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Deeply honoured to have been entrusted with the end-of-week post for The ATU Scandal: 7 Days of Action. Please mosey on over to the site HERE and see what you can do to help expose and end this terrible waste of lives.

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* Eden * Jack * Thomas * Tianze * Stephen * Robert * P *

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So, how are you feeling after reading all seven stories of life in an ATU? I feel punch-drunk. It is hard to credit that so much cruelty, both careless and deliberate, can be packed into a single week’s worth of posts, but there they are.

The first thing that struck me, looking back over them, was, where are the girls? According to data guru Professor Chris Hatton of Lancaster University, women make up a quarter of ATU inmates (in the light of these stories, I don’t feel ‘patients’ is an appropriate term). So we might have expected to see one or two girls alongside the lads, but no women’s stories were offered. We don’t know why no stories came in; but we do know that the stories of Claire Dyer, a Cardiff woman with autism and learning disabilities whose plight made national headlines in 2014, and Stephanie Bincliffe, who died in an ATU in 2013, have themes in common with the stories published in 7 Days of Action for ATUs.

So what are those themes?

From these stories, they seem to be:

– A failure of forward planning. The relevant authorities seem so bogged down in crisis management that they take a ‘cross that bridge when we come to it’ attitude to anything that isn’t an immediate, catastrophic emergency. Of course, the failure to plan in advance is what allows the crises to arise. Learning disabled people and their families don’t tip from totally hunky-dory to complete disaster overnight.

Eden ‘reached crisis point due to lack of the right support’. Robert ‘became depressed and very anxious’ after autism-unfriendly changes to the way his residential home was run. Jack stuck it out at college for 18 months, but his heightened anxieties were noticeable ’on the transition from school to college’. Thomas ‘started to be troubled’ in his early teens. Tianze was finding changes to his routines ever more difficult to cope with. The anonymous dude on Day 7, P, was hospitalised and sectioned, not because his behaviour had escalated or he was ill, but because his Mum was unwell. And Claire Dyer reacted against two years of utter boredom in a Unit in Cardiff that was not set up to support her needs as an autistic person.

– It is dangerous to ask for support, even when it is dangerous not to. Paula Rawnsley wishes she ‘never had asked for help’. Nina Ni thought Tianze’s Community Treatment Order ‘was part of a plan to help him get better and for us to receive better support’, but in fact Tianze got worse. Leo Andrade now wishes she ‘never agreed to send my son (Stephen) away in the first place’. When Mark Neary had flu, he asked for a few days’ respite care for his son; Steven didn’t come home for nearly a year, and only got to return because Mark took his case to court. After he assaulted a member of staff at school, Connor Sparrowhawk’s parents thought that by seeking treatment for him in their local Unit, they were ‘buying a bit of time for everyone, including Connor’. Connor’s time was cut short by neglect in the Unit and he never came home alive.

– Autism is not ‘curable’ and inappropriate approaches can worsen behaviour. Eden is losing his ability to speak. P was restrained so that the only part of himself he could move was his head, which he banged on the floor until he injured himself. Twice. Robert got stuck in a downward spiral of anxiety and frustration leading to outbursts which resulted in restrictions being imposed, which made him more frustrated and anxious, which….

– Mental health care does not, generally speaking, understand autism, which is a neurological condition, not a mental illness. An autistic person’s coping mechanisms – rituals, stimming, verbal tics – may be severely discouraged. Often, no allowances are made for a person’s sensory difficulties. P’s screams in the carpark were interpreted as mental illness – insanity, in effect – rather than perfectly understandable distress. Steven Neary’s quotation of song lyrics was dismissed as echolalia rather than a way of conveying meaning. Often the person is disciplined for behaving in the only way that their autism allows them to.

– Medication and ‘treatments’ like restraint and seclusion can and do adversely affect health. Jack had ‘extreme effects’ from the three-drug regime he was prescribed. Eden gained 16 stone in 5 years while being injected with the antipsychotic Clopixol. Steven Neary put on 15 stone in 5 years of taking the antipsychotic Risperidone, and developed the agonising and life-threatening condition called nonalcoholic steatohepatitis – an inflamed, fatty liver. (Neither Eden nor Steven have a psychotic disorder). Stephanie Bincliffe gained ten stone in five years from a combination of drugs and being confined to a single padded room. She died of heart problems and sleep apnoea, aged 25 and weighing 26 stone. P is becoming emaciated. Thomas was given ‘cocktails of drugs’ that left him zombiefied. Stephen has ‘changed from a beautiful handsome happy smiley boy to one with very sad empty eyes’. Tianze has frequently been restrained prone, and like both P and Thomas, has suffered restraint injuries.

