According to recent NHS data, more than 2,000 people with learning disabilities and autism remain housed in mental health hospitals across England and Wales.
An independent review into the use of segregation for people with learning disabilities and autism, published in 2023, found that a significant number were being held in solitary confinement – some for as long as 20 years.
Wide-ranging reforms to the Mental Health Act (MHA), in place since 1983, received royal assent in December 2025. Previously, learning disability and autism fell within the act’s broad definition of “mental disorder” and could be used as grounds for detention.
That is no longer the case. Now, in theory at least, you cannot be sectioned solely because you suffer from a neurodevelopmental condition.
The intention is clear: to reverse the over-reliance on inpatient placements and instead provide greater community support. Those requiring compulsory care but not demonstrating a mental health condition should now be able to receive it without the threat of institutionalisation.
Critics warn, however, that without significant investment in community services, the changes risk leaving some of society’s most vulnerable people without any adequate support. They are no longer detained, but not properly cared for either.
Autistic people’s rights will still be at risk, they say, increasing the threat of crisis, neglect or even entanglement with the criminal justice system.
The consequences of getting this wrong are not abstract. Behind the legal complexity are real people – often non-verbal, unable to advocate for themselves – for whom the difference between a hospital bed and a prison cell may hinge on how these reforms are funded and implemented.
Jen Craft, chair of the Learning Disability APPG, has urged the government to set out how it will provide support to people with autism and learning disabilities when they leave mental health hospitals.
“There currently doesn’t seem to be any kind of articulation of what sufficient community support looks like, or how we are going to get there, and that’s where my real issue with it lies,” the Labour MP tells Spotlight.
Craft cites a structural tension between the NHS and local authorities threatening to fundamentally undermine the reform. “If [the individual] is in an NHS setting, the local authority is not paying for it. Once they return to the community, [councils] then have to find the money to house them and fund that care package.
“So you have budgets constantly competing against each other, there is a temptation to look at what you can reasonably afford at that point in time.”
The result, in the most extreme cases, is that people end up trapped and held indefinitely in inpatient settings, at enormous cost to the public purse, because no local authority will fund the community package needed to discharge them.
Craft believes that the cost of keeping someone in long-term segregation – in some cases over £1m per person per year – would often be better spent elsewhere.
“[Families] tell me if you literally gave us the money you were paying to keep their loved one in long-term segregation, we can put the support in place for them in the community.”
But the money, she argues, is only part of the problem. The deeper issue is that this group of people has never commanded the political attention needed to force change.
“They’re just locked away, out of sight and out of mind. Being in a locked mental health unit is possibly the worst place that they could be,” she says.
“Treatment for someone with those conditions in that situation is completely and utterly impossible. The scandal of people being detained is the tip of an iceberg of how adults with learning disabilities and autism are treated as a whole. And what’s underneath it, I think, is horrific.”
Dr Peter Beazley, a clinical psychologist and mental health law specialist at the University of East Anglia, fears clinicians will seek alternative legal routes to detain patients now that section three is no longer available to them.
The most obvious alternative, the Deprivation of Liberty Safeguards (DoLS), he says, is “without question a much more poorly safeguarded option” than the MHA.
DoLS are legal measures designed to protect those who lack the capacity to consent to their care arrangements. However, critics argue the system offers limited access to appeal, patchy legal representation and no guaranteed funded aftercare support on discharge.
But Beazley’s central concern is what happens to people with autism or learning disabilities who cannot be detained in hospital, in a system where community services are already stretched beyond their limits.
In a submission to the Commons Mental Health Bill Committee last June, he warned that without intervention, more autistic people and those with learning disabilities risk being sent to prison because of “unmanaged and unnecessary escalation of risk in the community”.
Beazley outlines a hypothetical situation to Spotlight: a person with a significant learning disability, living in a residential home, seriously assaults a support worker.
Previously, that person would have been detained under section three of the MHA, if they are at risk of harming themselves or others due to a ‘mental disorder’.
Their future care, then, would be planned in a way that doesn’t involve the criminal justice system. Under the reformed MHA, that option disappears.
A criminal justice outcome is unlikely, he argues, because the Crown Prosecution Service will decline to press charges either where a person lacks the mental capacity to form criminal intent, or the case itself is not in the public interest.
The government’s assumption, he says, is that cases like this would instead be handled through DoLS.
But DoLS, Beazley points out, can only be used where a person is not actively objecting to those arrangements. Someone in acute crisis, distressed or resistant falls outside that framework entirely.
“If the person is objecting,” he says, “there will be no route to use this framework as a means to authorise detention.” If non-verbal individuals have residential provisions, sharing many of the restrictions of hospitals but without any of the safeguards, what will happen to these people?
“They would then have to be discharged,” he tells Spotlight. “By that time, they’ve been made homeless, so they can’t go back to their accommodation. There’s no way the local authority could have sorted another place. The criminal justice system isn’t going to be doing anything about it. So the person is on the street.”
Beazley worries there could be a new cohort of vulnerable individuals “essentially left with nothing”. Most people with autism or a learning disability, he stresses, present no greater risk to the public than anyone else.
But the reforms, he argues, dismantle the very process designed to support those who do without replacing it with anything adequate.
“We are removing a process that can deal with and support that in a way that doesn’t involve that person going through the criminal justice system,” he adds.
Dan Scorer, head of policy and public affairs at Mencap, agrees that the DoLS could be used “inappropriately” to keep the same people in the same hospitals, under a weaker legal framework with fewer safeguards.
“The government needs to be vigilant when these changes are brought in. That’s something we absolutely do not want to see happening”, he adds.
Community support presents a “chicken-and-egg” problem, he continues. “We need the government to commit to investing in and planning the community support so that they can meet their commitment to bring in this vital change to the [MHA].”
Some areas have already shown what properly resourced community support can look like.
In the West Midlands, Black Country Healthcare NHS Foundation Trust has worked with care provider Empowering U to develop crisis support to help families and social care providers. This includes a 24-hour crisis hotline and ‘crash pads’ – alternative short-term accommodation in the community that can be used in crisis situations.
“They’ve got a special provision that people can go to in a crisis situation and be supported, as opposed to being sent out of the area to an inpatient setting. They’ve not admitted anyone for years,” Scorer says.
For Scorer, the Black Country model shows what is possible. Without a government commitment to fund and replicate it nationally, he fears the legislation will continue to stay at a standstill.
“Unless we get that plan and that investment for community support and housing, we are all massively worried that this huge change in legislation will never be brought about,” he says. “We fear that, a bit like [Liberty Protection Safeguards], this is a legislative provision that will never actually be brought into force.”
What does that mean for those who cannot advocate for themselves? “It means people locked up in a cell and fed through a hatch, potentially for months on end. Families holding their loved one’s hand through a hatch in a cell door.
“These are conditions people would think were eradicated 100 years ago, but it’s still happening now.”
Nobody, including those who fought hardest for these reforms, can say when the waiting to see them properly enacted will end.
Scorer tells Spotlight he does not expect the changes to come into force until at least 2029. The people these reforms were written to protect have already been waiting long enough.
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