Channel 4’s Under Lock and Key: exposing the reality beneath the rhetoric

A TV documentary has highlighted the heartbreaking realities of a failing commitment to provide appropriate community care for people with learning disabilities and autism.

A TV documentary has highlighted the heartbreaking realities of a failing commitment to provide appropriate community care for people with learning disabilities and autism

Channel 4 Dispatches programme Under Lock and Key brought home in heartrending honesty the reality of how people with a learning disability or autism are treated in our society. It is clear that there is a woeful lack of commissioning of community provision for people whose families struggle to support them at home.

St Andrew’s Healthcare, which featured in the Dispatches investigation Under Lock and Key. 
Picture: Alamy

Ever since the Winterbourne View scandal the government has stated publicly that it will reduce the numbers of people going to inpatient units. It has closed many NHS facilities but that is the limit of what has been done. Far too little, far too late. And at the same time as the NHS have been closing facilities, independent hospitals have been building huge new multi-patient complexes in the sure knowledge these beds will be filled by desperate families at their wits’ end.

Last week I met a couple and their son who is in his mid-twenties and has autism. He lives at home, but he and they cannot cope. He is charming and likeable. However, because of his autism he cannot cope with excessive noise and there is a noisy building site and a school next door to their flat. He has encountered people dealing drugs on the street on the rare occasions that he leaves the flat and, because he has a strong sense of right and wrong, he will shout at them and tell them that what they are doing is against the law.

Intense meltdowns

His parents have boarded up all the windows in the flat to try and cut down the noise to help their son cope with the noise, but all three of them are struggling to cope in the environment they are in. The son has frequent intense meltdowns, showing his frustration by shouting, kicking doors and breaking property.

The local authority is aware he is in crisis and needs to move somewhere more supportive with staff who understand his autism. This is probably not going to happen. He will probably end up in an inpatient unit as that is all that is available. This will be the worst place for him due to the noise and the confinement. If he goes into hospital he will do everything he can to get out. Perhaps he will end up lashing out at people or self-harming while trying to escape. This will result in a label of ‘extremely challenging’, he will be heavily medicated, restrained and perhaps secluded – effectively locked in a cell.


The tragedy is this does not need to happen – and in 2017 it should not happen. What are we doing to the people we love and care for? We know what he needs but no one seems able to provide it. We are all standing back helpless as we watch the steamroller running down the hill.

Under Lock and Key brought home the awfulness of the situation for people with a learning disability or autism who need specialist help. It’s not the fault of the staff in places like St Andrew’s Healthcare, which was featured in the Dispatches programme. They are doing what they can in an environment that is wrong for the people they support.

We have known for more than 50 years that hospitalisation makes matters worse but we can’t seem to stop doing it. There needs to be more than rhetoric from the government, commissioners and NHS England. There needs to be action, otherwise more families are going to be faced with the distresses and anguish so clearly evidenced in the documentary.

About the author

Simon Jones is chair of the RCN’s Learning Disability Forum and nurse consultant with the Lifeways Group

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