Tue, 29 Nov 2016

Are surveys fair to autistics?

The National Autistic Society (NAS) ran a survey about terminology between December 2013 and February 2014, which informed its campaigning and led to the publication of the article Which terms should be used to describe autism? in Autism Journal in 2015.

As part of an otherwise frustrating dialogue with the NAS, Carol Povey, Director of its Centre for Autism, shared some of the processed anonymised data from this data as used internally by the NAS. A partial set of the cleaned data as processed for the article was later obtained from Liz Pellicano and Lorcan Kenny. The data for the article had been cleaned by the paper's authors in their initial submission and following review comments. Unfortunately, these data sets were shared in confidence and neither have been published.

In trying to better understand these datasets, I noticed some discrepancies between them. A concern is that the process of cleaning the data before analysis may affect survey-based articles on autism in a specific way. When both autistics and non-autistics are surveyed, the cleaning process appears to disproportionately affect the autistic cohort. Here's the text of the letter to the editor of the Autism Journal in which I detail this concern:

Does data cleaning disproportionately affect autistics?

In Kenny et al.’s paper (2016), titled ‘Which terms should be used to describe autism? Perspectives from the UK autism community’, the authors analysed data from the UK’s National Autistic Society’s (NAS) survey on terminology. In the paper, they detail how they removed a significant number of participants prior to data analysis. They state,

In all, 4622 people responded to the survey. Participants who (a) did not specify any connection with autism (n=19), (b) did not complete all four key questions on describing autism (n=453), (c) were under 18 years or preferred not to state their age (n = 284) and (d) were not resident in the United Kingdom or preferred not to state their place of residence (n=396) were excluded from the data set prior to analysis. Subsequent analysis was therefore based on complete responses from 3470 participants.

I believe that comparing results from the raw data and that of the data with these participants removed shows that this removal has disproportionately affected the processing for autistics compared to that for the other categories of respondents such as families and professionals.

For example, in Table 2, the modes for four rows for the ‘autistic’ column are different for the processed data compared to the raw results. Only one row is different for the ‘Parent’ and ‘Family/friend’ columns and none for the ‘Professional’ column.

I would suggest there is a reason for this. Anecdotally, autistics who have issues with the wording of survey questions or the possible set of answers often either object to continue filling in the survey or skip the offending questions (and often attempt to get in touch with the researchers for corrections and clarifications). There are 453 incomplete such entries in the NAS survey by autistics – which have been removed from analysis and, ultimately, were not taken into account for the processing in the final article.

This very limited comparison raises the hypotheses, supported by anecdotes, that cleaning of data in surveys targeted at both an autistic and non-autistic cohort may introduce a bias disproportionately affecting the responses from autistics. Further work on whole sets of data before and after the cleaning for several surveys is required to reach any conclusion.

Reference

Kenny L, Hattersley C, Molins B, et al. (2016) Which terms should be used to describe autism? Perspectives from the UK autism community. Autism 20(4): 442–462.

Autistic responses

Looking solely at responses by autistics in the cleaned data, i.e., the autistic perspective, there are a few interesting outcomes (see tables below).

The preference for identity-first terminology (e.g., I am autistic) by autistics is clear:

Also ‘autistic person’ is always rated lower, by autistics, than ‘autistic' or 'is autistic’. This seem to imply that adding 'person' is redundant, though it may of course be context dependent.

Lastly, the second table below shows at least 53% of the autistic respondents were aspie, so the autistic respondents may not represent the full diversity of autistics.

What next?

Hopefully some researchers will investigate further whether the cleaning of data in surveys targeted at both an autistic and non-autistic cohort does introduce a bias disproportionately affecting the responses from autistics.

Several questions in the survey had very similar, but different, sets of answers and I wonder how many respondents analysed the subtlety of the different questions when answering them. (It also means that one cannot directly compare the different questions as the sets of answers are not identical.)

This important research paper raises many issues about accessibility at all stages of research, when surveys questions could be confusing and the way the data was analysed may have created bias disproportionately affecting autistic respondents, who may have felt unable to answer one or more of the questions. The solution to improve autism research is to involve autistics from the design to the analysis of research projects.

