Written evidence submitted by Alexis Quinn[1] and Jennifer Kilcoyne[2] (MHB0068)

We ask that you kindly consider our evidence and give us the opportunity to expand on our writings in person/oral evidence. Unfortunately, we only became aware of the time frame of the consultation today.

Changes to the definition of mental disorder

We agree, in principle, with the changes to the definition (to remove autism and learning disability as criteria for treatment) and to increase the threshold for detention. They redress some of the discriminatory legislative practices surrounding the detention and treatment of autistic people and people with learning disabilities.

However, we feel the changes would not have the desired effect of reducing inpatient admissions or increasing the well-being of people in crisis without significant change to the infrastructure of community based services. We fear worse outcomes for people will result from the change and perpetuate the inequality, marginalisation and victimisation of autistic people and people with a learning disability.

The possibility of perpetuating inequality for autistic people and people with a learning disability

Alterations to the detention criteria, coupled with an increase in the threshold for detention, could result in “worse” or less desirable outcomes. For example:

1. Inappropriate use of the Mental Capacity Act
2. Given a mental health diagnosis whilst detained for assessment to satisfy the criteria to detain for treatment – AQ has lived experience of this and can evidence colloquially in her work with Rightfullives (RL).
3. Increase in suicide in the community, especially among so-called “high functioning autistics” – AQ has lived experience of this and can evidence colloquially in her work with RL. Research suggests that autistic people are 9 times more likely to die by suicide and the average life expectancy for a high functioning autistic person is 54, with biggest cause of death being suicide (Hirvikoski, 2018).
4. Increase in people entering the criminal justice system – Penrose Hypothesis and evidence from RL campaign group
5. Increase in people experiencing restrictive practice, especially long-term segregation (LTS) as autistic people are highly represented in the group of people subject to LTS. Definitions regarding LTS and seclusion require clarification.
6. Increase in people being criminalised for responding with distressed behaviours to intolerable social and physical hospital environments to satisfy the threshold for entry into more secure services/LTS – AQ has personal experience of this and JK has professional experience of this.
7. Autism (especially for so-called ‘high-functioning people’ will become a criteria for exclusion from services – AQ has experienced this – so if there are no services to support people in the community and people cannot be admitted for help, they will be left to struggle alone.

Solutions:

Before legislation is changed, community provision must improve.

Place a duty to monitor where people are going (if they are not being detained, what is happening to them e.g monitor the prison population, death by suicide for autistic people etc.)

Track the number of autistic people who accumulate other MH diagnosis to satisfy detention criteria

Inclusive communication needed for MHA assessments and tribunals

Legislative changes should make inclusive communication mandatory in MHA assessments and tribunals.

This does not currently happen in practice. The change in this legislation should drive the few that aren’t following law to abide by it! For example:

• in the MHA guidance link to Equality Act (2010) and Human Rights Act - to increase visibility, access and inclusivity in all areas of legislation that impact directly and interpersonally on autistic people and people with learning disabilities. The goal – to enable a more accessible interface between autistic people and people with learning disabilities and the law.
• autistic communication is being misinterpreted in MHA assessments and autistic people do not know what is going on
• Co-creating communicative support tools for assessment and tribunals

16 September 2022