{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T23:54:10Z","timestamp":1792108450374,"version":"4.4.0"},"reference-count":22,"publisher":"Royal College of Psychiatrists","issue":"2","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"unspecified","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych open"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec id=\"S205647242610996X_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Long-term segregation (LTS) is used in mental health hospitals in England to manage individuals perceived to pose a sustained risk of harm to others. Increasing evidence indicates that LTS causes significant psychological and physical harm and may breach international human rights standards. The HOPE(S) programme (2022\u20132025) was introduced nationally to reduce, and ultimately end, the use of LTS for autistic people, individuals with learning disabilities and children and young people.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S205647242610996X_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To explore the experiences of LTS from different perspectives and to examine its impact through a human rights lens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S205647242610996X_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Qualitative data were collected from 73 participants, including people with lived experience of LTS, family members, HOPE(S) practitioners, clinical staff, commissioners and regulators. Reflexive thematic analysis was conducted as part of a wider, mixed-methods evaluation of the HOPE(S) programme.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S205647242610996X_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>LTS was described by most participants as harmful, dehumanising and lacking in therapeutic value. Four interrelated themes emerged: (a) dehumanisation and erosion of personhood; (b) safeguarding and systemic failure; (c) psychological and relational harm; and (d) loss of hope and systemic inertia. These experiences reflected breaches of the Convention on the Rights of Persons with Disabilities, and of the Convention on the Rights of the Child.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S205647242610996X_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LTS is not a therapeutic intervention and is associated with profound psychological harm and human rights violations. Systemic reform and implementation of rights-based, trauma-informed alternatives, such as the HOPE(S) model, are urgently required to safeguard well-being and dignity in mental healthcare.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjo.2026.10996","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T06:55:40Z","timestamp":1774594540000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["Long-term segregation in mental health hospitals: qualitative study of its impact and human rights implications"],"prefix":"10.1192","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2443-7368","authenticated-orcid":false,"given":"Kathryn","family":"Fradley","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02hstj355","id-type":"ROR","asserted-by":"publisher"}],"name":"Manchester Metropolitan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6989-0943","authenticated-orcid":false,"given":"Alina","family":"Haines-Delmont","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02hstj355","id-type":"ROR","asserted-by":"publisher"}],"name":"Manchester Metropolitan University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"S205647242610996X_ref22","volume-title":"Final Report","year":"2023"},{"key":"S205647242610996X_ref6","volume-title":"Review of Restraint, Prolonged Seclusion and Segregation for People with a Mental Health Problem, a Learning Disability or Autism","year":"2019"},{"key":"S205647242610996X_ref12","volume-title":"Mental Health Bill","year":"2025"},{"key":"S205647242610996X_ref13","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2024.211"},{"key":"S205647242610996X_ref19","doi-asserted-by":"publisher","DOI":"10.1177\/104973202129120052"},{"key":"S205647242610996X_ref16","volume-title":"Thematic Analysis: A Practical Guide","author":"Braun","year":"2021"},{"key":"S205647242610996X_ref1","first-page":"39","article-title":"Long-term segregation and seclusion for people with an intellectual disability and\/or autism in hospitals: a critique of the current state of affairs: commentary","volume":"226","author":"Quinn","year":"2025","journal-title":"BMJ Psychiatry"},{"key":"S205647242610996X_ref4","unstructured":"4 Department of Health. The Mental Health Act 1983: Code of Practice. Department of Health, 2015."},{"key":"S205647242610996X_ref8","volume-title":"CQC Calls For Fundamental Change in the Way Care is Planned, Funded, Delivered and Monitored","year":"2020"},{"key":"S205647242610996X_ref15","unstructured":"15 Kilcoyne, J , Angus, D. HOPE(S) Clinical Guide to Reduce Long-Term Segregation . NHS Mersey Care, 2023."},{"key":"S205647242610996X_ref20","doi-asserted-by":"publisher","DOI":"10.22233\/20412495.0814.4"},{"key":"S205647242610996X_ref11","volume-title":"Convention on the Rights of the Child","year":"1989"},{"key":"S205647242610996X_ref3","unstructured":"3 Department of Health and Social Care. Baroness Hollins Final Report: My Heart Breaks \u2013 Solitary Confinement in Hospital Has No Therapeutic Benefit for People with a Learning Disability and Autistic People. Department of Health and Social Care, 2023."},{"key":"S205647242610996X_ref2","volume-title":"Government Must Not Waste Any More Time Following \u2018Disturbing\u2019 Findings in Independent Report on Long-Term Segregation in Modern-Day Asylums","year":"2021"},{"key":"S205647242610996X_ref21","first-page":"202","article-title":"The staff\u2019s emotional reactions to aggressive behavior in mental health services","volume":"64","author":"Husum","year":"2010","journal-title":"Nord J Psychiatry"},{"key":"S205647242610996X_ref14","volume-title":"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.","author":"Fradley","year":"2025"},{"key":"S205647242610996X_ref5","volume-title":"Restrictive Practices in Inpatient Mental Health Settings: A Realist Review","year":"2025"},{"key":"S205647242610996X_ref7","volume-title":"Out of Sight \u2013 Who Cares?: Restraint, Segregation and Seclusion Review","year":"2020"},{"key":"S205647242610996X_ref10","volume-title":"Convention on the Rights of Persons with Disabilities (CRPD)","year":"2006"},{"key":"S205647242610996X_ref18","doi-asserted-by":"publisher","DOI":"10.1177\/146879410200200205"},{"key":"S205647242610996X_ref9","unstructured":"9 United Nations. Universal Declaration of Human Rights. United Nations, 1948 (https:\/\/www.un.org\/en\/about-us\/universal-declaration-of-human-rights)."},{"key":"S205647242610996X_ref17","volume-title":"Doing Reflexive Thematic Analysis. Supporting Research in Counselling and Psychotherapy: Qualitative, Quantitative, and Mixed Methods Research","author":"Braun","year":"2023"}],"container-title":["BJPsych Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S205647242610996X","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T06:55:45Z","timestamp":1774594545000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S205647242610996X\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":22,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["S205647242610996X"],"URL":"https:\/\/doi.org\/10.1192\/bjo.2026.10996","relation":{},"ISSN":["2056-4724"],"issn-type":[{"value":"2056-4724","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e93"}}