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human rights

psychiatrists, approved mental health Government action ineffective
professionals and psychologists. CTRs were the governmental response to
These questions must not be shirked the findings of the serious case review
because of the potential harm that can into abuse at Winterbourne View.
arise from the significant decisions such Events since then have proved that CTRs
people make. have not produced the desired outcomes
First, when does “aggression” morph of significantly reducing the population of
into “abnormal aggression”? Who has the people with a learning disability
right to decide this, when the results are compulsorily detained by the state.
potentially momentous and life changing? At the Cawston Hall report launch, patients were They have also not led significantly to
Are we content to leave this to the described as “prisoners who were incarcerated” people having access to a good quality of
responsible clinician? life in the least restrictive placements in
Second, when does “irresponsible This becomes clear when one compares the community commensurate with their
conduct” morph into “seriously how the “abnormally aggressive and/or own and others’ safety.
irresponsible” conduct? Arguably, such seriously irresponsible” conduct criteria in Instead, institutional abuse of
perceptions are more culturally this act and its code of practice are vulnerable people continues. Following
determined in the eyes of the beholder applied to people with learning disabilities the Cawston Park review, the
than clearly demarcated within the law. and those who are not legally defined as government’s response has been to add
To what extent can the responsible having a mental disorder. yet another layer – safe and well reviews
clinician involved in admitting a learning Should a non-learning-disabled person – to an already-crowded area.
disabled person make an appropriate, exhibit such behaviour, his – for the Additional key lines of enquiry have
accurate clinical judgment – in a person is highly likely to be male – been added to an already extensive list in
frequently highly charged encounter – outcome will be very different from our CTRs, with an increasing focus on more
that the “abnormally aggressive and/or potential patient with a learning disability. detailed interviews with inpatients and
seriously irresponsible conduct” is directly If apprehended by officers of the state, their relatives. External investigators have
attributable to that individual’s identified our unfriendly male may find himself been allowed dedicated time to observe
clinical condition, in this particular case initially arrested, detained, possibly briefly activities on wards.
their learning disability? deprived of his liberty in a police cell, then As critical as it is to spend time with
Is it inconceivable that the genesis of cautioned or released on bail to appear in patients, families and advocates in their
the perceived “abnormal” aggression court at a later date. living environment, this does not address
might lie elsewhere and not be directly the question: what is key factor that
attributable to the learning disability? enables certain staff to bully, physically
The cause may lie in some other intense Quite simply, abusers do not and verbally abuse and humiliate
and powerful source, such as severe pain value, respect or like those vulnerable people?
caused by a medical condition such as Quite simply, abusers do not value,
kidney stones. Or it could be caused by they are charged to care for respect or even like those they are
some unknown trauma that has not been and support. They appear to publicly charged to care for and support.
identified because of the person’s They appear to revel in the power of
complex communication needs. revel in the power of control being able to control people.
In such cases, any compulsory Finally, what role – if any – do
admission would be unlawful, as would psychiatrists and psychologists play in
any mandatory treatment under the act. However, there will be no significant setting, reinforcing and challenging the
There is a substantial body of literature, hindrance to his human rights. Depending attitudes and practice that collectively
practice and evidence in the field of on various contextual factors, he may make up the culture within which the
learning disability that derives from the receive a custodial sentence, the length of powerless are detained?
social model of disability (in which people which will be specified by the court. Where were the psychiatrists and the
are seen as being disabled by barriers in The outcome is likely to be a very psychologists at Winterbourne View,
society). This is continuing to grow around different outcome for a learning-disabled Whorlton Hall and Cawston Park?
the role of what is labelled “challenging person who, from the point of admission, Is the model of leadership open
behaviour” in the communication will experience significant effects on their and transparent? Is the model of care
strategies of cognitively impaired people. human rights through detention. under the Mental Health Act still
Many require the skills of specialist Also, I would like to examine some of the appropriate, given the concerns that have
speech and language therapists to factors that over time have contributed to emerged in relation to people with
minimise misunderstandings and reduce the gratuitous violence and neglect learning disabilities?
Evelyn Simak/geograph.org.uk CC BY-SA 2.0 interventions might prevent a breach detained in assessment and treatment operating within a closed system. We
In every case of institutionalised abuse,
inflicted upon patients with a learning
the possibilities of aggressive conduct
disability who have been “lawfully”
being interpreted incorrectly. Such
the issue to urgently address is the culture
of human rights because of an
units and in private and NHS hospitals.
need to be more intrusive to explore the
On each occasion, some of the most
culture operating the institutions and who
unlawful admission.
sets or defines it, as well as how cultures
appalling abuse has been perpetrated on
I regard the criteria under the
Mental Health Act for the lawful
vulnerable, dependent human beings by
change for good or ill and how they can
admission of a person with a learning
other human beings deemed professional
be reinforced or challenged. n
disability into compulsory psychiatric care
as discriminatory.
or other.
Community Living Vol 36 No 1 | Autumn 2022 25
www.cl-initiatives.co.uk or given the status of carer by someone Ken Stapleton is a social worker