The Winterbourne legacy

摘要

In June, 2011, horrific abuse at Winterbourne View residential hospital near Bristol, UK, was exposed. Secret filming by an undercover BBC reporter showed patients with learning disabilities regularly being pinned-down, hit, taunted, and teased by staff. The shocking revelations led to several arrests and charges and the eventual closure of the hospital. In December, 2012, in response to the scandal, the government announced that it was planning to reduce substantially the number of people with learning disabilities who were receiving care in hospitals. All hospital placements were to come under review and when such care was found to be inappropriate, patients would be moved to community-based support. Although the government's plans are welcome, it should not mean the death of in-patient services. A new report by the Royal College of Psychiatrists published last week highlights why in-patient services remain important for a subset of patients-those with learning disabilities and mental health, behavioural, or forensic problems. Some of these patients will require treatment in specialist in-patient services and the report emphasises that these services should be of the highest quality with clear treatment goals and outcomes. It makes several recommendations such as the need for different categories of in-patient beds, ranging from high, medium, and low security beds to beds for neuropsychiatric conditions such as epilepsy and movement disorders. Importantly, the College recommends that patients should receive multidisciplinary therapeutic care that is monitored regularly and that all in-patient units should go through an external accreditation process.