Samizdata

Yesterday’s Sunday Times carried a story to break your heart: “‘Life in a box’: young autistic man confined in hospital’s former file room”.

The first thing to say is that the headline is clickbait. It gives the impression that he’s locked in a cubbyhole. In fact quite a lot of money has been spent by the state to construct a purpose-built apartment with bedroom, bathroom, “snug room”, lounge, an unlabelled room, and a garden. It is not a dungeon. But it is a jail – this young man, referred to as “Patient A”, is has been confined there alone for years. In terms of lack of privacy his “secure apartment” at Cheadle Royal Hospital is worse than a conventional jail: he is monitored by closed circuit TV at all times.

Behind a serving hatch with a small Perspex window, a figure of a young man shuffles into view and reaches out to receive a pizza box being pushed through the hole by his mother.

“Mum, please, put me in the car and take me home,” the 24-year-old says. “I don’t want to be here any more.”

His mother, Nicola, 50, does her best not to cry. “I would if I could,” she replies. “I’m trying my best.”

Patient A, a young autistic man, has been confined to his small secure apartment in a hospital since September 2017.

A Saturday night takeaway pizza, pushed through the hatch by his mother and eaten alone in his room, is the highlight of his week.

Why is he imprisoned? Because he is violent. After a relatively happy and normal childhood his behaviour began to deteriorate in adolescence, until…

Eventually he was admitted to a unit for patients with severe mental illness at the Countess of Chester Hospital, where his behaviour was put down to “neurodevelopmental difficulties”.

There, he was restrained for the first time by clinical staff. The experience left him terrified. He stayed on the ward for three weeks, losing half a stone. He was prescribed risperidone and sent home — but the attacks continued.

“He would just constantly want to hit you,” Nicola said. “He would want to run at my mum. Run at my dad. All of us. You couldn’t stop it. I’ve never seen anything like it. He would open his eyes, and the moment he woke up he was on us.”

The Sunday Times report is much better than its irresponsible headline would suggest. It goes on to describe in depressing detail the failure of various treatments. The young man continues to attack the hospital staff, with the result that they are no longer willing to play football or computer games with him. Ever more isolated, he gets worse.

It’s horrible. But what would you have them do? His mother wants him to be released into supported housing in the community. This was due to happen, but at the last moment the care provider lined up for him pulled out. “They said his behaviour had become too challenging,” Nicola [his mother] said. “But his behaviour is challenging because of where he is.” I hate to say it but her second sentence, while undoubtedly true, does not solve the problem described in the first. Can an organisation be forced to take on the care of someone who constantly attacks their staff? To an extent, that is what is happening now at Patient A’s secure apartment at Cheadle Royal Hospital. The state does what it is obliged to by law. But care in the community for a potentially violent patient requires more intelligent and responsive supervision than keeping someone in prison. No company providing paid care is willing to provide that level of supervision for Patient A. It has been established that his family cannot do it; part of his mother’s torment is that she herself was the person who started his imprisonment by calling the police while her son attacked his grandmother.

In any case, though supported care in the community has transformed many lives for the better, it can go horribly wrong. One of the comments mentions the case of Jonty Bravery. He was the man who threw a six year old boy from the roof of the Tate Modern gallery because he wanted to be on the TV news. He caused the child life-changing injuries. Before the attack Bravery had been living in just such a placement, with two-to-one care, no less.

Back and forth the arguments go…
“Mum, please, put me in the car and take me home.”
“He would open his eyes, and the moment he woke up he was on us.”

I was going to ask, “What is the Libertarian solution to this?”, but forget Libertarianism – what is any solution to this?