Which words/phrases do you prefer to use when communicating about autism? (Select all that apply)Autistic
Autism64%
Autistic61%
On the autism spectrum56%
Aspie47%
Autism spectrum disorder (ASD)39%
Autistic person36%
Has autism35%
High functioning autism (HFA)32%
Person with autism28%
Autism spectrum condition (ASC)28%
Low functioning autism (LFA)8%
Autist7%
Classic autism6%
Pervasive developmental disorder (PDD)5%
Kanner’s autism2%
Kanner’s syndrome1%
Other (please specify)20%
How do you describe yourself, your child, or those you work with? (Select all that apply)Autistic
Has Asperger's53%
Aspergers syndrome51%
On the autism spectrum45%
Autistic43%
Aspie38%
Is autistic35%
Autism spectrum disorder (ASD)28%
Has autism28%
High functioning autism (HFA)23%
Autistic person22%
Autism spectrum condition (ASC)18%
Person with autism18%
Is Aspergic6%
Autist4%
Pervasive Developmental Disorder (PDD)3%
Classic autism2%
Low functioning autism (LFA)1%
Kanner’s autism1%
Kanner's syndrome0%
Other (please specify)11%
Please rate the following words or phrases (mode)Autistic
Asperger syndrome5
Aspie5
On the autism spectrum4
Autistic4
Person with autism or person with Asperger’s4
Has Asperger’s or autism4
Autistic person3
High functioning autism3
Autism spectrum disorder (ASD)3
Autism spectrum condition (ASC)3

This post was simultaneously published on the Speak up blog, which accepts comments.

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Sat, 18 Jun 2016

Consultation process for the Met Detention Equality Impact Assessment flawed

In March 2015, Met Detention, the Metropolitan Police Service (MPS) centralised command for police custody, invited independent custody visitors (ICVs) to review its Equality Impact Assessment (EIA) (pdf) and provide feedback. As ICVs we do surprise visits to police stations and talk to the persons being detained. As we are independent of the police and have regular experience of the custody environment, this request for feedback made lots of sense and was welcomed.

Several members of my ICV panel did provide feedback and ICVs from other boroughs likely did as well. As we were not informed as to how our feedback had been used, I asked for a copy of the updated Equality Impact Assessment. In February 2016, I received a copy… of the same document we had been sent to review a year earlier.

I subsequently asked via a Freedom of Information request for all the feedback received when creating and revising this Met Detention Equality Impact Assessment. Met Detention could only find a single feedback dated October 2015 (pdf), that briefly touches upon two issues of interest to Superintendents. Nothing else, neither the feedback from ICVs nor from anyone else.

And they apparently did an exhaustive search for any feedback received. The initial response to my request was delayed as

'Enquiries are still being made in relation to the second part of your request.'

The first part of my request was about the EIA documents, and the second part was about 'the feedback received following each review of these documents'. When a further response was sent with some versions of the EIAs attached, I was then told:

'With respect to the second part of your request, reasonable searches have been made and as at today's date no information relevant to your request has been located.'

And an internal review (delayed as well) explained that:

'the review is satisfied that reasonable enquiries were carried out in the original case with the most appropriate Unit (Met Detention) for ‘The feedback received following each review of these documents’. Following further enquiries only one relevant feedback email was located and is attached to this review - subject to the exemption of personal information by virtue of section 40(2)and(3).

The review is satisfied on the balance of probabilities that no further information is held which falls within the scope of your request for feedback following each Equality Impact Assessment.'

That a year after a review process was initiated, only one feedback can be found raises concern as to the validity of this consultation process. This is compounded by the experience that the feedback that was thought out and had been sent in was obviously ignored.

Bootnote 1: Here's a copy of the feedback I had sent (well within the three weeks we had been offered):

Thank you for sharing this EIA. Here is some feedback (in no particular order) which you may hopefully find useful.

A related point is that there should be representation of vulnerable and disabled individuals (with MH, LD and/or autistics) in forums affecting what’s happening in custody. With Met Detention being a central command, this can’t happen at the SNB level, I would be interested to learn what consultative forums exist at which custody will be looked into.

Thank you for forwarding my earlier comments. As the draft EIA was shared specifically asking for our feedback I do hope the responses received will be taken into account.

Two further thoughts about the EIA I should have included earlier:

Thank you. FYI, I just realised that there’s guidance from the College of Policing as well about sensory issues for autistics and other vulnerable detainees:

'Those carrying out the risk assessment for detainees experiencing mental ill health should consider whether there is any additional risk of short and longer-term harm. It is also important to identify specific areas which could adversely affect those who are vulnerable because of learning disabilities and difficulties. For example, people who have autism or Asperger’s syndrome can be highly sensitive to their environment, and loud noises or bright lights may in some cases cause distress and possibly even aggressive behaviour.

