Evaluation of the National HOPE(S) Programme to end long-term segregation (LTS) for children and young people, autistic adults and/or adults with a learning disability in inpatient hospital settings

Fradley, Kathryn, Rajan, Dineesha Georgeena and Haines-Delmont, Alina ORCID: https://orcid.org/0000-0001-6989-0943 (2025) Evaluation of the National HOPE(S) Programme to end long-term segregation (LTS) for children and young people, autistic adults and/or adults with a learning disability in inpatient hospital settings. Research Report. Manchester Metropolitan University, Manchester.

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Abstract

Long-term segregation (LTS) is a restrictive practice used in mental health services that disproportionally affects autistic people, individuals with a learning disability, and children and young people. LTS is often experienced as traumatic, isolating and dehumanising. Despite strong policy commitments to reduce the use of coercion in care, LTS continues to be widely used across the system in England. This report presents the findings of the first national evaluation of HOPE(S): a rights-based, trauma-informed intervention designed to reduce the use of LTS and improve outcomes for individuals, families, and staff. Conducted by Manchester Metropolitan University, the study used a mixed-methods approach across 40 NHS-commissioned organisations and 68 hospital settings in England. Results are based on a large sample (n=73) of in depth semi-structured interviews and focus groups and secondary analysis of routine clinical data and key outcome measures for 122 individuals in LTS, 11 family members and 388 staff. Quantitative results show that the HOPE(S) intervention was associated with: (i) Significant reductions in the use of physical and chemical restraint and seclusion; (ii) Improvements in quality of life for individuals; (iii) Increases in access to fresh air and meaningful activity; and (iv) Improved staff wellbeing, including reduced burnout and secondary trauma. Qualitative findings, co-produced with stakeholders, highlight HOPE(S) as a catalyst for cultural change. It helped shift practice away from containment toward connection, dignity, and relational safety. However, significant systemic barriers remain, including inconsistent definitions of LTS, service resistance, and the need for long-term relational continuity. This study provides robust, rights-based evidence to support national reform of restrictive practices in mental health and related services. The HOPE(S) model is scalable, impactful, and aligned with international human rights frameworks, including the UN Convention on the Rights of Persons with Disabilities (CRPD) and WHO guidance.