– Units are total institutions, with commensurate risks of neglect and abuse. Families, the people who know and understand the learning-disabled person best, are sidelined, their expertise dismissed, their contributions disdained or blocked, and their visiting arbitrarily cut short or denied. Stephanie Bincliffe was neglected in her padded cell for seven years. Connor’s epilepsy was not recorded or acknowledged, so that he was left to bathe alone and drowned following a seizure. P is receiving neither assessment, nor treatment, nor discharge planning. Thomas was assaulted by a staff-member in one care home, and suffered carpet-burns in another from being dragged along the floor. Although his mother repeatedly told staff that he had a serious chest infection, he was not treated for it and succumbed to a fatal pneumonia.

– For people with complex difficulties, leaving an ATU is much harder than entering one. As Sallowpad the Raven remarks of Tashbaan, it’s a case of “Easily in but not easily out, as the lobster said in the lobster pot”. People may enter as voluntary patients, or under Section 2 of the Mental Health Act (a 28-day detention for assessment and treatment) but if their distress causes them to behave in a way that the facility does not approve of, they may end up in long-term detention under the provisions of other sections of the Mental Health Act. Eden was admitted as a voluntary patient, but ended up on a forensic section – that is, he was detained in the Unit as an alternative to being sent to prison – because staff pressed assault charges against him. P is trapped in a limbo that is more like his and his family’s personal hell. Tianze’s parents’ home has been fully adapted to meet his needs, but he is still detained in hospital, two years after he was told he was going to hospital for a one-night admission. Leo Andrade reports that, ‘In the meetings about Stephen, discharge is never discussed.’

– Once Local Authorities have got someone into long-term NHS care, they are extremely reluctant to reassume the cost and effort of providing that person’s care in the community. Bromley are doing nothing to bring Robert home from Stoke, although the hospital says he does not need inpatient treatment. It is fourteen months since Hammersmith and Fulham were told Eden was ready to come home, and in that time they have done nothing with the information given them to facilitate his return. Hillingdon were keen to ship Steven Neary off to a permanent placement in a hospital in Wales. Connor’s return home, which depended on adequate community support, was first mooted on April 14. There was still nothing in place or even in prospect when he drowned in the Unit bath on 4 July.

– Your adult children are not your children any more, and if they have learning disabilities or autism, they may not even be your family members. They belong to the State. Leo has been told that her son’s data protection rights override her right as his mother to seek a second opinion in his best interests, and is being given the runaround by various organisations which each ‘own’ a piece of Stephen, but none of which actually take overall responsibility for his welfare. Mark Neary is not acknowledged as Steven’s Dad; in officialese, he is Steven’s ‘live-in carer’.

But parents do not stop caring about and for their children just because they hit a particular age. Indeed, in other circumstances, parents are expected to continue their caring roles for their competent adult children. Eldest is in Year 13 and turned 18 some months ago, as college very well knows, but if he is late to or absent from classes, I still get a text from staff demanding that I account for his whereabouts.

The truth is that people do not care about and for their family members simply as a function of their age, but as a function of their needs. We naturally spend more time looking after a very young, or a sick, or a disabled child. We look after unwell or frail parents, while leaving our healthy and energetic octogenarians to walk their dogs, run their errands, take holidays to Samarkand and generally get on with it as they have always done. When I was ill after Eldest was born, my parents came to help. My father spent his time in the kitchen, impersonating a six-foot-two Food Fairy. My mother hovered over me and shuttled E from his cot to my arms every time he woke up. “Why?” I asked fretfully, one day. “Why don’t you take a turn with E? Why are you fussing over me? Why don’t you leave me in peace?” Mum smiled. “Because he’s your baby, and it’s your job to look after him. But you’re our baby, and it’s our job to look after you.” I was in my 30s.

The odds are weighted – dangerously and disgracefully – against caring families. Once upon a time, autism was blamed on ‘refrigerator mothers’, who were said to be responsible for their children’s ‘failure’ to ‘develop normally’.

Parent-blaming is still widespread, as shown in the exchange recorded at 12.56 on day 7 of Connor’s inquest. Families are blamed for ‘upsetting’ their incarcerated young people and banned from visiting or have their visits arbitrarily curtailed. Visits from under-age family members are generally forbidden and such children actually have less contact with their relatives who reside in ATUs, than they would if those people were in prison.

Families’ rights to be consulted are easy (illegally) to ignore or bypass. Their legitimate efforts to act in their children’s best interest may be blocked by jobsworthy use of improbable pieces of legislation, as with the Andrades and the Data Protection Act. In an adversarial legal system, they may be given one piece of accurate but unilluminating information, yet have other, potentially helpful information withheld from them because “it’s not my job”. Or they may be treated to ignorant or wilful misinterpretations of the law, as the Neary family was. Questioning the system can be treated as a punishable act. Some families are threatened that if they make waves, they will be cut off from their loved ones, that speaking about what has happened will result in their ties being legally severed and their child becoming a permanent ward of the State. Sometimes these menaces have more to do with the perceived risk to the organisation’s image and reputation than they do with the best interests of the person supposedly at the centre of the concerns. Hillingdon clearly demonstrated their focus when they breached Steven Neary’s Article 8 rights by putting out a disgusting press release about him, “full of contentious and inaccurate information, and creating a particularly unfair and negative picture of Steven and his behaviour”, the day before the 2011 hearing into his case opened ([2011] EWCOP 1377, para 155(7)).

