from our summer 2012 issue

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10 Autism|eye Issue 6 2012 www.autismeye.com 11 Autism|eye Issue 6 2012 Seclusion The use of padded ‘restraint rooms’ in schools and care homes is thankfully becoming rare, but their replacement with ‘quiet rooms’ has its own potential problems. Fiona McNeil reports Havens or hell? It was called ‘the blue room’. It sounds lovely, but in fact it was a place of misery – a padded room at a special school in Lancashire in which a teenager with severe autism was frequently locked in an effort to control his behaviour. A court has since ruled that the practice, at Beech Tree School near Preston, was unlawful under the Human Rights Act. The school is now set to close. The families of autistic people, hearing about this or similar cases, may worry that their relatives could come across a similarly brutal approach at their own school or care home. Reassuringly, the use of these padded cells, or ‘restraint rooms’, is much less common than it was 20 years ago, according to Richard Mills, director of research at the National Autistic Society and research director of Research Autism. The idea behind the rooms had been to provide a safe, quiet place for people to thrash around and let off steam when they became upset; however, the reality was that they were often forced into them. “That’s dangerous, for one thing,” Mills comments, “and unless someone has been sectioned and is in a mental institution, it’s actually illegal to force anyone into a room or lock them inside. “You could be charged with assault or false imprisonment.” Andrew McDonnell, director of Unless someone has been sectioned and is in a mental institution, it’s illegal to force anyone into a room”

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Feature from the Summer 2012 issue of Autism Eye.

TRANSCRIPT

Page 1: From Our Summer 2012 Issue

10 Aut ism|eye Issue 6 2012 www.autismeye.com 11Aut ism|eye Issue 6 2012

Seclusion

The use of padded ‘restraint rooms’ in schools and care homes is thankfully becoming rare, but their replacement with ‘quiet rooms’ has its own potential problems. Fiona McNeil reports

Havens or hell?

It was called ‘the blue room’. It sounds lovely, but in fact it was a place of misery – a padded room at a special school in Lancashire in which a teenager with severe autism was frequently locked in an effort to control his behaviour. A court has since ruled that the practice, at Beech Tree School near Preston, was unlawful under the Human Rights Act. The school is now set to close.

The families of autistic people, hearing about this or similar cases, may worry that their relatives could come across a similarly brutal approach at their own school or care home. Reassuringly, the use of these padded cells, or ‘restraint rooms’, is much less common than it was 20 years ago, according to Richard Mills, director of research at the National Autistic Society and research director of Research Autism.

The idea behind the rooms had

been to provide a safe, quiet place for people to thrash around and let off steam when they became upset; however, the reality was that they were often forced into them.

“That’s dangerous, for one thing,” Mills comments, “and unless someone has been sectioned and is in a mental institution, it’s actually illegal to force anyone into a room or lock them inside.

“You could be charged with assault or false imprisonment.”

Andrew McDonnell, director of

Unless someone has

been sectioned and is in a mental institution, it’s illegal to force anyone into a room”

Page 2: From Our Summer 2012 Issue

12 www.autismeye.comAut ism|eye Issue 6 2012

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Seclusion

clinical services with Studio 3, an organisation that provides training and advice on managing challenging behaviour, agrees that, in general, families and institutions are becoming more aware of calmer and kinder ways of handling outbursts.

But he cautions that the ‘time out’ or soft playrooms that have largely taken over from restraint rooms can also be misused.

First resort “The idea, again, is for people to have somewhere to go to unwind, but if a member of staff is having a bad day these rooms can be used as a punishment instead,” he says.

“If you tell an employee that they can only use a particular room as a last resort, eventually for some people it will become the first resort.

“There’s also the question of monitoring,” McDonnell adds. “A significant proportion of autistic children and adults self-harm, so they shouldn’t be left alone.”

Because of this, McDonnell is largely against the use of any kind of enclosed area for removing, calming or protecting an autistic person. Instead, he advocates giving them the freedom to choose their own methods.

“Autistic people usually have an overriding need to escape whatever’s upsetting them,” he points out. “One boy I know was allowed to go to a particular corner of a field in the grounds of his school when he was upset. Another boy liked to put on his headphones and listen to music to drown out the noise.”

Support McDonnell also says he knows of two families of autistic children who were advised to build padded rooms in their garages. “That’s all very well, but what if the child kicks off in Tesco? Better to support families and train them to manage difficult behaviour whatever the setting.”

Christopher Beaver, a partner at GA Architects, a practice specialising in the design of autism-friendly buildings, says that in 16 years he has twice been asked to include a padded room in

a building’s plans. “However, I must emphasize that I have never come across the term ‘punishment’ in my work,” he says.

“We worked at a special school in Hackney where there was one young man with very challenging behaviour. He was big and strong and had to have three full-time carers. While we were there he injured three members of staff who then required hospital treatment. There were 69 children at the school, but the padded room was solely for him so that he wouldn’t hurt himself.”

The other instance, Beaver continues, was in the Midlands, where he was asked to design a ‘one-person hospital’ for a woman in her twenties whose problems were so severe that she was a danger to herself. “I remember the doorway had to be three-persons wide so that her carers could

escort her inside,” he says. “The idea was that, to start with,

she would spend all her time in the padded area, but that her carers would gradually teach her other ways of functioning so she would learn to use the kitchen area or the bathroom.”

“We don’t have restraint rooms, we have ‘quiet rooms’,” says Jacquie Twitchell, head of autism services at TCES, an organisation that runs schools in London and Essex for children with behavioural, social or emotional problems. “The rooms are empty except for a couple of beanbag floor cushions and children can choose to go in there if they need to calm down.

“To start with it’s usually the teachers who suggest it when they can see the child is becoming upset,” she continues, “but no-one

is ever forced to go in there.”Twitchell explains that the

organisation’s ultimate goal is to provide its autistic pupils (who are either high-functioning or have Asperger’s syndrome) with a calm, structured and predictable environment so that they don’t get distressed in the first place.

“So far, we’ve succeeded,” she says, “although there have been one or two incidents where a child has ‘lost it’. If they need to have a good old chuck around we just move everyone else out of the room, remove anything dangerous, move the laptops and let them get it out of their system.”

Stress levels This low-arousal approach is now widely accepted in the UK as the best way to minimise outbursts, Andrew McDonnell agrees. However, he emphasises it is equally important to address the stress levels of those caring for autistic people. “In one study, where staff in a special school were taught mindfulness techniques for stress reduction, there was a reduction in challenging behaviour from the children,” he says. “It’s all connected. We don’t support and train families and carers enough.”

Presumably, carers who are happy and calm will be less likely to use the heavy-handed tactics that make the headlines and make families’ blood run cold.

Managing Family Meltdown: The Low Arousal Approach and Autism, by Linda Woodcock and Andrea Page. Jessica Kingsley Publishers.

Managing Aggressive Behaviour in Care Settings: Understanding and Applying Low Arousal Approaches, by Andrew McDonnell. Published by Wiley-Blackwell.

Read more

CONTACTS

● GA Architects: 0208 960 4418;

www.autism-architects.com

● Research Autism: 0203 490 3091;

www.researchautism.net

● Studio 3: 01225 334111;

www.studio3.org

● TCES: 0208 543 7878;

www.tces.org.uk

Where staff were taught

mindfulness techniques for stress reduction, there was a reduction in challenging behaviour from the children”