The risks that a detainee with mental ill health or learning disabilities may pose to themselves or others are individual to each case and cannot be generalised.

Being in a police cell can have an adverse effect on a person’s condition if they are already suffering from mental illness. In particular, isolation and the noise in a busy custody suite can be aggravating factors.

Mental ill health and alcohol/drug misuse often coexist and a person’s impulsivity may make it more likely that they will self-harm or consider suicide.'

Bootnote 2: To become an independent custody visitor and join the panel of the borough your live or work in, apply to the Mayor's Office for Policing and Crime (MOPAC).

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Thu, 21 Apr 2016

Fewer detainees held for longer by Met police

Over the past two years, the Metropolitan Police Service (MPS) has detained fewer and fewer persons for longer and longer. Information obtained via a Freedom of Information request shows that all 740 police cells available 24/7 are staffed and run by Met Detention, the MPS centralised command for police custody. This transfer of control from the Borough Operational Command Units to Met Detention happened early 2015. The average occupancy rate of these cells has been 44% over this period. 20,465 persons were detained by the MPS in March 2014, 18, 457 in March 2015 (a 9.8% decrease) and 16,793 in March 2016 (a further 9% decrease).

The average waiting time between the arrival at a station and the authorisation of the detention by the custody sergeant has remained more or less the same at respectively 22, 22 and 21 minutes in March 2014, 2015 and 2016.

However, the average detention duration was already long in March 2014: 12 hours and 54 minutes and has been getting longer ever since. That increased by 4.5% to 13 hours and 20 minutes in March 2015, and further increased by 8.7% to 14 hours and 39 minutes in March 2016.

The average time spent in custody last month (including the initial waiting time) was 14 hours 59 minutes and 27 seconds, just 33 seconds short of 900 minutes (see graph below). That's 1 hour 45 minutes more than two years earlier.

Average time in custody

That's not the only issue affecting the custody environment, custody suites are understaffed and a recruitment freeze on Designated Detention Officers has made the situation worse. One suggested solution is to close several custody suites.

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Fri, 15 Apr 2016

A brief intro to autism

As part of the autism acceptance month, I was invited to make a short presentation at the CLR James Library in Dalston, Hackney. Below are the preparatory notes I wrote for this short introduction to autism.

Being autistic is a different way to be human. An atypical way of experiencing and relating to the world. A different way to think and process information.

Being autistic is developmental, it is lifelong. It is not a mental illness though autistic people may have mental health issues such as anxiety and depression often brought on from the frustration of not being accepted.

'Autism is a way of being. It is pervasive; it colors every experience, every sensation, perception, thought, emotion, and encounter, every aspect of existence.' (Don't mourn for us; Jim Sinclair - 1993)

Autistics have spiky profiles, an unusual combination of abilities and challenges. Autistics can find some tasks easy and others difficult, and this may change depending not just on the task, but also on the environment, and recent experiences. You can imagine autistics as forming constellations (like stars).

Each autistic individual is different and will have different needs. Autistics are diverse in their autistic traits and their severity. Some have an unusually large vocabulary while others are non verbal. Some autistics work and have a family (but may still find it difficult to cope) while others need full-time support.

'Once you've met an autistic person, you've met one autistic person' (Lorna Wing)

Rejecting stereotypes and embracing autism

Don’t believe the stereotypes.

Some autistics have deep empathy (even if expressing it can be difficult). Some are both trusting and trustworthy (white lies can be as abhorrent as any other lie). Some are conscientious and will persevere in difficult situations. Some are artistics. Some are experts. Some even have a sense of humour!

Some contribute to this society and many more would if we were better accepted.

Social

People being unpredictable, social relationships may be hard. Autistics tend to lack an intuitive sense of what is appropriate to say and do in a social setting. Reading faces may not be intuitive either. Operating in groups or integrating a new group can be difficult as one has to figure out when to take turn in a conversation, accept some of it may be factually incorrect or boring, etc. It is also common for an autistic to have one or a few topics of special interest and be keen for most conversations to focus on these.

Processing

Sensory and information overload (which can result in pain), anxiety, difficulties communicating, etc. can cause great frustration leading to atypical behaviours, meltdows and shutdowns.

