We were shocked, as the family of a 26-year-old autistic son who has been in four residences since leaving school, to read of the abuse in a National Autistic Society care home (Somerset care home staff bullied autistic residents, review finds, 9 February). To think that this could occur within an NAS home is almost unimaginable. There are two clear problems in homes looking after adults with autism in England.
First, there is no system of compulsory registration of individual support workers/carers as exists in Scotland, Wales and Northern Ireland. This enables a public record to be kept of all support worker qualifications, as well as any concerns around their conduct or standard of work. Removal from the register means carers cannot be employed in that role. The English government currently refuses to introduce such a register.
Second, CCTV should perhaps be compulsory in all public areas of residential and supported-living homes. Cameras exist in nearly every other aspect of our lives and are there to protect us. Why should the particularly vulnerable people in these homes (who often cannot speak for themselves) not be afforded the same protection?
Who will protect our autistic son when we are dead and gone?
Professor Neil Munro
• Yet again an account of the appalling “care” provided by staff at a residential care home throws up a number of areas of grave concern that shame us all. Given the exceptional financial pressures on local authorities, it was astonishing that the abuse was in part continuing because the authorities paying the fees of these adults with autism appeared to have little or no interest in checking whether the service was any good, and staffed by appropriately skilled staff.
Even if a reputable charity, as in this case, runs the home, the state continues to be accountable for the amount of money spent, and whether it represents “value for money”. Although we are living through a period of austerity, best professional practice dictates the need for regular reviews of people’s needs and whether they are being effectively met.
• Sadly this story of humans with complex needs being sent miles away from home to be forgotten and abused will be shocking but not surprising to many of those working within the system. On 31 March 30% of people detained under the mental health act were in independent hospitals. With diagnoses such as borderline personality disorder, compulsory treatment goes against Nice guidelines but is still widely used. We must consider why statutory services commission such provision, potentially concluding that it is better for organisations for difficult patients to be out of sight and out of mind. If the best we can do for people is ensure that they are not thought about, we cannot be surprised when they are subject to the unthinkable.
• The notion that psychoanalysis can be effectively applied to autism (Anger grows over treatment of autistic children in France, 8 February) is dangerously close to three now discredited but in some cases widely held beliefs: that autism can be “cured”, that the mother is somehow at fault, and that “trapped” inside an autistic person is someone who does not have autism.
In fact, in my view, the person who is autistic rarely actually suffers as a direct result of his or her autism and therefore does not need to be “cured”, let alone psychoanalysed. It is disappointing that in France these outdated attitudes still have currency, but perhaps not altogether surprising given the fact in French the word “mongol” is still commonly used to refer to people we describe as having Down’s syndrome.
Little Bradley, Suffolk
• Your article condemns the way autism is treated in France and says the main problem is persistence with a “psychoanalytic approach” in place of educational and behavioural therapies. Beside questioning the use of psychoanalysis to treat autism, the article quotes that “psychoanalysis was abandoned a long time ago” and that “France is the last bastion of psychoanalysis”. This is far from true.
Psychoanalysis is a modern discipline that continues to expand and provide insight into the origins and treatment of mental illness. It contributes to the wider social good and, in recent years, much based research has shown the enduring effects of psychoanalytically based therapy in patients with complex needs and those suffering from chronic depression. Even though it should not be the sole tool in helping autistic children, its value should not be underestimated. The London Clinic of Psychoanalysis continues to help many children, adolescents and adults with a range of difficulties.
President, British Psychoanalytical Society
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