Assessment and Treatment Units

Julie Layton – Chief Executive at Advance Housing & Support

Who could fail to be moved when reading Tony’s story. It is a tragedy for Tony, his family and the other 100 patients like him that have been held in Assessment and Treatment Units (ATUs) for more than 20 years. Equally, it is incredibly disappointing that six years after the Transforming Care Programme began, there are still over 2,000 people with learning disabilities and/or autism who are detained in ATUs across the country. With every target to reduce this number being missed and pushed to future years, we cannot be surprised to hear stories such as Tony’s.

We firmly believe and call on Government to do everything it can, and with the utmost urgency, to ensure that everyone in an ATU has access to the expertise and funding to support a transition into the community.

As a not-for-profit housing and support provider we have a proud record of using Positive Behavioural Support and intensive 24/7 support to help people out of long-stay and secure settings to live well and successfully in their own homes.

There are certainly challenges. Finding suitable housing with skilled Support staff is a complicated process. We are pleased to be a founder member of the Learning Disability and Autism Housing Network (LDAHN), pushing Government for a policy framework to enable the development of quality homes and housing services, specifically for people with learning disabilities and autism. Recruitment of Support colleagues is getting ever more challenging as we struggle to compete on pay with other sectors.

But we firmly believe that with the right amount of determination, collaboration and funding, it should be possible to give everyone the opportunity to move out of a setting which no longer meets their needs and into their own home in the community.

Some of our customers come from a forensic mental health setting; others come from, what may have been, years spent in children’s homes, care homes, hostels as well as long-stay hospital settings. Where some agencies or providers may give up fighting, challenging and demanding the change that these people deserve, we will not. We do not pretend we have a magic formula that makes things work perfectly but what we have found is that our person-centred approach is successful when all parties and agencies work together to find a solution that preserves the dignity and level of independence the individual deserves.

We have a long history of this type of work. For example, John – a young man of 24yrs old – had been at Winterbourne View. When we got involved with his support it was clear that a safe solution was needed to support him in the community – his behaviours were challenging and certainly exacerbated by the terrible experience he had in Winterbourne. Advance worked with the local council and NHS England to fund a shared ownership arrangement to enable him to purchase a bungalow in which he has lived in since 2015, with 2:1 support.

Our home ownership for people with long term disabilities product enabled him to buy a stake in a home of his choosing. This gives him the security of home ownership and his family have assurance that we will maintain the property to a high standard. In his new home he receives additional support and input from two other local mental health charities.

We initiated a Multi-Disciplinary Team meeting with all partners to pull together the right support package for John. Our Regional Housing Officer secured a disabled facilities grant to adapt the property to meet his needs and we brought together a dedicated team to support him in his transition to independent living. While the work was being done to adapt his new home, and to minimise disruption, John was supported to go on holiday - the first in his life.

As well as a better quality of life, moving out of ATUs makes economic sense. The cost of a bed in an inpatient unit (such as an Adult Treatment Unit) is estimated by NHS England to cost on average £3,500 per week. The National Audit Office identifies the cost of inpatient admission for people with a learning disability in a mental health hospital as £180,000 per annum (£3,461 per week). In reality, however, the costs can vary hugely from one person to another, with packages in ATUs costing upwards of £10,000 per week.

Moving people out of ATUs and long-stay secure units is not simple – the slow but gradual progress with the Transforming Care Programme shows us that – but transition is possible and is a reality for some. ATUs have their place and purpose in certain situations but for those families who want their sons and daughters to live in the community with dignity - shouldn’t that be an option open to all of them?

It will take a concerted effort on behalf of housing and support providers, charities, local authorities and Government to work collaboratively to find the right `person-centred’ solution and provide a fully funded package of care and support that works for the individual. Living as independently as possible with dignity, free from fear and harm is a basic human right.

Ten years on from Winterbourne View. Two years on from Whorlton Hall. Bethany’s story – driven by the pain and anguish of a father fighting to improve the life of his daughter. Now Tony and the pain and frustration of his parents, Pam and Roy, who just want their son to have a suitable home and support in the community.

We are still hearing harrowing stories of people living in the most awful conditions while there are solutions available in the community. We can and must all do better together.”


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