#7days of action – Why History

by Jan Walmsley

I felt like a murderess. I really felt I had condemned him to death. And that was when I threw myself into Mencap heart and soul. I thought I must fight for all those who are in the community because perhaps parents won’t have to undergo this trauma in the future if we can improve services in the community. I won’t give up until I die.

(Rolph et. al., 2005)

This was Rene Harris, a founder of Luton Mencap Society, speaking to me about her decision to put her adolescent son, Colin, into Bromham mental handicap hospital in 1954.

There are uncanny echoes of Rene’s words in this blog, written by Paula Rawnsley for #7daysofaction in 2016:

I asked for help. How I wish that I never had asked for help now. How I wish darling Thomas I had kept you by my side and never let you go … I’ll never forgive myself. I can’t live with the knowledge that I left him there in their hands. (https://theatuscandal.wordpress.com)

Unlike Rene’s son, Colin, Thomas did die. His case will be the subject of an inquest. And like Rene, though using different media – Twitter and Facebook rather than fetes and coffee mornings – Paula is campaigning in #7daysofaction so that others do not have to undergo the trauma.

The parallels are striking. An adolescent boy, a family asking for help to manage him as he struggles to come to terms with growing up. And the response, at a distance of 60 years, is to put the young man away, cut him off from family and all that is familiar.

In this blog I explore those parallels, and ask whether there is hope.

The week beginning 18th April 2016 was designated a week to really push home the message that 3000 citizens are detained in Assessment and Treatment Units across England; and that this must end. It’s a campaign spearheaded by families, like Paula Rawnsley, whose relatives are (or were) in these Units. Each day a new harrowing story of an individual who, because of the absence of support and understanding for them and their families at key points in their lives – often adolescence – found themselves taken away from all that was familiar, and placed in a sterile environment, frequently miles from their homes, where relatives need permission to visit.

How can this be? In 2010 I, along with many others, celebrated the final closure of Orchard View, the ‘last learning disability hospital to close’. Despite the shortcomings of ‘care in the community’, it was an important landmark. Yet, even then, I knew this was not the end of institutions. It was just that it was the last NHS hospital to close. Except it wasn’t, because as hospitals closed Trusts were busily building units on the campus to house the people they could not be bothered to support elsewhere. One of these I visited, on the site of St Ebbas Hospital Surrey. It housed people who, in their frustration tore down curtains, damaged furniture, behind closed doors and high wire fences. The TV was high on the wall. There were no carpets, just bare floors and equally bare furniture. As researchers we were not welcomed. And then there is Calderstones, housing over 200 people. Its closure has recently been announced a decade after its first closure. How many closures can any hospital need?

It is families who are leading #7daysofaction. Families have long been the driving force to close institutions. It was Judy Fryd who, in 1946, took the first step of a movement which continues to this day. She published an appeal in Nursery World to hear from other parents in her situation, alone at home with their ‘mentally deficient’ child. She started a ball rolling which eventually created the organisation we know as Mencap. Rene Harris, whom I quoted above, was inspired by Judy Fryd. Mark Neary is the spearhead of #7daysofaction. His son spent a year in an ATU, following a short spell in respite when his dad needed to go into hospital. His Local Authority, reacting not to Steven’s distress at being plucked from everything he knew and made him feel safe, but to some higher order imperative, announced that Steven needed secure accommodation. And Mark had a devil of a job to get him back.

Each heart rending story is different. But there are obvious trigger points. Frequently, as young people with autism and complex needs get into their teens, not only do they struggle with the changes associated with adolescence, they also begin to face the truth that their lives will not be like those of their siblings. They will not leave school get a job, go away to Uni or College, they are unlikely to get a girl or boyfriend, their lives will probably be sheltered and limited. There is a reaction, a change in behaviour, often violence or depression. The family asks for help. No help is forthcoming. Other than the offer of a place in an institution. In the 1950s the advice given to Rene Harris, and many others, was ‘put him away and forget about him’. Now it is more subtle – ‘assessment’, ‘treatment’; beguiling terms which give hope to embattled families. But the result is the same. The young person is removed, often triggering a further round of ‘challenging behaviour’, which is not understood as a response to traumatic separation, but is seen as a further justification to keep the person detained. And the family is left, regretting their decision to comply, but now the situation has gone beyond their control.

A further parallel with earlier parent struggles is the determination of the authorities to deny families access to relatives. In the days of the long stay hospitals this was done by placing people in distant – often rural – sites, with poor public transport. Visiting times were limited to half a day once a month. Families were prevented from seeing the wards. Mail was censored. Home leave was often denied even at Christmas.

