpatient services were subject to each month, again broken down by whether people are in independent sector or NHS inpatient services.

We've seen from the graphs above that the number of people in inpatient units has started to gradually increase, and the number of people reported as subject to restraints has increased over time (partly due to more comprehensive reporting), so the percentage of people in inpatient units reported as subject to restraints has also increased sharply over time, now standing at over 20% of people. 

The next graph below in some ways shows a similar picture - changes during the Covid-19 pandemic (a reported decrease in the independent sector, a reported increase in the NHS), a big increase reported in the independent sector with the introduction of the statutory guidance, and a general trend of continuing increases more recently. What is different is that despite having smaller numbers of people in their inpatient services and smaller numbers of people reported as subject to restraint, the total number of restrictive interventions reported by independent sector inpatient services is beginning to match those reported by NHS inpatient services.

What does this mean for a person being subject to restraint? The graph shows the average number of restrictive interventions in that month for every person that was subject to at least one. There are different trends over time for people in NHS services compared to people in independent sector services. 

In NHS inpatient services, there was a peak in the Covid-19 pandemic where people who were subject to at least one restraint were restrained on average nearly 13 times in the month - approaching once every 2 days. From this point, the average number of restraints per person for people in NHS inpatient services has reduced to between 7 and 8 times per month (still around once every 4 days).

The trend in independent sector inpatient services is the opposite. There was also an increase during the Covid-19 pandemic, but the average number of restrictive interventions per person subject to at least one has continued to increase ever since. In March 2026, a person subject to at least one restrictive intervention was on average restrained 14.2 times in that month - approaching once every 2 days.

What restrictive interventions are people subject to?

What do the statistics tell us about which types of restraint people with learning disabilities and autistic people in inpatient units have been subject to over the past seven years? The MHSDS records a lot of different types of restraint - for this blogpost I've grouped them into three sets of graphs:

1) Three forms of restraint which have been the subject of specific policy and legal attention: prone physical restraint, seclusion and segregation.

2) Various types of chemical restraint, and also mechanical restraint.

3) Various types of physical restraint (to help interpretation, I've included prone restraint in this as well as in the first set of graphs).

For each of these groups of restraints, there are two graphs; one about the number of people being subject to these types of restraint, and one about the number of instances of these types of restraint being used. With all of these graphs, the comprehensiveness of reporting really matters, so it is difficult to know the extent to which any increases over time are about more people in inpatient services, better reporting, or more people being subject to more restraints.

Prone physical restraint, seclusion and segregation

Prone physical restraint has been the subject of much policy and practice attention, with the intention of prone restraint no longer being used in inpatient services. The graphs below show that, with some fluctuations, the trend is very gradually downwards (the purple lines), although in March 2026, 65 people were still subject to 150 instances of prone physical restraint.

Seclusion and segregation have both been described as forms of solitary confinement, again with policy aims of reducing these to as near to zero as possible. If anything, the graphs report increases over time in both seclusion and segregation. Although interpreting changes over time is difficult, we can say that the current picture is grim. In March 2026, 170 people were subject to 340 instances of seclusion (the grey lines); and 65 people were subject to 95 instances of segregation (the red lines). The huge increases in the number of people reported to be subject to segregation with the introduction of the statutory guidance in 2022-23 shows just how many people were being hidden from official statistics.

Chemical restraints and mechanical restraint

The two graphs below use the same format for specific types of chemical restraint and for mechanical restraint. 

Restraint using rapid tranquiliser injections (the orange lines) are the most commonly used form of chemical restraint. Apart from a sharp jump during the Covid-19 pandemic and an apparent dip in 2022/23, the number of people subject to rapid tranquiliser injections is reported to have increased over time, reaching 120 people experiencing 410 rapid tranquiliser injections in March 2026.

Oral chemical restraint (the yellow lines) is also common. Again, there was a sharp jump in the reported use of oral chemical restraint during the Covid-19 pandemic, and fluctuating levels of oral chemical restraint reported ever since. In March 2026, 75 people were reported to have been subject to 180 instances of oral chemical restraint.

The number of people reported to have been subject to mechanical restraint (the light blue lines) seems to have gradually reduced over time (to 10 people in March 2026), with the number of instances of mechanical restraint generally fluctuating between 50 and 80 instances per month, but dropping to 20 in the month of March 2026.

Physical restraint

The graphs below report the same type of information for various types of physical restraint (including prone restraint). It's worth noticing here that vertical scales on these graphs are different to the previous two sets of graphs, as so many people are subject to so many instances of particular types of physical restraint. With the exception of prone restraint, pretty much all types of physical restraint are reported to have increased in the last seven years.

By March 2026, by far the most common form of physical restraint is standing restraint (the orange lines), exercised on 495 people a reported 2,315 times. Seated physical restraint (the purple lines) was experienced 1,860 times by 260 people in the month of March 2026. Also common are supine physical restraint (the lilac lines), experienced by 205 people on 825 occasions in March 2026, and restrictive escort (the yellow lines), experienced by 155 people on 465 occasions in March 2026. Despite apparent improvements in reporting over time, in March 2026 there were still 175 people experiencing 875 instances of 'other' physical restraint (the grey lines).

Summary

So, what do I think the MHSDS information tells us about restraints being used on people with learning disabilities and autistic people in inpatient services over the last seven years? A few things:

• There has to be a real lack of confidence in the comprehensiveness of the data on restraints being reported by inpatient services - this really hampers any interpretation of reported changes over time or differences between NHS and independent sector organisations. Clearly the belated implementation of the Use of Force Act (2018) has resulted in a big improvement in the comprehensiveness of the data provided, but we still have no way of knowing how complete the information is.
• Whether due to better reporting, changes over time, or a combination of both, the picture for people with learning disabilities and autistic people in inpatient services with regard to restraints is grim, and if anything getting worse rather than better.
• Overall, over 20% of people with learning disabilities and autistic people in inpatient services will be subject to an average of 10 restrictive interventions per person in any given month. That's over 850 people being subject to a restrictive intervention roughly once every three days.
• With more comprehensive reporting, it seems that NHS inpatient services and independent sector inpatient services are similar in the percentage of people being subject to restraint, but independent sector inpatient services on average restrain people more often (14 times in a month) than NHS inpatient services (8 times in a month).
• Standing, seated, supine, restrictive escort and 'other' physical restraints are most commonly reported (at least 150 people are subject to each of these types of physical restraint every month), and possibly increasing over time.
• Policy statements about reducing levels of prone restraint, seclusion and segregation are not working. Although the number of people reported to be subject to prone restraint has gradually reduced over time, around 65 people every month are still subject to prone restraint. The trends for seclusion (170 people) and segregation (65 people) suggest increases rather than decreases over time.
• Injected rapid tranquilisers and oral chemical restraint are the most commonly reported forms of chemical restraint, with the use of injected rapid tranquilisers (120 people in March 2026) possibly increasing over time.

This is such a grim, grim picture. What chance do people have in services with long-standing cultures of restraint, combined with support for people all over falling apart, crisis-driven and inadequately funded mental health services, and policy attention that studiously avoids focusing on what matters?