From Hospitals to Homes: Learning Disability Inpatient Services

A report by the Stolen Lives Homes Not Hospitals Task and Finish Group, a subgroup of the Learning Disability Ministerial Advisory Group which advises on improving the lives of people with learning disabilities in Wales.

In memory of Hefin David MS (13 August 1977 to 12 August 2025)

Friend and ally of Stolen Lives. A strong advocate for social justice. A principled politician who led with his heart.

This report has been compiled by the Stolen Lives Homes Not Hospitals Task and Finish Group regarding the inappropriate sectioning and hospitalisation of people with learning disabilities and autistic people. 

The only way to end this human rights scandal is for Welsh Government to listen to those affected and to act. Anything less is a failure to confront the issue.

Welsh Government has a legal obligation to respect, protect and fulfil human rights. Whilst people with learning disabilities and autistic people continue to be inhumanely detained in hospitals then Wales is failing in its human rights obligations.

This report outlines the key issues within the current system and provides a comprehensive set of recommendations to address them. There is much that needs to change, and the report is unapologetic in the number of recommendations required to achieve the sea change that is so evidently needed.

I would like to thank the Stolen Lives Homes Not Hospitals Task and Finish Group for their work on producing this report.

To the families across Wales who are living through the nightmare scenario of their loved ones incarcerated in a seemingly pitiless and invulnerable system, I hope this report provides some confidence that things will change.

It is incumbent upon Welsh Government to lead this change and I look forward to working with them on ensuring that the recommendations in this report are delivered at pace.

Dr Dawn Cavanagh

Founder of Stolen Lives

The Stolen Lives Homes Not Hospitals Task and Finish Group met 8 times between November 2024 and August 2025. Members of the group discussed the 5 calls to action in the Stolen Lives Manifesto and made recommendations based on each manifesto ask. The recommendations were then refined between meetings, incorporating member feedback via email, and a final shaping meeting on 14^th August, 2025. The Task and Finish Group comprised members of the Learning Disability Ministerial Advisory Group and the Stolen Lives campaign group.

Membership

Sophie Hinksman (Co-Chair, All Wales People First)

Joe Powell (Co-Chair, All Wales People First and Stolen Lives)

Professor David Abbott (Stolen Lives)

Jordan Brewer (Cymorth Cymru)

Adrian Burke (First Choice Housing)

Dr Dawn Cavanagh (Stolen Lives)

Janis Griffiths (Stolen Lives)

Julian Hallett (Down’s Syndrome Association)

Sion Jones (Mencap Cymru)

Jessica Keeble (All Wales People First)

James Radcliffe (The National Autistic Society Cymru)

Oliver Townsend (Mirus)

Kirsty Warner-Davies (Mirus)

Sam Williams (Learning Disability Wales)

Officials in attendance

Jim Widdett (Social Care Wales)

Julie Annetts (Welsh Government)

Shelley Davies (Welsh Government)

Lara Homan (NHS Wales Performance and Improvement)

Rhiannon Ivens (Welsh Government)

Emily Johnson (Welsh Government)

Rachel Ann Jones (NHS Wales Performance and Improvement)

David O’Brien (NHS Wales Performance and Improvement)

Natalie Hughes Owen (Welsh Government)

Dave Semmons (NHS Wales Performance and Improvement)

Andrew Stevenson (Welsh Government)

Sharon Williams (Welsh Government)

Introduction

People with learning disabilities and autistic people are being admitted to hospital inappropriately because the right care and support in the community is not there. Many people stay too long in these settings and are subject to unnecessary restrictive practices, breaching their human rights. 

The Stolen Lives campaign group was formed by families in response to this, following years of fruitless work alongside learning disability organisations to raise concerns with the Welsh Government. Stolen Lives’ manifesto for change launched in April 2024 alongside a protest outside the Senedd under the banner of ‘Homes Not Hospitals.’ This led to a meeting with the Minister for Mental Health and Early Years, Jane Bryant, the result of which was the establishment of the Task and Finish Group, which has authored this report.

Human Rights abuses

Inappropriate detention of people with learning disabilities and autistic people is a human rights issue. Detaining people with learning disabilities and autistic people in hospitals can be a breach of their human rights under the Human Rights Act (1998), particularly the right to liberty (Article 5) and freedom from degrading treatment (Article 3), when detention lacks the provision of individualised, appropriate, and therapeutic treatment. Current practice also contravenes Articles 14 (the right to liberty) and 19 (the right to live in the community) of the UN Convention on the Rights of Persons with Disabilities.

Even when a mental health need is present, a secure hospital is not the right environment and leads to increased distress, often taken as justification for prolonging their incarceration. Abuses in these settings cause long-term psychological harm and trauma.

Oftentimes, people are placed far from home, where they are put at greater risk isolated from their families and support networks.

This does not just happen to adults. There are children who have lost their entire adolescence in secure hospitals.

Families do not know or understand their rights, are often traumatised, and feel isolated and helpless. Legal injunctions are used to stop them from speaking with the media, and families live in fear of repercussions from speaking out.

The closure of specialist Learning Disability Assessment and Treatment Units by some Health Boards in Wales has resulted in people placed in mainstream mental-health inpatient hospitals where their behaviour is viewed through a mental health lens, and sometimes criminalised rather than understood in the context of unmet needs.

