Transforming Care – Supporting someone to move out of an Assessment and Treatment Unit

Assessment and Treatment Units (ATUs) are often used as emergency care, usually when someone is sectioned under the Mental Health Act. This can happen when someone is in crisis and their existing community-based services or families are unable to cope.

They are usually supposed to be short term facilities, used until they are able to return home, or an appropriate, supportive placement is found for them.

Around 3,000 people with a learning disability or autism spectrum condition who are currently living in inpatient facilities such as ATUs and hospitals, awaiting such time as they can be found the right placement. For those people, it can be incredibly frustrating if it looks like the situation isn’t moving or that barriers are being thrown up that seem unassailable. The frustrations can cause them to behave in ways that challenge professionals and make a new placement even less certain. But ATUs are not usually conducive to people learning how to manage their lives and to better manage the things which can lead to a crisis.

For some, advocacy could be the answer.

How can advocacy help?

2 people talking - advocacyAdvocates support people by listening to them. Listening to what they want, listening to what they need. They talk to the person about how what they want can be achieved. They help to find and understand the options available. Advocates support the person to hold professionals to account, to keep professionals focussed on them, their care, their wishes, needs and aims. Advocates help the person to challenge professionals and to raise awareness of their situation with key decision makers.

This is what happened with Bethan. Bethan knew what she wanted but nothing was happening. So Bethan asked for an advocate, and together they fought to get Bethan exactly what she needed and dreamt of – a home where she could be supported to live independently, a future where she could gain skills, experience and confidence. It wasn’t easy, and they needed to get NHS England and Bethan’s local MP to intervene. But Bethan is now living in a great place, near her family, with the right care for her. 

Is everyone in an ATU entitled to an advocate?

Many people living in an ATU are entitled to have access to an advocate at various points.

  • The majority of people living in ATUs are sectioned under the Mental Health Act, which entitles most people to an Independent Mental Health Advocate
  • If someone’s care is being assessed, planned or reviewed, then they may be entitled to an advocate during those processes. This is a legal entitlement under the Care Act 2014. There are eligibility criteria that need to be met and you can find out more about these here.
  • If someone lacks capacity about particular decisions, they may be referred to an Independent Mental Capacity Advocacy service. 
  • As well as the legal entitlement to advocacy, NHS England recognise that advocacy is vital for many people. They state, in their Transforming Care Service Model (see more below) that “should be available to them either at key transition points and/or for as long as they require at other times in their lives. This will include in preparation for and on leaving a specialist hospital.” Some forward thinking local authorities do commission non-statutory advocacy, so it is important to check if there is something available in your area.

If you don’t know whether you can access advocacy or not, the staff at your ATU should know and will be able to refer you.

My loved one is in an ATU. How can I help them?

Picture of a familyThe need for advocacy is understood by most professionals. But the term is used to include the involvement of families and friends, as well as independent professionals.

Under the main pieces of legislation controlling the availability of advocacy support, the eligibility criteria can mean that people who have family and friends may not be able to get an advocate. If your loved one is able to have advocacy support, your voice and your wishes are just as important. 

So it’s important for families to understand what they can do to act as an ‘advocate’. Below are some resources which you can use to make sure that your loved one is at the centre of their own care. You can use the information to hold professionals to account and to make sure their rights are being upheld.

  • Understand how you can challenge professionals. VoiceAbility have produced a comprehensive guide, useful for anybody acting as an advocate. It includes details of the best routes to challenge under the legislation mentioned above. 
  • Read NHS England’s plan for change – Building the Right Support – which sets out how they will close inappropriate inpatient facilities and establish stronger support in the community. 
  • Alongside, look over the new service model for commissioners which shows what NHS England think ‘good’ services look like. More information about the principles of the new service model are below. 
  • Each person who is living in an ATU should receive information in a format that they can understand, and receive appropriate support to help them communicate. This is a new ‘Accessible Information Standard’ and all health and social care services should adhere to it. 
  • Each person living in an ATU, who has a learning disability, should be given an ‘Independence Pack’, and supported to complete it. If you don’t think your loved one has one, download it here. 

Transforming Care Service Model

Aimed at all health and social care commissioners, the new service model (Oct 2015) sets out to provide clarity on ‘what good looks like’ for health, social care and housing services for people with a learning disability and/or autism.

It is structured around nine core principles (below) which show what the expectations of anybody using such a service should expect. Additional information for commissioners has been published alongside this to provide further detail on each aspect of the model outlined.

  • I have a good and meaningful everyday life
  • My care and support is person-centred, planned, proactive and coordinated.
  • I have choice and control over how my health and care needs are met.
  • My family and paid support and care staff get the help they need to support me to live in the community.
  • I have a choice about where I live and who I live with.
  • I get good care and support from mainstream health services.
  • I can access specialist health and social care support in the community.
  • If I need it, I get support to stay out of trouble.
  • If I am admitted for assessment and treatment in a hospital setting because my health needs can’t be met in the community, it is high-quality and I don’t stay there longer than I need to.

Transforming Care Service Model Infographic