Sensory processing

Processing the information coming in from the many senses all at once can be overwhelming. Also it is common for autistics to be over (hyper) and/or under (hypo) sensitive to some of their senses; and there are more than five, e.g., sight, hearing, taste, smell, touch, temperature, pain, kinaesthetic sense (proprioception), balance, etc.

So many senses are involved with food that eating and digesting often strongly affects autistics.

Autistics often tend to experience emotions more strongly, but may also appear not to have much emotional reaction or have difficulty moderating these emotions leading to outbursts.

Language processing

Autistics might need to focus on listening, and therefore will avoid eye contact, which is often difficult and sometimes even painful, when concentrating.

Autistics might find subtle social conventions difficult, such as when people rely on implied conventions or do not say what they mean.

Autistics might be non-verbal and use Augmentative and Alternative Communication.

Executive function

Autistics might find it difficult to deal with unpredictability, spontaneity and change, and require extensive planning and advance knowledge.

Also having to deal with many things at the same time may not be possible.

Self-preservation, coping or not

Stimming, calming repetitive movements or sounds that self-stimulate, and reducing stimuli helps with living. Autistic spaces where the environment and interactions are adapted to most autistic needs can be very calming places (however what is autism friendly for one autistic may be unhelpful to another). Meltdowns and/or shutdowns often happen when it is no longer possible to deal with the pain and/or stress being experienced.

Models

As autism is an integral all-pervasive part of who autistics are – the way their brains and bodies work – many autistics are keen on the use of identity-first language and refer to themselves as 'autistics'.

Being called 'a person with autism' can be offensive as it implies that autistics should strive for a state when they are 'without autism'.

Medical model of disability

The medical model finds autism to be a professionally diagnosed condition (or even a disorder) that must ideally be cured and require interventions. A person is disabled and doctors offer to fix that person, to treat or cure the disability. Autism is defined as a neuro developmental disability characterised by impairments (DSM 5 / ICD 10):

Autism is legally recognised as a disability:

Social model of disability

The social model considers that society must work to eliminate discrimination and accept us as we are in all our diversity. If someone has difficulties fitting in due to some impairments and/or differences, what is disabling is society not being inclusive. The aim is to remove all barriers, not just the physical ones, limiting life choices.

Neurodiversity

The world is made up of neurodiverse individuals: people with a variety of brains and minds, most are neurotypical and some are neurodivergent including autistics and everyone else whose brain is not typical (e.g., epileptic, dyslexic, etc.). Being neurodivergent is not intrinsically positive or negative.

The social model celebrates a neurodiverse world in which autistics (and others) are fully accepted with all their differences. It focuses on the positives, e.g., attention to details, factual, etc.

Acceptance, not (just) awareness

Everyone's identity should be respected. Autistic behaviours, which are likely atypical but not anti-social, should be respected and accommodated for. E.g., some care should be shown for autistic sensory needs and executive function difficulties, especially during interactions.

Challenge stigma and discrimination: 'As part of human diversity, autistic persons should be embraced, celebrated and respected. However, discrimination against autistic children and adults is more the rule rather than the exception. [...] Autistic persons should be respected, accepted and valued in our societies, and this can only be achieved by respecting, protecting and fulfilling their basic rights and freedoms.' (Discrimination against autistic persons, the rule rather than the exception; UN rights experts - 2015)

Society must show equality, respect and full inclusion of neurodivergents.

Bootnote

Some related posts:

First published on 2016-04-15; last updated on 2016-07-05.

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Fri, 01 Jan 2016

Blog posts in 2015

2015 posts (created with Wordle)

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Mon, 30 Nov 2015

Beware, undercover police officers carrying out behavioural detection in this area

Beware, plain clothes police officers operating in this area

‘Undercover officers trained to spot people carrying out terrorist reconnaissance are being covertly deployed to boost efforts to thwart an atrocity on British soil, the Guardian has learned.

They have been trained in behavioural detection and sent to areas deemed at risk of attack, such as transport hubs and high profile buildings.

A pilot of the scheme detecting suspicious behaviours already claims to have deterred hostile reconnaissance, a precursor to terrorist planning for a potential attack which involves the collection of information so terrorists can maximise the effectiveness of their violent actions.’

This will likely result in more arrests of innocent neurodivergent people who happen to be different, have an atypical behaviour and may not conform in their reaction when approached. Autistic behaviour can be found to be suspicious and an arrest is traumatic even when one appears almost too calm.

