Current practice and adaptations being made for people with autism admitted to in-patient psychiatric services across the UK

Keir Jones; Satheesh Gangadharan; Philip Brigham; Edward Smith; Rohit Shankar

doi:10.1192/bjo.2021.58

Current practice and adaptations being made for people with autism admitted to in-patient psychiatric services across the UK

BJPsych Open. 2021 May 14;7(3):e102. doi: 10.1192/bjo.2021.58.

Authors

Keir Jones¹, Satheesh Gangadharan¹, Philip Brigham², Edward Smith³, Rohit Shankar⁴

Affiliations

¹ Intellectual Disability Department, Leicestershire Partnership NHS Trust, UK.
² Cornwall Intellectual Disability Epilepsy Research (CIDER) Cornwall Partnership NHS Foundation Trust, UK.
³ Autistica, UK.
⁴ Cornwall Intellectual Disability Epilepsy Research (CIDER) Cornwall Partnership NHS Foundation Trust, UK; and University of Plymouth Medical School, UK.

Abstract

Background: A significant number of people with autism require in-patient psychiatric care. Although the requirement to adequately meet the needs of people with autism in these settings is enshrined in UK law and supported by national guidelines, little information is available on current practice.

Aims: To describe characteristics of UK in-patient psychiatric settings admitting people with autism. Also to examine psychiatric units for their suitability, and the resultant impact on admission length and restrictive interventions.

Method: Multiple-choice questions about in-patient settings and their ability to meet the needs of people with autism and the impact on their outcomes were developed as a cross-sectional study co-designed with a national autism charity. The survey was distributed nationally, using an exponential and non-discriminatory snowballing technique, to in-patient unit clinicians to provide a current practice snapshot.

Results: Eighty responses were analysed after excluding duplications, from across the UK. Significant variation between units across all enquired parameters exist. Lack of autism-related training and skills across staff groups was identified, this becoming disproportionate when comparing intellectual disability units with general mental health units particularly regarding psychiatrists working in these units (psychiatrists: 94% specialist skills in intellectual disability units versus 6% specialist skills in general mental health units). In total, 28% of survey respondents felt people with autism are more likely to be subject to seclusion and 40% believed in-patients with autism are likely to end in segregation.

Conclusions: There is no systematic approach to supporting people with autism who are admitted to in-patient psychiatric units. Significant concerns are highlighted of lack of professional training and skill sets resulting in variable clinical practice and care delivery underpinned by policy deficiency. This could account for the reported in-patient outcomes of longer stay and segregation experienced by people with autism.

Keywords: Autism; developmental disability; inpatients; intellectual disability; mental health.