Has much changed since? Not much as far as the stories in #7daysofaction are concerned. Almost half of the people detained in inpatient services are more than 50 km from their homes. Families face long journeys. Their access to their relatives is restricted. Home leave is often denied:

Just before Christmas 2015, Nina Ni, went to visit her son, Tizane, in the ATU he is currently being detained in. Tizane had been unsettled for days. He had repeatedly asked to spend some time at home over Christmas but this had been refused by the Responsible Clinician. (https://theatuscandal.wordpress.com)

In the past, the belief that learning disability was inherited gave professionals confidence in denying families access. Now the argument is that as adults people have the right to choose whether to see their families – and all too often, as Sara Ryan’s painfully documented account of her son’s detention and death in the Slade Unit in Oxford shows, professionals choose to believe that the choice is not to see them. The result is the same. Families kept at arm’s length, sometimes with disastrous results, as in Connor Sparrowhawk’s case.

There are differences too. To our shame, little is known about death rates in the past, but some sampling suggests they were high. Undoubtedly many people died prematurely in institutions, from accidents and, pre antibiotics, from infectious disease. Too many young people, like Thomas Rawnsley and Connor Sparrowhawk have died whilst detained in modern institutions. Without their families’ ferocious campaigning these deaths might have been swept under the carpet. But, thanks to social media and those same families, we know about them. The closed doors are not quite as closed as they were.

Is there hope? I think so. Families coming together in campaigns such as #7daysofaction is probably the most significant development in learning disability for decades, since Mencap lost its way, back in the 90s. These families are leading a loose but powerful alliance of people, to put continuous pressure on a resistant and complex system, to hold the NHSE Transforming Care Team to account for their actions. And to use the appeal to our common humanity to garner wider support, from press, media and the public. What next? We can’t let up. Media attention is brief unless fed with new stories. We can all help to keep the media beast fed, to keep those 3000 detainees in the public eye, until they are brought home, and those Units closed.

References

Sheena Rolph, Dorothy Atkinson, Melanie Nind and John Welshman (eds) (2005) Witnesses to Change: families, learning difficulties and history, Kidderminster, BILD.

Transforming Care – thoughts prompted by the All Party Parliamentary Group on Learning Disabilities on 18 November 2015 – by Jan Walmsley

by Jan Walmsley

Transforming Care is the title NHS England has given to its plans to bring people out of distant Assessment and Treatment and Inpatient Units to be supported nearer home. Mencap produced an excellent Briefing Paper to support this meeting of the APPG, presided over by Chris Heaton-Harris MP – the new chair of the APPG, and addressed by the Care Minister Alastair Burt, Chief Nurse Jane Cummings, Viv Cooper of the Challenging Behaviour Foundation and David Jack whose son spent 6 years in an inpatient unit.

The briefing paper indicates why I might have attended this with a sense of déjà vu. I have followed with a sense of despair the battle being fought by Connor Sparrowhawk’s family for justice for their son, and the obstacles placed in their way. I listened to heart rending stories from families at an APPG last year at which Simon Stevens seemed powerless to implement the Winterbourne View Concordat. Now there is renewed energy and even some political muscle being brought to bear with Building the Right Support published in October 2015 re-committing to closure of in-patient beds.

What is different this time was a theme of the questions. Very fair. We have heard all this before. There is a difference this time. £30 million has been committed by Government to support Local Authorities with transitional costs associated with building community supports while still paying for in-patient beds. There is more money for capital funding, and some ‘dowries’ for people who have been incarcerated for more than 5 years. That helps, for sure. I have argued elsewhere that DHSS money was the crucial factor which enabled hospital closure in the 1980s.

But … why do I remain less than convinced that all this high level attention won’t necessarily change things. The commitment appears to be in place, and to be genuine, but methinks the gap between rhetoric and reality has never been greater. So what is needed on the ground? Some findings from SHLD research came to mind.

Sue Ledger’s PhD ‘Staying Local’ examined what enabled people to remain in their own locality, an inner London Borough. What did she find? That family carers were successful when they had ‘social capital’, from other family members, local staff, faith groups, neighbours and friends. That such networks were fostered through Borough based segregated services, like hostels, Day Centres and local Mencap groups or Gateway Clubs. At times of crisis, responsive and flexible support was crucial. Local staff who knew the families in their patch were able to avert out of area placements at times of crisis by taking responsibility for sorting something out. It might be finding a respite bed when a key family carer was unwell. It might be putting in place interim arrangements while longer term solutions could be set up. It might be creating ways to support people which were at variance with ‘official’ service remits. Shared care arrangements between families and services. Help getting to medical appointments. Assistance in getting tenancies transferred when the carer died. In all cases this required trusted relationships between families and staff. It required staff who knew people as people, knew their histories, who and what mattered to them. People willing to break a few rules. And people who had a commitment to keep them local.