Bedlam is still with us in Britain

Published by The i paper (8th October, 2018)

Bethany is 17 years old. She is a girl who likes Bob Marley’s music, spending time with animals and being outside. Her father says she is the funniest girl he has ever met. But this teenager has not felt the sun or the wind on her face for nine months. And she rarely laughs. Instead, she is shut away in solitary confinement behind a locked door, fed three times a day through a hatch like a dangerous creature in a zoo.

She is obese from inactivity and has diabetes. Her small cell is furnished with just a foam bed and chair. Sometimes she gets books or colouring materials. Other times, a television is wheeled outside the big glass window. Her father finds visiting his daughter ‘horrific’ as he walks into the seclusion area and sees a row of rooms, often full of distressed young women. ‘Do you remember that scene in Silence of the Lambs when the agent Clarice Starling walks down the corridor to see Hannibal Lecter?’ he asked me. ‘Well, it’s like that.’

You might assume Beth has carried out some terrible deed to be locked up like this for the past 21 months. Even her father must kneel to speak with his daughter through the metal door’s hatch. But she has committed no crime. Instead, she is a victim of a callous state that treats a slice of society with cruelty and contempt. For this teenage girl has learning disabilities. And like scores of others, she has been left to rot by an inadequate health service while politicians break promises to help, and bureaucrats bicker over funding people in dire need.

Beth has autism, suffers extreme anxiety and cannot cope with stress – yet instead of being helped to enjoy life she is shut away in dismal seclusion. This has led to self-harm; a bit of a ballpoint pen stabbed in her arm was left there for weeks, removed only after this tragic teenager’s case was highlighted in a haunting edition of Radio 4’s File on Four. She uses ligatures made from her clothes, so staff strip off all she is wearing. The cruelty of her case spotlights shameful Westminster inertia. And, yet again, it shows how little this country cares about citizens with learning disabilities.

It is seven years since events at Winterbourne View care home in Gloucestershire exposed grotesque abuse in a supposed sanctuary of state care. Ministers responded with gushing promises to get people with learning difficulties out of such assessment and treatment units, where they were being dumped for years. But for all the fine talk, little has been achieved. There was a review three years ago, with fresh pledges to slash numbers by 30 per cent by next March. Instead, more than twice as many children are now housed in them, while 2,400 adults are trapped in institutions after a tiny drop in numbers.

This is the latest failure in noble efforts begun almost four decades ago to care for people with learning difficulties in the community. With decent support, many of these people can live freer and fuller lives in society. Yes, Beth can get stressed or become aggressive, and has been sectioned three times. But a review last year suggested she needs a sheltered home with outside access, and concluded that she could thrive with the right team. Instead, she will soon be shunted into a two-room unit, still held like a criminal in seclusion, in the same huge Northampton hospital. Beth symbolises acute political failure. But she also demonstrates the crass stupidity of a care system riven with self-defeating divisions.

She costs the National Health Service up to £13,000 a week – or £676,000 a year. It would be far cheaper – as well as more humane – to house this teenager in her own West Midlands community, where she would be closer to her family. Yet this cost would fall on her council, which – like others – struggles from the austerity that was overloaded on local authorities. Her father says one council jobsworth has already complained that Beth has cost them more than £1m. She is far from alone in being imprisoned by such official ineptitude. At least 825 others with learning disabilities are stuck in hospitals because of ‘delayed discharge’. Meanwhile, charities and private firms are doing well out of the system.

Beth’s hospital is run by St Andrew’s Healthcare, which claims to be the country’s biggest provider of specialist mental healthcare, deriving almost all its revenue from the NHS. As a charity, this body boasts that profits are ‘reinvested into patient care’. Yet accounts show it gave its departed chief executive £930,000 in salary, bonuses and a pension over the past two years, and there were 72 other staff on six-figure salaries last year. Meanwhile, nurses earn about £12 an hour and some care assistants just £8 an hour.

This organisation’s income has more than doubled in a decade from the NHS. It was investigated last year by Channel 4’s Dispatches, which exposed 600 instances of face-down restraint used on young people over six months and questioned if restrictive measures might be worsening behavioural issues in young charges with learning disabilities. St Andrew’s told me it would not comment on individual cases but insisted its role was to provide the best possible care and help people to move on.

Ministers talked grandly of ‘transforming care’ after the Winterbourne View scandal, then abandoned the issue – and the citizens most in need of support – at bottom of their in-tray. Earlier this year, the Health Secretary did not even bother responding properly to a scathing review that found poor NHS care contributed to early deaths of people with learning difficulties. Now think of Beth trapped in her tiny cell. She has started talking to imaginary friends. Have we really moved on that far from Bedlam?

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