What this is
A review by the Care Quality Commission, published on 22 October 2020, of restraint, seclusion and segregation for autistic people and people with a learning disability and/or a mental health condition. It was prompted by a BBC File on 4 programme in 2018 and commissioned by the Health and Social Care Secretary.
Inspectors visited 43 hospital wards for people with a learning disability or autism, specialist child and adolescent mental health wards, and other facilities. The review was published with an appendix listing the regulatory action taken against services where it found poor care or risks to people’s human rights.
What it records
Most of the mental health wards inspected were not therapeutic environments; the review describes them as “noisy, chaotic and unpredictable”. People were seen “as a condition or a collection of negative behaviours”, and the response to that was often restraint, seclusion or segregation.
81% of 313 wards for children and young people had used physical restraint in the previous month.
Patients were secluded or segregated for periods ranging from three days to 13 years. A lack of suitable care in the community was preventing the discharge of 60% of the people the review saw.
Some people held in seclusion were not allowed to wear their own clothes. Others lacked a clean environment, crockery, cutlery and toilet paper.
The regulator said it was concerned that some patients were prosecuted for injuring staff when a failure to treat their needs may have contributed to their aggression.
How to read it
This is a finding about normality, not extremity, and that is what makes it usable. Restraint here was not an exceptional response to exceptional danger. It was a routine part of the week on most child and adolescent wards, running alongside seclusion measured in years rather than hours.
Two rules follow.
It is a review of services, not of individuals. No patient in it is named here, the review anonymised the accounts it used, and nothing in it settles what happened to any one person.
And it is a snapshot of 2020 practice, taken before publication. It says what inspectors found in the wards they saw, and it makes no claim about what happened after the report, or about whether the regulatory action it lists changed anything.
Where it stops
England only, and 2020 only. The figures are the regulator’s own sample, not a count of all inpatient restraint in England.
Two bases appear in the review as the record carries it: 43 wards visited, and 313 wards behind the 81% figure. The published summary available here does not reconcile them, so neither is presented above as a national rate, and this page uses the 81% for what it is, a proportion of a stated set of wards.
There is no denominator per admission or per detention, no breakdown of the restraint by type or duration, and no follow-up measurement. A service that compares its own numbers to this report is comparing itself to an inspection sample, not to a benchmark.
Sources
- Care Quality Commission, Out of sight – who cares? A review of restraint, seclusion and segregation for autistic people, and people with a learning disability and/or mental health condition, 22 October 2020
- BBC News, “CQC report: Care of people with learning disabilities ‘inhumane'”, 22 October 2020
Where restraint has become ordinary in a service, our physical interventions training starts with how to see the pattern in your own numbers before changing a technique.
Reviewed 20 October 2026.