sun 21/07/2024

Dispatches: Under Lock and Key, Channel 4 | reviews, news & interviews

Dispatches: Under Lock and Key, Channel 4

Dispatches: Under Lock and Key, Channel 4

Disturbing documentary about life inside a hospital for people with learning disabilities or autism

One of St Andrew's young patients, much happier since his release

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).

Dispatches: Under Lock and Key, Channel 4In 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? 


It was powerful testimony to the perseverance of campaigners and parents who listened to their distressed children


Editor Rating: 
Average: 5 (1 vote)

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I have a put yet another complaint in concerning the care and safety of my daughter I feel like I'm being ignored and my complaint is not being taking seriously despite numerous phone calls to St Andrews. I totally believe what I saw on your eye opening programme and feel disgusted what I saw and even more concerned for my daughter I want to go and take her now! My thoughts are with the families who shared their stories us one with devastating consequences through the hospitals ignorance and lies! I to am now going to seek legal advice about the lack of response to my complaint I will not be ignored.

I too have a daughter in St Andrews,we have been fighting for 14 months to get her moved,she is worse now than when she went in,her physical health is suffering too and their answer to everything is to pump her full of drugs which make her even more ill.She is in the Essex Hospital and it is just as bad.

I DO blame the parents! Why not look after your own child in your own home? You brought a disabled child into the world with your bad genes you pick up the bill & care for your kid!!!

Ugh Em. What an unnecessary comment.

"Bad genes?" What shill -paid reock did YOU crawl out from under? What a nasty minded bigoted little neoliberal you are! I wonder whether you could be put somewherfe where the rest of us don't have to see your ignorance, lack of education and poverty of spirit so blatantly exposed to ridicule! It would be kinder on us all. YOu we don't much care for. Disability is a fact of life, learnt bigotry is a cancer on humanity. You are as ignorant a person as I have ever encountered! "Bad genes" is a false eugenic concept and the last people to credit it were the Nazis. As for parenting - your own parents signally failed with even your supposedly 'normal genes'? And what was their /your excuse for a person like you? Any bets this person isn't an UK citizen and has no idea hiow our healthcare system works?

Are you serious. Do you have a child? And one with special needs? How the **** can you say that? It's not our choice you moron.

Only someone incredibly ignorant could have left this comment Firstly autism is not a condition that is passed down by bad genes Secondly in all cases it's a last resort for people who can not be looked after in a home environment in many cases the parents don't have a choice as the child is sectioned for they own safety and safety of others Sadly this doesn't always result in the care that is appropriate to the persons needs

Em, I actually feel sorry for you, that you will never allow yourself to see or experience the unconditional love (of which you obviously have none) that people with special needs spread so freely; whereas you choose to spread hate. Karma is a bitch...

I think this may be a valid point and i worked in social care for 25 years, people are too willing to just leave there child in the care of someone else. They then turn up ever few weeks for a few hours and say what should and should not be done. To be fair if they saw more they would know more. May i add this is not all cases. But going to see your child once a month does not make you an expert on what they want or need. The amount of times i have been verbally abused by families is unreal and the so called experts who read a book and do not know the individuals annoy's me.

Excellent programme. Now will you do an investigation into the care of the dying in NHS hospitals. It is a national scandal that the dying are put into ordinary wards, with nurses trained to care for the living, many of them agency nurses.A consultant told me they will not give the medication required because they do not want to give the last injection before death, so they just get to the end of their shift and leave it to someone else. I had an horrendous experience when my husband was on Palliative Care for two weeks without even water. The regime is cruel and it seems the dying are just hidden on ordinary wards. There should be a Hospice environment within NHS hospitals with specialist nurses. In Mid Yorks Trust,, Dewsbury and District hospital and Pinderfields, there are only 5 Palliative Care nurses to cover both hospitals. I slept at the side of my husband in a side ward for two weeks and some of the staff were very good but the organisation of the dying was abysmal. I firmly believe that those patients who had no-one to be constantly with them were just ignored. When I had witnessed three patients pass away in the bed opposite my husband on an open elderly care ward I was so distressed I had to go to A&E with a stress induced Asthma attack. I complained many times and It should be exposed and changed into something at least humane. In my experience there was no respect or dignity afforded to the dying in the Mid Yorks Trust. I have many documents to support my allegations.

Thank you channel 4 for exposing the shameful way autistic and young people are being treated in these NHS funded so called hospitals. The council and government should be ashamed. It was the most distressing TV programme I have ever seen. it made me ashamed of mankind

This program makes unfounded allagations, that are conjecture at best. This kind of nonevedence based documentary making is irresponsible and harmful. Due to the patient confidentiality act, i assume no one involved would have been able to counter the allagations or make any defense at all. To make a blatant one sided program based on conjecture is not documentary making. It is manipulated story telling and should never be permitted to pose as truth.