Welsh policies and legislation

There is a gap between the aspirational policy set out in The Social Services and Well-being (Wales) Act, and implementation on the ground. Years of austerity, exacerbated by the COVID-19 pandemic, have heavily impacted services, which has increased the likelihood of placement in secure hospital settings, as families struggle without the support they need.

Social workers, with unsustainable caseloads, and insufficient budgets are found by families to be unsupportive gatekeepers of resource, rather than providing the help they need to avoid going into crisis. Indeed, asking for help has sometimes directly resulted in sectioning of families’ loved ones, rather than providing the reasonable support requested.

Policies and procedures, supposed to safeguard and protect people, are failing, and oftentimes are not implemented as they are issued as guidance rather than mandatory duties.

Practice on the ground is a far cry from the groundbreaking All Wales Strategy of 1983, which recognised that learning disability is not a medical condition and people with learning disabilities are entitled to live normal patterns of life in the community.

Data Collection

Data must be collected to accurately measure the scope and extent of inappropriate placements, which will also give an idea of the types and quantities of services that need to be built to address the issue.

Recommendations

Recommendations are categorised under 8 headings:

1. stop the inhumane detention of people with learning disabilities and autistic people in secure hospitals
2. improve services so we can prevent admission and get people out
3. review (undertake a number of reviews of current practice to reduce and prevent harmful approaches)
4. report and publish concerns so that there is transparency and real accountability in the system
5. strengthen legal processes and current legislation to enhance the rights of individuals and their families
6. appoint a commissioner for learning disability
7. review the work of social workers and other professionals
8. improve complaints processes

Introduction

Numerous reports have highlighted that people with learning disabilities and autistic people are admitted to hospital inappropriately because the right care and support in the community is not there, and that many people stay too long in these settings and are subject to unnecessary restrictive practices (Care Quality Commission, 2020). The Bubb report Winterbourne View – Time For Change, which came in the wake of the Winterbourne View scandal in 2014 stated that:

For many years too many people with learning disabilities and autistic people have been, and continue to be, in inappropriate inpatient settings, often a very long distance away from family and their communities.

Although this is an issue that exists across the United Kingdom, it is the responsibility of the Welsh Government to address this concern in Wales.

The Stolen Lives campaign group was formed by families in response to the inappropriate detention of people with learning disabilities and autistic people in secure hospital settings, and the threat that this poses to their human rights, due to a lack of appropriate housing and community support in Wales.

Prior to this, concerned families reported that they had tried to work with learning disability organisations such as the learning disability consortium to raise their concerns with the Welsh Government, but saw little change in their relatives’ circumstances. Families felt frustrated by the Welsh Government’s position that they did not get involved in individual cases. Parents felt they had no choice but to work together to campaign for change.

On 17^{th of} April 2024, the Stolen Lives campaigners protested outside the Senedd under the banner of ‘Homes Not Hospitals’. They were supported by the third sector and many members of the Senedd, including Hefin David MS, Sioned Williams MS, the Chair of the Cross-Party Group on Learning Disability, and Mark Isherwood MS, the Chair of the Cross-Party Group on Disability. Stolen Lives produced a Manifesto.

The Manifesto contained 5 calls to action:

1. tell us how many people with a learning disability and autistic people are in hospitals
2. explain how you will bring children and young people closer to home and out of these places
3. listen to us and understand what families go through
4. see that sectioning people is not the answer just because services fail to meet their needs
5. work with us and people with a learning disability to make support better

On 8^{th of} May 2024, the Stolen Lives group, supported by Sioned Williams MS and third sector representatives, met with the then Minister for Mental Health and Early Years, Jane Bryant. Dr Dawn Cavanagh of the Stolen Lives campaign explained the issues that many families across Wales were facing and explained how she believed that this was a systemic issue and one that needed urgent Welsh Government intervention. The Minister approved a dedicated Task and Finish Group to be established, under the Learning Disability Ministerial Advisory Group, to make recommendations to the Minister about how to address this issue.

A Human Rights issue

The inappropriate detention of people with learning disabilities or autistic people is a human rights issue. The Human Rights Act (1998), which draws its fundamental rights and freedoms from the European Convention on Human Rights (ECHR, 1950), contains important human rights protections for people who are deprived of their liberty in mental health settings. Some of these are:

• procedural safeguards against arbitrary (unlawful) detention (Article 5 ECHR)
• right to be free from inhuman and degrading treatment (Article 3 ECHR)
• right to home and family life (Article 8 ECHR)

The failure of the State to provide social care support should not be considered an appropriate criterion for admission and sustained detention. Allowing the detention of people with learning disabilities or autistic people, without therapeutic benefit, places the Government at risk of breaches of the ECHR. (Scottish Human Rights Commission, 2025, p.4). 

The UK ratified the UN Convention on the Rights of Persons with Disabilities (CRPD, 2006) in 2009 (The House of Commons Library, 2022). The CRPD (2006) is an international human rights treaty that aims to protect and promote the human rights of people with disabilities. Article 14 specifically guarantees the right to liberty and security of persons with disabilities. This includes the right to be free from arbitrary detention or deprivation of liberty (Doyle Guiloud, 2019). Article 19 promotes the right to live in the community, with choices equal to others, and against institutionalisation: 

[t]o respect the rights of persons with disabilities under article 19 means that States parties need to phase out institutionali[s]ation.’ (United Nations Committee on the Rights of Persons with Disabilities, 2017). 

