Five years ago BBC Panorama went undercover, sending in a reporter with a hidden camera to expose the horror going on at Winterbourne View, a hospital for people with learning disabilities and/or autism. There was outrage as the nation watched Winterbourne’s patients being tortured, degraded and abused by staff. After the programme aired, it made headlines and debates in Parliament led to promises of major reform. There was a commitment that the 3,000-plus disabled or mentally ill people kept in Assessment and Treatment Units would be moved instead to smaller units closer to their families or supported to live independently in the community.
Sadly, tonight's Dispatches showed that five years on, people are still being held in institutions that do not meet their needs, make them better, or in some cases, even keep them safe. While Dispatches did not go undercover and did not reveal any actively sadistic staff, it did paint a damning picture of medical neglect, inadequate treatment and families excluded from decision making.
There was incisive criticism of institutional care from MP Norman Lamb
The programme’s focus was on St Andrew's in Northampton, which is one of Britain’s largest psychiatric hospitals. It has been run as an independent charity since 1838 with 95 per cent of its patients referred by the NHS. There was no access to the hospital for film-maker Alison Millar, who instead relied on three families to tell their stories outside its walls. We met Fauzia, diagnosed with autism and learning disabilties; at 15 she had become too aggressive and self-harming to live at home.
She was sectioned under the Mental Health Act and kept in St Andrew's for over two years. Segregated from other patients and prescribed anti-psychotic medication, Fauzia's behaviour deteriorated further. She was occasionally physically restrained and confined to a small room for most of her days. She was lucky to have a very eloquent aunt, herself a psychiatrist, who gave a devastating description of her niece's treatment.
We also met the parents of Matthew (main picture); they had originally fought to get their teenage son into St Andrew's because they thought he would receive specialist care that would help him with his aggression, but ended up desperate to get him out as it became clear that the regime wasn't helping him. His parents described how they felt he was punished for being autistic and how they worried about his health as he lost three stone in six months. We saw footage of the excrement found in his shoes when they visited and heard of the face-down restraint positions used.
Most distressing was the story of Bill; he had suffered a brain injury at birth and was later diagnosed with schizophrenia and sent to St Andrew's, where he died in 2011. An inquest concluded that there had been medical neglect and awarded compensation to his elderly parents (who described it as blood money, and have since given it to improve local support for mentally-ill people).
In the absence of access to the hospital itself, Millar had to rely on moody aerial shots of its extensive buildings, family footage from phones at visits, home movies and photographs of their loved ones to intercut with interviews and present-day footage. We heard directly from Matthew and Fauzia (pictured above) who have left St Andrew's and are much happier in smaller units where the staff work hard to manage the anxiety, sensory overload and obsessions that triggered their aggressive behaviour. It was heartbreaking to hear Bill singing about death on a recording that his parents had kept. Under Lock and Key was a powerful testament to the perseverance of campaigners and parents who listened to their distressed children, all of whom had speech. I couldn't help worrying about those autistic or learning disabled people kept in institutions who do not have any means of communication or family or friends to fight their corner and bring them to the media's attention.
There were no interviews with staff at St Andrew's, but incisive criticism of large-scale institutional care from MP Norman Lamb, a longstanding campaigner for reform who helped Fauzia's family get her out of St Andrew's. Matthew's family had enlisted their MP, Helen Hayes. She described being shocked that a meeting she attended with Matthew’s parents had minutes which did not reflect its content, and was signed by Matthew who had been absent for most of it.
Expert psychologist Glynis Murphy gave her opinion that large institutions like St Andrew's – noisy, busy, with high staff turnover – made matters far worse for people already severely distressed and suffering from sensory overload. For decades, dedicated film-makers have made TV documentaries exposing conditions in Britain’s hospitals for the mentally ill or those with learning disabilities. Every time, they make headlines, and promises are made to reform the system. But despite the outcry, the number of people kept in large hospitals stays stubbornly high. It would be wonderful if this Dispatches was the last such film and we were shamed into reform, but in our age of austerity, how likely is it?