Even if it is not actually within the legal powers of the organisations to do the things they have threatened, families are in a multiple bind: they do not know what is true and what is not; they do not know where to start looking in order to disentangle truth from oppressive fiction; seeking legal advice for their child may be prohibitively costly or excessively lengthy via the legal aid route; and if the organisation goes ahead regardless and does whatever it intends, there may end up being no available redress, despite the illegality of the organisation’s actions, because those actions may have moved the situation to a point where it seems inescapable and the problems insoluble.

Families inhabit one of two spaces: naïveté or fear. When your learning-disabled child is small, you live in hope. People tell you about all the provision that is available and to celebrate every milestone. You learn the word ‘inchstone’ and celebrate every one. Later on, you realise that you were naïve, and you begin to worry. The more you learn, the more the fear grows. Speaking out about your fears can draw unwelcome official attention. You may even receive threats. Some families have thought about participating in 7 Days, and then decided it is too much of a risk. P’s family feel his story is crying out to be told, but were too afraid to do so except in conditions of anonymity.

So is there any hope?

Yes.

The first beacon of hope comes from the families who have so bravely and generously shared their stories this week. Not only are they helping to spread knowledge in the world – always A Good Thing – but they have begun a class action to get it formally acknowledged that if a person is kept in an ATU beyond the period needed for active assessment and treatment under the Mental Health Act, or when the ATU is no longer the ‘least restrictive option’ under the Mental Capacity Act, he or she is unlawfully detained and must be released. It then is the duty of the home Local Authority, under Section 9 of the Care Act 2014, to assess whether the person has needs for care and support, and, if he or she does, what those needs are. Having found and assessed needs, the Local Authority has a duty to promote the person’s wellbeing and to meet their eligible needs.

The second is that the Care Act 2014 is complemented by Children and Families Act 2014, which instituted Education, Health and Care Plans (EHCPs) for disabled children and young people from birth to 25. EHCPs are focussed on working towards the best possible outcomes for the children who hold them, and they require a longer view to be taken of future needs and planning for transitions that will help the young person move towards those outcomes. I don’t for one moment suppose that either piece of legislation on its own will miraculously make everything run smoothly. Nevertheless, families now have the opportunity to insist that their Authority thinks about, and plans for, their disabled child’s future.

The third is that there are some ‘ninjas’ out there, ready and willing and able to help. People like Sam Sly, who has a proven track record in successfully springing people from ATUs and keeping them in their communities, and who wrote 7 Days’ how-to. People like lawyer Hedd Emrys, who wants to look at ‘establishing a permanent pro bono unit to deal with ATU cases … at an early stage’ (although I’d hope any ATU pro bono unit would also hit legal aid for every penny to which families may be entitled, in the interests of offering pro bono support to the greatest possible number of families). People like Paul Richards of Stay Up Late, who is running the ‘CareBnB’ service to offer people somewhere to stay when they have to travel very long distances to visit the ATU where their family member is held.

Please, think about what you could do. Talk to people about what would be helpful and feasible. Then go and set about it, and let as many people as possible know what you are up to.

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I want to finish by going back to the young man who was the original inspiration for Mark Neary, who is the person behind Seven Days of Action.

Steven Neary survived his year of unwarranted imprisonment in an ATU remarkably well for an autistic person who was pushed right out of his comfort zone for such an extended period. He persisted in putting forward his desire to go home. Whenever the Unit manager came in, Steven would sing Queen’s ‘I Want To Break Free’. And when another male member of staff was on shift, Steven would treat him to a rendition of ‘Sloop John B’.

The Beach Boys’ version of ‘Sloop John B’ was released exactly fifty years ago this month, in April 1966. Here it is, with a new lyric for Steven, Connor, Eden, Chris, Jack, Thomas, Robert, Stephen, Tianze, P, Claire, Stephanie, and all the other dudes who just want to go home.

I’m stuck in an ATU
Years after Winterbourne View
Seems like I’ll be here forever, I want to go home
The NHS say
I’ll have to ask my LA
I feel so broke up
Just want to go home.

So close long-term Units down
Take me back to my home town
Somewhere I can be safe, a place of my own
And give proper thought
To what I need for support
I feel so broke up
I want to go home.

Connor got put inside
A hundred days later, he died
His inquest found neglect, so Southern Health lied.
They still spin and hedge
Claim failings ‘alleged’
I feel so broke up
He never went home.

So close long-term Units down
Take me back to my home town
Somewhere I can be safe, a place of my own
And give real thought
To what I need for support
I feel so broke up
I want to go home.

Verita One and Two
Mazars and Hunt’s UQ
Monitor, NHSI, the CQC
It’s painfully clear
That money’s why we’re still here
We all feel broke up
We want to go home.

So close long-term Units down
Take me back to my home town
Somewhere I can be safe, a place of my own
And give proper thought
To my need for support
I feel so broke up
Just want to go home.

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