The Convention prohibits any discrimination based on disability, including discrimination related to detention or deprivation of liberty (Equality and Human Rights Commission, 2017). 

New Routes Home, the Scottish Stolen Lives equivalent, worked with the Scottish Human Rights Commission to produce a human rights assessment of progress from institutionalisation to independent living in Scotland. Together, they have produced a framework of human rights measurement based on internationally recognised best practice, for duty bearers to apply and to identify what is needed to ensure that people with learning disabilities or autistic people move out of hospitals and into their own homes in the community in accordance with the CRPD Article 19 right to independent living (Scottish Human Rights Commission, 2025). There is the potential for Wales to adopt this framework.

On 5^th December 2024, the Senedd supported calls to end the human rights scandal of people with a learning disability or autistic people being inappropriately detained in secure hospitals. Sarah Murphy MS, Minister for Mental Health and Wellbeing, remarked 

this is a human rights issue…one person in a bed and not in a home is one too many (Senedd Record Plenary, 4 December 2024).

Many people with learning disabilities admitted to hospital do not have a mental health condition. There is nothing to ‘treat’, so they are merely being contained and restrained both physically and chemically due to a lack of appropriate housing and social care support (UK Parliament, 2019).

Where people with a learning disability or autistic people do have mental health needs, a secure hospital is still not appropriate. Hospitals are restrictive, noisy, congregate, and very difficult places for people with sensory issues. They often result in people with learning disabilities or autistic people becoming increasingly distressed. As people become distressed, they are more likely to be subjected to restrictive practices, such as restraint, long-term segregation, and seclusion (Care Quality Commission, 2020; Hollins, 2023).

Staff working in secure inpatient environments often have limited experience of working with people with learning disabilities or autistic people. This can mean that distressed behaviours triggered by a poor environment and inadequate support can further justify in the minds of the professional that the person is not yet ready to leave the facility, delaying discharge and creating a vicious cycle (Care Quality Commission, 2020).

Stolen Lives families report harrowing cases of human rights abuses, such as inappropriate use of physical and chemical restraint, and the use of solitary confinement. Such abuse causes significant long-term psychological harm and trauma for people with learning disabilities or autistic people (Care Quality Commission, 2020; Hollins, 2023). Stolen Lives knows of 2 deaths that have occurred in secure hospital settings.

Some people with learning disabilities or autistic people are sectioned as children, far from their homes and families. Stolen Lives is aware of cases where children have been sectioned and lost their entire adolescence behind hospital walls. Stolen Lives is aware of children who have been subjected to restrictive practices, including physical and chemical restraint, and seclusion. The rights of the child are a set of entitlements recognised for all individuals under the age of 18, as defined by the UN Convention on the Rights of the Child (UNCRC) (UNICEF, n.d). Article 37 states:

Children should be arrested, detained, or imprisoned only as a last resort and for the shortest time possible. They must be treated with respect and care, and be able to keep in contact with their family. Children must not be put in detention with adults.

Article 23, concerning children with a disability, states:

A child with a disability has the right to live a full and decent life with dignity and, as far as possible, independence and to play an active part in the community. Governments must do all they can to support disabled children and their families.

Stolen Lives believes that the Welsh Government is failing children with disabilities in this regard.

Families report that they do not know or understand their rights and often do not know where or how to access those rights (Joint Committee for Human Rights, 2019). Families report being traumatised. Many feel isolated and have experienced difficulties with their mental health. Some family members have felt suicidal, with a few having attempted to take their own lives. There is no psychological support for family members and people with learning disabilities or autistic people post-discharge (Stock et al., 2024). 

Stolen Lives families have reported having legal injunctions placed on them to prevent them from speaking to the media or their MP/MS about their loved one’s experiences. Such injunctions may be necessary to protect vulnerable individuals or sensitive information. However, they can also raise significant human rights concerns, particularly around freedom of expression and access to justice, especially if families are trying to raise concerns about the care of a loved one or challenge decisions made by public authorities. Families report that this leaves them feeling completely powerless and in fear of repercussions if they do speak out, such as losing visitation rights or being shut out of decisions.

There are also people with learning disabilities or autistic people placed in secure hospitals who do not have families to advocate for them, which makes it even more difficult for their voices to be heard.

Stolen Lives families report that even when people are deemed to be doing well by health professionals there is no loosening of restrictions, let alone discharge to a good home. There are cases of people with learning disabilities who have been placed in hospital settings for over 30 years. 

Concerns were raised about people with learning disabilities being placed out of county following the Winterbourne View Scandal, a scandal that was acknowledged by the Welsh Government (Welsh Government, 2013):

In 2011 we were all shocked to learn of the appalling abuse suffered by adults with a learning disability at Winterbourne View Hospital, near Bristol which was identified through a BBC Panorama Programme. We determined then to do all we can to ensure that such abuse never happens in Wales.

The number of people with learning disabilities or autistic people known to Stolen Lives placed outside of county or country indicates that the Welsh Government are yet to address the issue of people being placed far from home. Stolen Lives knows of families from Cardiff whose relatives have been placed in St Andrews in Northampton. St Andrews Hospital in Northampton has faced documented issues of patient abuse and neglect, including allegations of staff misconduct, inadequate safeguarding procedures, blanket restrictions, and insufficient staffing (Care Quality Commission, 2025). When people with learning disabilities or autistic people are placed far from home they are at greater risk because they are isolated from their support networks and families. This makes it difficult for families, and health and social care professionals, to stay involved in their care.