You probably work there that's why your against the programme.

I think bills postmortem confirms the TV programme is factual.

I would agree that there were failings at St Andrews, and some serious ones at that. However, I would also acknowledge that this is a very biased documentary with unfound allegations. Unfortunately, unless you work in this kind of environment it is very difficult to understand the complexity of patients and their risks. While many patients would function well in the community, this requires a lot of support, specialist homing and staff, which requires a lot of funding. Especially to ensure the safety of clients and staff. Currently, this is unfeasible due to the lack of placements and funding. Hospitals need to exist, as some patients risks are too high and cannot be managed in the community. For example, sex offenders or those or are physically violent. It would be inappropriate to place these people in a prison or juvenille centres due to their vulnerability, so where else will they go? These days, hospitals are so heavily monitored by the CQC plus care and treatment teams, that I would be confident that a hospital that is failing patients so severely would be shut down. I understand that it must be very distressing for parents to see their child in secure settings and being restrained, but I also think it is important the remember the reality of the situation.

FINALLY somewhere that we can have a voice! There should be MORE EXPOSURE on what is being done to the MOST vulnerable people in our society. My older brother has autism and learning difficulties. He has been in care for close to ten years. Unfortunately, because the people who are given the reigns to hold these poor people's lives in their hands are the MOST INCOMPETENT stupid ignorant fucking idiots, my family are now awaiting COURT HEARING - which by the way has been moved to a senior judge due to the "complex nature of the case". The fundamental root of the problem is a total lack of education, lack of understanding and lack of treatment that is appropriate for people with autism. People with this GENETIC CONDITION are treated like CRIMINALS - LOCKED UP THROW AWAY THE LOCK AND KEY and left to rot in the hands of an evil vile institution of stigma and ignorant prejudice. Meanwhile, we give murderers, thieves and rapists (i.e. actual criminals) free TV, freedom to bribe and use facilities and drugs, freedom even to go away for the weekend. What a fucked up system this is.

What a travesty ... For those young people whose needs have not been met by the 'system' and for the families/friends etc that struggle to find a suitable place for the specific needs of their loved ones. What a travesty .... That this programme did not take the opportunity to really understand the challenges facing those seeking to support young people with complex needs. The very sad fact is that there are very few 'institutions' that are able to cater for the needs of specific groups. Hence hospitals like St Andrews become a place where some do not have their needs effectively met. Equally, from personal experience, I can say that St Andrews has provided very effective care for the young person that I can specifically speak about. She spent over 3 years bouncing between adult mental health hospitals and children's residential care - due to a complex mix of learning difficulties, traumatic early years, destructive behaviours and an emerging serious mental illness. Since arriving at St Andrews the care and treatment she has received has been exemplary and her life has been transformed. Although a large hospital, the wards are small. Yes, the wards are locked. Yes, there are times where restraint is necessary due to extreme behaviours (to safeguard the young person, fellow residents and staff). BUT I have been visiting the hospital regularly for nearly 2 years and I have seen the very structured and caring approach to psychiatric care, education, psychological and occupational therapy as well as social activities. This young person has been 'reset' and in a stepped approach moved towards the bring of constructive (and supported) independence. As part of that process this young lady has been supported to make monthly visits (several hundred mile round trip), has begun to take herself into local surroundings safely, etc. What I have also seen at St Andrews is many young people with complex needs and very difficult behaviours who, for many reasons, have little contact with their families. Who, for their birthdays and Christmas receive little or no contact (let alone cards or gifts) from the outside world. The staff do their best - providing this kind of care from their personal resources. You may ask yourselves what my 'vested' interest is ... I foster care the young lady's younger siblings. I am a mental health professional and have worked in psychiatric intensive care wards and in community treatment teams within the NHS. I have also worked with Social Services and in education. I have never worked at St Andrews ... BUT I know the challenges faced in providing 'ideal' care at home, in the NHS, in Social Care and in the private sector. In short, the programme is covering a very small part of a very big picture. It is UNBALANCED, INCOMPLETE and UNFAIR ... so is the 'system' ... so is life. We ALL do the best we can don't we? Before we vilify one small area, lets consider what WE can do that is positive, constructive and informed!

This was an important topic that looked at the lives of some people evidently struggling to cope with their experiences at St Andrew's Hospital (SAH). Unfortunately I felt that the programme itself was very badly made. Extremely partial and an insult to the many patients and families who have had good experiences at SAH It is never enough, when discssing such important topics, to have individual case reports on their own. They are necessary but not sufficient. There was no real effort to include even rudimentary statistics on outcomes at SAH, no counter arguments to look at positives in their approach, no direct interviews with staff or satisfied families. No real historical context whatsoever. These are the basics of a balanced and well-informed approach. The criticisms levelled at SAH could have been raised with any psychiatric, or general, hospital throughout the developed world. Whether private, charity or governement funded. This was a crucial omission. So they focused only on the negatives, only on SAH and only on 3 case reports. I felt that the programme had very clear political interests that ended up doing a diservice to those involved. The state of our health service deserves much, much better that this. Shame on the producers and C4.

