Autistic people and people with a learning disability, who have been or are at risk of being admitted to a mental health hospital, should have their care, treatment and level of risk reviewed regularly. NHS England has recently published a refreshed policy for health professionals, introducing changes to when these reviews happen and what they should focus on. The new policy has been coproduced by people with lived experience and should be implemented by May 2023. It is hoped that this will reduce the number of autistic people and people with a learning disability that are admitted to mental health inpatient settings unnecessarily.  

Some measures in the new Dynamic support register and Care (Education) and Treatment Review policy may make it easier for some autistic people and people with a learning disability to receive the right care. For example, reviews will now take place if an individual is moved to another hospital or has a diagnosis of autism or a learning disability removed. This will mean there are more opportunities to hold health professionals to account when something important changes. However, the changes in the new policy are limited and much wider reforms are needed.  

While regular treatment reviews can be a useful tool for highlighting the additional support an individual needs to stay out of hospital, too frequently this additional support is just not available.  We urgently need more Government funding for effective social care and mental health services in the community. Without it, autistic people and people with a learning disability will continue to reach crisis point. 

You access the new policy or read the easy read version here.  

There is also a plain English guide to the new policy here. 

What is a Dynamic Support Register? 

 A dynamic support register is a list of autistic people and people with a learning disability who are at risk of being admitted to a mental health hospital without mental health or social care support. Information about people’s levels of risk and their needs are collected and shared by health professionals with the aim of helping them to live safely in the community. An individual must provide their consent to be put on the register. 

Dynamic support registers are colour coded in the following way: 

• Red risk for those at high risk of needing to go into hospital straight away 

• Amber risk for those at high risk of needing to go into hospital if they don’t get the right care and treatment soon 

• Green risk for those managing well at home 

• Blue risk for those already in hospital 

What is a C(E)TR? 

A C(E)TR is a plan for adults that are at risk of being admitted to hospital or are in hospital already. During a C(E)TR, a plan should be put in place to make sure so a person can safely stay living  at home or  be discharged from hospital. It can include support they need in the community and what living arrangements are necessary. 

C(E)TRs are run by an independent panel, this means they are not the same people who are involved in providing day to day care. The panel includes a chairperson, somebody with lived experience and a clinical expert. Others can be invited to attend the meeting, including advocates, health professionals and someone the individual trusts like a family member. A C(E)TR meeting should give the individual a chance to talk about their own care and how they feel about the treatment they are receiving. The plan should be reviewed regularly to make sure that all of the information is up to date.  
  

What is changing? 

The new policy for C(E)TRs and Dynamic support registers includes some changes that could make it easier for autistic people and people with a learning disability to get the right care and support, including: 

• Having the policy for Dynamic support registers and the policy for C(E)TRs in the same place so that the two can be used together to make sure people are getting the right support and only go to hospital if they really need to. 

• Anybody can ask a health professional involved in their care to arrange  a C(E)TR, although they will only receive one if they are seen as needing one due to their support needs. 

Also C(E)TRs should now focus more on: 

• physical health 
• quality of life 
• advocacy (an advocate is somebody that can help an individual to have their needs, rights and choices respected) 

The new policy also explains that a C(E)TR should happen:  

• six weeks after an individual is admitted to hospital if they have already had a C(E)TR in the community 

• if a clinical review shows that someone is not autistic or does not have a learning disability when they have been told before that they are autistic, or do have a learning disability 

• If an individual is moved to another hospital or a ward with higher or lower security 

• if someone finds out they are autistic or have a learning disability when they are in hospital or after they leave hospital 

C(E)TR panel members will also now be expected to complete mandatory C(E)TR induction training. 

Further Information 

• Read about the Young Ambassadors open letter to Prime Minister, Rishi Sunak. 
• Read our news story on the number of autistic people in mental health hospitals. 
• Read Alexis’ story about being locked inside a mental health hospital for three years. 
• Read our statement on the Dispatches and Panorama documentaries about the abuse of patients in mental health hospitals. 
• Find out more about our Autism Inpatient Mental Health Service which offers advice and support to autistic people in England who have been detained in a mental health hospital or are at imminent risk of detention or re-detention, and their families. 
• Read our news story on the Draft Mental Health Bill Joint Committee Report