Stolen Lives families believe that there have been huge ramifications caused by the closure of specialist Learning Disability Assessment and Treatment Units by some health boards to save money. Stolen Lives families report that the closures have resulted in people with learning disabilities or autistic people being placed in mainstream mental health inpatient hospital provision, where they are more likely to be viewed through a mental health lens. Families report that distressed behaviour has been criminalised rather than understood within the context of unmet needs for people with learning disabilities or autistic people, with gateway assessments undertaken for forensic secure hospitals.

The benefits of not being in hospital for no justifiable reason and living a good/normal/flourishing life are obvious, and there are families whose loved ones now live in the community having endured years of unnecessary hospitalisation. On the one hand, this is positive but begs the question about why they were ever hospitalised in the first place. See Head et al. (2018) and their research, Transforming identities through Transforming Care: How people with learning disabilities experience moving out of hospital: 

For the participants in the study, moving was an opportunity to extend and elaborate this sense of identity from something narrow or problem-focussed, to becoming someone who had a wider array of meaning-making about who they were.

We see this clearly in work by Dowling et al. (2024), where people talk about their new lives after being finally discharged to live in the community:

I can have my friend round to have dinner and watch TV. I can phone anyone when I want to. I can have sugar in my tea. I like it here. I don’t want to move; I wouldn’t change a single thing.

Jack is a young man with a learning disability and autism, who was once locked up in hospitals in Wales. Jack says that life in the community means that he is now ‘a free man’, he can ‘see the moon and the stars’, and ‘he has grass in [his] garden’ (Caerphilly Observer, 2024).  This is a sad indictment of a system in Wales that has deprived him of such simple pleasures for so little reason and at such cost to him, his family and the taxpayer.

Welsh policies and Legislation

In 2011, The Welsh Assembly Government’s Sustainable Social Services a Framework for Action was published by Gwenda Thomas MS, the then Minister for Children and Social Services (Welsh Assembly Government, 2011). The report outlined concerns about the political times of austerity and recognised that the services that were being offered were not adequately meeting the needs of those who were using them, and that resources were not being used efficiently. Wales needed to change the way it delivered services in order to better meet people’s needs in a sustainable way. The framework aimed to anticipate and mitigate the challenges of austerity with a clear focus on prevention. The publication of the framework was accompanied by a Ministerial Statement (Welsh Assembly Government, 2011).  This Framework was the forerunner to the Social Services and Wellbeing (Wales) Act 2014 and the National Outcomes Framework (2023). 

It was inevitable that the Social Services and Wellbeing (Wales) Act 2014 would have teething problems when it was first enacted. It is only during implementation that we can adequately assess how effective a policy is.   The Measuring the Mountain report, commissioned by the Welsh Government to measure the effectiveness of the Social Services and Wellbeing (Wales) Act 2014, stated that access to appropriate services was a barrier to many people (Cooke, Iredale, Williams, and Wooding, 2019). There was a gap between aspirational policy and implementation. This is a sentiment shared by many families and people with learning disabilities or autistic people. Overall, there is a perceived and persistent lack of urgency in dealing with such a pressing issue as hospitalisation. This lack of ‘urgency’ is reflected in the summary of a large programme of research undertaken in England by Gladsby et al (2024). The top tip from people affected by ‘being stuck in hospital’ was: 

Our lives are on hold – do your jobs and get some “oomph”.

Fourteen years of austerity have heavily impacted the infrastructure of available services for vulnerable adults with learning disabilities or autistic people. This situation was exacerbated during the COVID-19 pandemic. Many day services, for instance, have still not reopened or are running on a reduced capacity (University of Warwick, 2022). This increases the likelihood that people with learning disabilities or autistic people will be placed in secure hospital settings, as more families struggle because the support is not there. Learning Disability Wales (2025) paint a picture of crisis in the learning disability community in Wales. There is a sense of a decade of ‘activity’ committees, reports, strategies, but no meaningful change beyond the façade of ‘action.’ 

Poor social care is a key factor in sectioning. Stolen Lives families have told us that sectioning has taken place after placements have broken down and often after families have made complaints about those placements due to inappropriate environments, issues with staff, and concerns about use of restrictive practices, abuse, and neglect. We found almost no examples of effective social work support (sometimes quite the opposite with social workers perceived as unsupportive gatekeepers of resource).

Stolen Lives families report that people with learning disabilities have found themselves sectioned after family members have asked for respite or other forms of support, such as care packages. Stolen Lives families report that some people with learning disabilities have been detained because they were told by health boards and local authorities that the situation could become unsafe if this support was unavailable. 

It is becoming more difficult to find appropriate placements for people with learning disabilities or autistic people when in a crisis. Many Stolen Lives families feel that Regional Partnership Boards, which were supposed to help ensure that health and social services shared commissioning responsibilities and removed previous barriers to commissioning, have not worked. They feel that this is because the Regional Partnership Boards do not have any executive functions. The local authorities and health boards still hold the purse strings. 

Families from Stolen Lives report that the processes around sectioning are not lawful. Families state that appeals to the Public Service Ombudsman often fail, and that they follow the same procedures and protocols that led to the original decision of the sectioning. This means the Ombudsman concurs with the original incorrect decision.