My son spent 2 years on the autistic ward at St Andrews from the age of 16 because he was very mentally ill. His experience was very positive and all the staff were great with me and my son. He now lives in a hospital near me and is ready to live in the community again when a suitable placement has been found. He comes home to me most weekends. It was heart-breaking to see the terrible experiences other young people had but it is important to know that not all cases are the same.

I worked there for awhile and saw how they managed the patients. I tried to say something to the extent of not turning up for work but rather I got a transfer. They moved me to another ward where it was better but i was still not happy within myself so eventually left. The show describe they poor care given but i have to admitted some wards do care for their patients. Personally, it was not a good experience for staff member how much more a patient.

I can talk from first hand exp I am grateful to C4 for exposing the terrible things that go on in St Andrews daily. My daughter suffered verbal and mental abuse from the staff and management at St Andrews. On one visit to see my daughter she had 2 black eyes a carpet burn to her face and bruising to her groin which the director of patient services discribed as a 'accidental kick by a memeber of staff ! she had been taken to the floor by her neck and the staff member had to be pulled of her by sercurity. I tried to report the injuires to Northamptonshire Police but they told me there where cuts to their police force so couldnt do it. I then reported it to my home police force who took up the investigation with the Northamptonshire Police (after they had apologised to me) The staff member was arrested but it could not go to court as no notes had been kept on file of the incident by staff members ( My daughter was put into isolation for days on end, I was not allowed to speak to her and was told by the manager of the ward that she would not be allowed out until she had shown some remorse. She had been placed in a padded room without proper heating or any toliet facilities and was given a bowl to use as a toilet. She was not allowed outside into the fresh air for 6 months because she was told she needed to get her levels up. I bought her a Ipod for her birthday she only saw it once before staff took it from her and she never saw it again. I complained and they said it was lost (whilst in the care of staff) On almost all the the visits to see my daughter i found her heavily sedated, unable to make sentances and dazed. Again I complained but was told she had asked for the drugs. I requested the notes from the ward rounds but this stopped when i found out that my daughter was constantly been drugged or restrained. When I asked why they had been stopped the doctor told me it was at the wishes of my daughter. I was at my wits end and approcahed anyone and everyone who i thought could step in including a formal compalint to the CQC. They visited St Andrews unannounced and found they had failed on 8 accounts with notice to urgently improve on: Staff training, including restraints and adminsitration - patients files were al mixed up and serious conditions relating to a patients health had not been recoreded. The wards were flithly with needles spilling over the top of needle bins, ligature points everywhere for self harmers to attempt to take their life, not enough staff on duty to patient ratio with patients having to monitor each other. A lock of knowledge about the Mental Health Act and Human Rights Act. ( i asked a manager a question on the mental health act which he informed me he would have to read up and comeback to me) I wrote again to the CQC and met with them to again relay my fears for my daughter however, they were relcutant do to anything as they stated "St Andrew's was one of the biggest in the country and do close that down would mean a major shortage" I was astonished by this disclourser as it meant that all was lost. I took my daughter case to the Parlimentary Ombudsman in the hope that they would take my case on - I found out that they will only take on 3% of hospital complaints. I quickly found out why - firstly they sent me to NHS Engalnd to fight my daughters case only to learn 3 months on that they had been in error in doing this as they should not have sent me to NHS but that it was the PHSO - Parlimentary Ombudsman that should have been doing the investigating - The whole process was a shambles from start to finish. They told me i could not bring a case against St Andrews but that my daughter shoudl do it - I constantly had to remind them that my daughter was 16 and sectioned under the mental health act so was not able to put forward a complaint - she wasn't allowed to have a pencil let alone write a complaint. I was told by one of their directors that if i didn't agree to it being a complaint from my daughter then they would not continue with the investigation. This I told them was black mail. It was at this time that i approached my MP Ranil Jayawadana with a complaint into the PHSO but he made promises but did not carry them through. My daughter finally made an escape from St Andrews when a member of staff gave her a massive overdose of her medication - they released her to another hospital very quickly once they discovered their error. Since leaving St Andrews she has thrived and is doing well. She is approaching her 2nd year of college and she is loving life. I say to all non bellievers - St Andrews is a cruel, evil place which should be shut down, Please consider stepping in to the shoes of someone with mental health issues or that of their parents - seeing someone you love subjected to the daily toruture handed out at the hands of St Andrews will soon make you think again - i know, my daughter lived it and so did i and my family

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