Stolen Lives families report that the policies and procedures that are supposed to safeguard and protect people with learning disabilities or autistic people are failing. Families feel that many of the policies are not being implemented. They say this is because they are largely non-statutory, open to interpretation, and there is little or no accountability when the policies are not being implemented. It is essential that current laws are tightened in order to address this.

There is also a belief that the Learning Disability Strategic Action plan 2022 to 2026 (Welsh Government, 2022) and the Guidance: Commissioning accommodation and support for a good life for people with a learning disability in Wales (Welsh Local Government Association, 2019) are not only non-statutory, but they also focus mostly on people with learning disabilities with lower levels of need. Families say that unless there are mandatory duties placed upon those charged to commission and deliver services for people with learning disabilities or autistic people, policies are going to continue to fail vulnerable adults. The recommendations set out in the Homes Not Hospitals Manifesto (Stolen Lives, 2024) are destined to fail unless this issue is addressed. 

Stolen Lives families report that there are no specific, actionable goals concerning the ‘Homes Not Hospitals’ issue. The Learning Disability Improving Lives Programme (2018) provides a descriptive account with no significant recommendations for the Welsh Government. Section 3.1 of the Learning Disability Strategic Action Plan 2022 to 2026 (2022) states: 

3.1 Implement recommendations from the 2020 review of Adult Specialised Services ‘Improving Care, Improving Lives, National Collaborative Commissioning Unit.’ 

1. Reduced admissions through increased community-based crisis prevention and early intervention support 

2. Access to high-quality, safe, and effective specialised care as close to home as possible. 

3. Individuals are supported to return home /close to home as soon as possible. (p. 8)

It is unclear how exactly this will be achieved, by when, and by whom? Learning Disability Wales (2022) has noted the absence of specificity:

While we believe that this plan has the potential to make a significant difference to people with a learning disability in Wales, we are looking forward to seeing more detailed information in the delivery plan that clarifies how the Welsh Government is planning to achieve its goals. We also hope to see some of the goals clarified and be more ambitious in their aims so that they will make a more substantial difference to people with a learning disability in Wales.

Without the infrastructure in place to house people with learning disabilities or autistic people in more appropriate settings, placing people into a hospital in many cases is currently the only available option for people with learning disabilities or autistic people.  Indeed, it is the opinion of the decision makers who place people with learning disabilities or autistic people in secure hospitals that the placements are appropriate in the circumstances.

The placement of people with learning disabilities or autistic people in secure hospital contradicts the aspirations of the groundbreaking All Wales Strategy of 1983 (The Welsh Office, 1983) which recognised that learning disability is not a medical condition and that people with learning disabilities are entitled to live normal patterns of life in the community. 

Data collection

We must collect data to accurately measure the scope and the extent of the issue around people with learning disabilities or autistic people being placed in inappropriate settings, as well as to plan for their move into more appropriate settings. This will also give us an idea of the types and quantities of services we need to build to remedy the issue. There are broader gaps in data in relation to people with learning disabilities in Wales (Senedd Research, 2022). The Welsh Government decided neither to explore the feasibility of a Learning Disability Observatory nor to fund one.

"It’s not a hospital but it feels like one": Social care detention

Whilst the focus of Stolen Lives is on stopping the inhumane detention of people with learning disabilities or autism in hospitals, the campaign group is sometimes contacted by families whose sons or daughters are removed from their care. This tends to occur in cases where the person has just reached adulthood and has a more severe to profound learning disability. Sometimes it happens after the person has had a period of ill health and has been in hospital or has had to go into residential care temporarily. 

Families report being taken to the Court of Protection by health boards and local authorities and having legal injunctions placed on them so that they cannot speak out. Families tell Stolen Lives that there are restrictions on seeing their loved ones, who are placed outside of their communities and often in unsuitable accommodation. For example, one young person has been placed with older adults in a nursing home outside of their community. Their mother has told Stolen Lives, "It’s not a hospital, but it feels like one."

Recommendation 1: stop the inhumane detention of people with learning disabilities or autistic people in secure hospitals

• Welsh Government must make a clear statement of intent that people with learning disabilities or autistic people will be supported in an appropriate setting in their local community, for example, not a hospital or secure unit.
• Welsh Government must make it clear that any person placed in a hospital setting without a co-occurring diagnosis of a ‘treatable’ mental health condition has been placed inappropriately.
• Welsh Government needs to make it clear that Distressed Behaviour is not a valid reason to place someone in a secure hospital.
• Welsh Government needs to act to prevent the inhumane detention of children with learning disabilities or autistic children in secure hospitals.
• The Mental Health Act (1983) (MHA) is the primary law governing the assessment and treatment of people with mental health conditions in the UK, especially when they are detained in hospital. The term ‘mental disorder’ in the MHA (1983) is currently defined to include learning disability and autism, even though they are not mental health conditions. This means people can be detained under the MHA (1983) when they do not have a mental health condition, which is a significant point of discrimination.  Mental health reform aims to change this by linking Community Section 3 to ‘psychiatric disorders’ only.  However, without investment in community housing and support many people could remain in hospital under the Deprivation of Liberty Safeguards (DoLS) system, with no right to s117 aftercare. This is a system already under pressure. There might also be an increase in forensic detentions with individuals held under criminal law for behaviours that could be better addressed in a community-based setting. It is important that Welsh Government plans for mental health reform and any unintended consequences of the proposed Mental Health Bill.   
• Problems often occur soon after transition from children’s to adult services. Welsh Government should insist upon and oversee more proactive and timely strategic planning whilst people are still under children’s services, to reduce the risk of hospitalisation.
• Learning disability hospitals should be closed. We need to provide support in a community-based environment. This can be long-term or, for example, with “crash pads," which are short-term, safe, supportive accommodations that can be used as an alternative to traditional Assessment and Treatment Units.
• Welsh Government should explore human rights-based approaches developed from research and clinical practice that aim to reduce restrictive practices and support discharge, so that detained individuals can move forward with a successful transition out of hospital. For example, the Welsh Government could explore the English model HOPE(S), to end the practice of long-term segregation (Fradley, Rajan, and Delmont-Haines, 2025).
• Health boards and local authorities must change their practice so they can adequately support people in their local communities in suitable provision. It is not acceptable that any person with a learning disability or autistic person is placed out of county because the services they need do not exist locally.
• Welsh Government should issue a public apology on behalf of health boards and local authorities who for too long have placed people inappropriately, far from their communities. The apology needs to specifically acknowledge that inappropriate and prolonged detentions have occurred. Families feel that the safeguards that were supposed to protect people with learning disabilities or autistic people have been inadequate. This has had the unintended consequence of violating the human rights of people with a learning disability or autistic people.

Recommendation 2: improve services so we can prevent admissions and get people out 

Detention is an inevitable outcome of not meeting a person’s needs. Welsh Government must therefore commit to the implementation of current proposals for a full redesign of learning disability community and inpatient services. This includes improvements to:

• Prevention strategies (for example, community-based support services and interventions to prevent inappropriate hospital admissions and reduce behaviours of distress).
• Early intervention and crisis care within community services.
• Addressing the barriers to hospital discharge, such as available accommodation (especially for people with high support needs), a suitable workforce, and available funding (pooled budgets).  
• Budgets should be increased to ensure that adequate resources are available to implement the proposals to redesign community and inpatient services. This need not be permanent additional investment.  Focused investment to create suitable bespoke provision in local communities will enable expensive out of county and out of country placements to end, with the resources saved available to deliver the new locally based services.
• Creation of specialist crisis support for people with learning disabilities and autistic people who have mental health issues.

It is also important that the appropriate services are adequately commissioned and funded to deliver high-quality advice and support, which includes Psychologically Informed Environments. The workforce should be well-resourced and supported to provide this. All services should be commissioned to follow the social model of disability regarding their delivery.

There should be greater oversight and scrutiny of commissioning because when commissioning is flawed, it can result in poorly designed services, a lack of access to necessary support, and inadequate monitoring of quality and safety. This can increase the risk of sectioning or re-sectioning.  Stolen Lives recommends establishing clear expectations for the design, quality, and safety of services and regular monitoring of commissioners and providers against these standards.   

There should be mandatory duties placed upon those charged to commission and deliver services for people with learning disabilities and autistic people to ensure that people’s needs are met, especially those people with high support needs, who may need more bespoke provision. 

Stolen Lives recommends investment in training and support for commissioners and providers to ensure they have the necessary skills and knowledge to support individuals with learning disabilities and their families effectively. 

Stolen Lives is concerned that private providers may prioritise profits over the needs of individuals with learning disabilities, potentially leading to lower quality care and inadequate staffing. Stolen Lives recommends that profit be removed from the care of people with learning disabilities in Wales.   

People with learning disabilities and autistic people are rarely recognised as having housing needs when they are detained in a secure hospital.  The social housing grant should be used to move people with learning disabilities and autistic people from secure hospitals into homes in their local communities. 

Budgets should be pooled between health and social care, with the possibility of giving regional partnership boards the powers to implement this.

Health boards and local authorities must work together to address the issues of inadequate housing provision. 

Regional Partnership Boards in Wales should be given greater powers to ensure that service changes in line with these recommendations are delivered. Capital Grants must be ringfenced for this purpose.

Stolen Lives families stress the importance of community and respite services. When provision of these services is inadequate, the risk of people with learning disabilities and autistic people being detained in secure hospitals increases.  Following years of austerity, and the impact of the COVID-19 pandemic, many services have closed or are operating at unsustainable levels. These services need urgent reinvestment as part of the prevention agenda.

There needs to be a universal model of care for people with learning disabilities and autistic people in Wales, which incorporates prevention, early intervention, and crisis. 

Welsh Government should ensure greater financial transparency over the funding of placements in secure hospitals. It should publish total direct spending on this annually, including the amounts given to private sector providers. It should commission research into the total costs to the system, including indirect costs such as administration time, legal costs in defending decisions, stress on families, and associated health costs, as well as costs that will be incurred in the future, due to the trauma caused by incarceration in secure hospitals.

Direct payments should only be provided when families actively want them and when provided, they should be at a level sufficient to fund quality services.

Recommendation 3: review (undertake a number of reviews of current practice to reduce and prevent harmful approaches)

Please note there are 3 reviews advocated within this recommendation. There are other reviews advocated for in other recommendations.   

An independent panel (chaired by an independent commissioner) should review the plans and cases for each person living in a secure hospital or unit to support the process of discharge. Where this involves a child, the rights of the child under the UNCRC and other specific legislation, should be recognised.  All patients should be entitled to an independent review, not just those who have been placed inappropriately. 

This review group should include and be supported by people with lived experience, including family carers and family members. It should have sufficient powers and leverage to effect change. It should identify systemic barriers to change as well as steps that could be taken to move people with learning disabilities and autistic people from secure hospital settings and units or a specialist service into their local communities. Welsh Government should set a specific deadline for the completion of this transition.

The review group should also consider how to make amends (emotionally and financially) to people and their families who have suffered as a result of inappropriate detention. 

The review group should make recommendations for the continued improvement of data collection, analysis, and sharing. This is necessary to be able to continue to assess and address the scale of the inappropriate detention of people with learning disabilities and autistic people in secure hospitals or units.

Separately to the review into cases for each person living in a secure hospital, we recommend that there is an independent review into the inspection system in Wales. The review should be undertaken with the involvement of commissioners, and with the direct support of families, to establish whether it is effective at identifying and addressing care quality issues that lead to avoidable sectioning.

It is important that we strengthen how care and support are commissioned. We need to review the way care is commissioned for people with learning disabilities and autistic people in domiciliary care.

Recommendation 4: report and publish concerns so that there is transparency and real accountability in the system

It is recommended that Welsh Government use the review panel (recommendation 3) to establish, co-design, and operate a process for reporting, monitoring, and evaluating concerns raised by families, individuals, or services concerning the care and treatment of people with learning disabilities and autistic people entering or receiving secure inpatient services. The panel should, in all matters, have direct lines into relevant departments of the Welsh Government and the appropriate regulators.

An appropriate independent organisation should lead this work and provide Ministers and organisations with regular updates and reports on these concerns. These findings should be in the public domain. 

Automatic reporting of sections to Care Inspectorate Wales (CIW) and Health Inspectorate Wales (HIW) is needed, with reports made accessible to families and professionals.

Recommendation 5: strengthen legal processes to enhance the rights of individuals and their families

Welsh Government should strengthen existing legislation or create new primary legislation to enhance the rights of people with a learning disability and autistic people against detention in secure hospitals or units (including children). This legislation must include meaningful sanctions against bodies that fail to protect the rights of people with a learning disability and autistic people. There must be meaningful duties on public bodies to facilitate the voices of people with a learning disability and autistic people and their families in decision-making and a duty of candour on public services concerning these processes. 

The Reducing Restrictive Practices Framework should be made statutory. 

Current processes and procedures relating to the sectioning of people with learning disabilities and autistic people require stricter monitoring and evaluation. This work could also be led by an independent review panel.

Families should be able to request an independent legal review without cost if proper procedures are not followed. 

Objecting to the detention or seeking discharge can lead to negative repercussions and abuses of power. For example, one family member reported to Stolen Lives that they objected to their relative’s sectioning when told that the situation at home could become unsafe after they requested services and were told they were unavailable.  After the family member objected to the sectioning, they were told that they would be taken to court to have their right as nearest relative removed. It would seem that a lack of funding triggered an abuse of legal powers to force an unnecessary and unwarranted sectioning. Health boards and local authorities can also abuse their power through the Court of Protection, and this also needs to be addressed (please see section 3.5  "It’s not a hospital but it feels like one":  Social care detention). Families should have their rights to complain, object and seek review and remedy, without punitive action taken in response. There should be an automatic review by an independent body, if a family’s rights are changed for the worse, after they have made complaints or challenged decisions.

Going to judicial review or pursuing litigation under the Human Rights Act (1998) for breaches of human rights can take a very long time. It requires knowledge of the legal system. Furthermore, it can be difficult to find human rights legal representation as many solicitors are over capacity and not always willing to work at legal aid rates.  More should be done to support families in advocating for their relative’s human rights. 

Injunctions are sometimes used too readily, without sufficient consideration of the impact on vulnerable individuals and their families. Greater scrutiny and oversight are needed. The Joint Committee on Human Rights (2019) has called for guidance to ensure that public authorities obtain approval from the Secretary of State before applying for injunctions that ‘gag’ parents. This is to prevent the misuse of such orders and to ensure that the rights of vulnerable individuals are protected. Stolen Lives recommends that Welsh Government act on this recommendation, and where possible, that approval is sought from the relevant minister in Welsh Government for Welsh cases.

The various ways in which families report having been prevented from having a voice in the sectioning, hospitalisation, and treatment of their loved ones through legal means speaks volumes to the inequality of resources and power between organisations and individuals. Families have been intimidated by legal processes and are restrained by unequal access to funding to fight cases on an equal footing with local authorities and health boards, who have access to in-house lawyers and funding for external counsel.  Welsh Government should consider an immediate review of the current high expense and extended legal cases that are going through the Courts of Law. This should look at how the human rights of families may have been violated by the application of legal processes that do not protect the individual, but rather the organisations implicated in the detention of people with learning disabilities and autistic people. 

A bespoke specialist advocacy service for families concerning the Mental Capacity Act (2005) and the Mental Health Act (1983) should be created. It should provide trauma-informed support to families and independent legal advice. Its work and effectiveness must be subject to independent evaluation to ensure it delivers for families.

Recommendation 6: appoint a commissioner for learning disability

Welsh Government should establish a commissioner (or similar independent public appointee) for learning disability. The appointee would oversee the transition from hospitals to community settings for an interim period of 5 years and drive improvement in services. They would lead the work of the review panel (recommendation three). The aim must be to significantly improve the lives of people with learning disabilities and autistic people in Wales. Determining the timeframes for action and change should be an early task for the commissioner or appointee.

The appointee should work with families and individuals who raise concerns to ensure that lessons are learned and enable a cultural shift towards listening and understanding the concerns of those with lived experience.

The appointee will also ensure that the needs of people with learning disabilities are featured and are integrated into all areas of social and public policy and work with Senedd neurodiversity initiatives.

Welsh Government should consider whether the Learning Disability Ministerial Advisory Group could be strengthened to better scrutinise progress made against the recommendations. The Learning Disability Ministerial Advisory Group could be replaced by a programme board responsible to the Minister.

Recommendation 7: review the work of social workers and other professionals

Many Stolen Lives families report long histories of attempts to gain social work support as problems develop, or experience of ineffective social work interventions when their family member is at a point of crisis. This has resulted in inappropriate sections and has led to unreliable and inappropriate responses when complaints are raised. Parents say they have experienced verbal and written judgments about their fitness to parent that cannot be substantiated by evidence, including acts of perjury by professionals.

Families also say that there is a regular turnover of social services staff, and that they have heavy workloads. Many are working in a constant state of crisis and are not sufficiently aware of the law. There is a pattern of failure to adhere to legal duties to produce documentation. Stolen Lives has evidence of inaccurate documentation when it is produced and a failure to regularly review the quality of placements. They say there has been a neglect of duties to prioritise the welfare and well-being of people with learning disabilities and autistic people and their families. The statutory right to independent advocacy for families has not been safeguarded. This also applies to health settings.

The role of social work, social work management teams, and social care in the lives of people with learning disabilities who are wrongly detained, or ‘placed’, should be scrutinised at a national level and as a matter of urgency. This review should encompass the work of CIW in overseeing the quality of social services departments. It must be acknowledged that the CIW do not have the confidence of many service users and their families, who see reports as heavily curated and over-optimistic in their judgements of social work departments within local authorities when measured against actual lived experience.

Families report a lack of available social workers to support their family member with a learning disability and autistic people. We need data on the number of social workers who are qualified to give good care to people with learning disabilities and autistic people. This should go hand in hand with a review of social work training, to ensure that all social work students spend time in learning disability or autistic placements.

Social workers are often constrained by having to strike a balance between their budget and the best interests of the person they are working with. Families report that there is little or no accountability when social workers make decisions that have a damaging impact on their family member. There should be an additional unit to the Social Work curriculum that addresses how to support people with learning disabilities and their families. 

Stolen Lives families report how Approved Mental Health Professionals (AMHPs) do not engage with them when it comes to sectioning. This has meant that contextual factors are not taken into consideration. Stolen Lives report that that the sectioning process is rushed, which means that there is no time to ask questions or to investigate any concerns. Families are not told of their rights or are only told of their rights after the sectioning has taken place. Stolen Lives families have also shared some examples of malpractice. For example, one family’s child was woken from his sleep to be sectioned several days after an incident. The training undertaken by AMHPs should be reconsidered in light of this and AMHPs held accountable when they do not follow the correct process.

Recommendation 8: improve complaints processes

When families try to challenge poor care in secure hospitals that could potentially breach their relative’s human rights there are few options available to them. Families report that safeguarding teams do not always act on their concerns. For example, one family discovered serious injuries sustained to their son during restraint, which the hospital then reported to safeguarding. However, because the hospital report was incomplete and did not significantly describe the injuries, safeguarding did not pursue the matter. This was despite the family telling safeguarding about the nature of the injuries and having photographic evidence of them. When a further safeguarding report was filed, only then did safeguarding intervene. The voices of families are often viewed as less credible (testimonial injustice) and this has to stop. Safeguarding need to listen and act on the concerns of families. There needs to be a greater level of intervention from safeguarding, recognising that people with learning disabilities and autistic people are a particularly vulnerable group and at higher risk of abuse.

Many families fear complaining to the hospital for fear of repercussions, and the internal complaints process tends to be defensive. Families report that going through Public Services Ombudsman Wales (PSOW) is a pointless, exhausting exercise and that the PSOW has little knowledge and understanding of learning disability and autism. This needs to be addressed. We would recommend that safeguarding thresholds are lowered for people with learning disabilities and autistic people, especially when they are within settings where there is limited choice and control (we know that in institutionalised settings, abuse and restrictive practice is much more prevalent (Kamavarapu, Ferriter, Morton and Völlm, 2016). 

Welsh Government should adopt the recommendations from the Care Quality Commission (CQC) in England regarding the lessons learned from the Winterbourne View scandal. There should be a review of the complaints processes in Wales to make recommendations for improvement based on lived experience. 

Welsh Government should take a public position that parental membership of Stolen Lives is not reasonable grounds for local authorities and health boards to refuse to engage, or to treat parents and families differently, and should mandate where it has the powers to do so, that membership of this (and other relevant campaign groups) should not be recorded in notes or records.

To cite this report, please use the following reference:  Powell, J., Cavanagh, D., Abbott, D., & Griffiths, J.  (2025).   From Hospitals to Homes. A Report by the Stolen Lives Homes Not Hospitals Task and Finish Group, a sub-group of the Learning Disability Ministerial Advisory Group which advises on improving the lives of people with learning disabilities in Wales.