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Thu, 20 Aug 2015

Open letter to the NAS trustees

If you have had any dealings with the National Autistic Society, please read an open letter to its trustees calling for its use of inclusive language, and its focus on the positive of autism and on equal opportunities for autistic people. (This letter concludes a campaign of engagement with the National Autistic Society detailed in a separate document.)

If you are supportive of this letter and are happy to sign it, email me and I’ll add your name as a signatory.

The letter was sent to the National Autistic Society trustees on 2015-09-04. They responded on 2015-09-11 with a short generic text (copied below the open letter) ignoring all the issues raised in the letter and demonstrating a lack of respect to the signatories.

I have requested the membership department of the National Autistic Society to terminate my membership with immediate effect.

First published on 2015-08-20; last updated on 2015-09-12.

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Tue, 28 Jul 2015

‘Being Autistic’ – Calm, almost too calm

Ten years ago I was unlawfully arrested when attempting to take the tube after work. The police noticed that my behaviour was different, found it suspicious and decided I must be a terrorist. In the book Being Autistic – Nine adults share their journeys from discovery to acceptance I explore this difference:

Being Autistic cover

My understanding of how autism is an integral part of myself has been a long journey. I have always been different, eccentric, with very few friends. In primary school I was nicknamed ‘dictionary’ and in secondary school was bullied. I identified as a techie person and spent a lot of time with computers and online. Around 1998, when I was in my thirties, I read a review of the book Shadow Syndromes, which made me wonder whether I might be autistic.

The review picked among other things on the incapacity of one ‘patient’ to ‘clap in time to music’. This, in particular, resonated strongly with me. I can only clap in rhythm by visually syncing with another person’s clapping. I had never met or read of anyone with the same difficulty for what is apparently such a simple task. (It is ironic that this is not considered a characteristic autistic symptom.)

Reading more about autism and doing some online tests convinced me I was autistic and I self-diagnosed as having Asperger’s Syndrome. However coming from a medical family I was very aware of the unreliability of self-diagnoses generally and my family did not agree with this self-diagnosis. Tests, especially online ones, didn’t seem to be much more reliable. This resulted in believing that I was likely autistic, as many of my behaviours and past experiences matched some I had read about as being autistic, but not in the confidence to identify as autistic.

In 2013, in my late forties, I eventually sought a professional diagnosis. The reasons were two-fold.

Having previously worked as a software developer, a technologist and a journalist, I was unemployed, doing voluntary work and had decided to go back to university to do an MA. I thought a diagnosis could help me (as I eventually dropped out, this outcome was not fulfilled).

Also I had been wrongfully arrested. When I attempted to take the tube at Southwark station on 2005–07–28, police officers found my behaviour suspicious and decided to stop and search and subsequently arrest me as a potential terrorist. I thought a diagnosis would help if I was arrested again (this has not happened so far).

To get the diagnosis I went to my GP equipped with a printout of the information page for GPs from the National Autistic Society (NAS) and asked to be referred. My GP did not know anything about autism and asked me for a list of symptoms on one side of an A4 page and for a blood test. I attempted to explain that a blood test was irrelevant (and that I have an aversion to needles) but as I wanted the referral I went along with this request. (This GP also made some derogatory comments about my autism to my wife and we have both since changed surgery.)

In May 2013, a neuropsychologist eventually diagnosed that from information I had given him ‘there are features in social interaction and communication that, in the absence of other diagnoses, places you on the autistic spectrum – of the Asperger’s type.’

The validation from this diagnosis had the effect of enabling me to identify as autistic and to start to explore my autistic identity. Only after this professional diagnosis did I feel a sense of belonging, the confidence to join groups such as the Asperger London Area Group (ALAG) and to attend the Autscape conference; whereas before I felt I was not entitled to do so.

The diagnosis also helped me to reinterpret some traumatic experiences. It has made me realise that when police officers had found my behaviour suspicious, it was because of how they had interpreted some of my typical autistic behaviour, such as a lack of eye contact with them (i.e., I was ‘avoiding them’) and how I was dealing with the sensory-rich environment of the tube station. When I was made to wait in the entrance of the station before being led to a police van, some station’s alarms were ringing; I am hypersensitive to sound, but as my hands were still handcuffed I could not block my ears. When I was eventually processed, the custody sergeant found me ‘calm on arrival [at the police station], almost too calm’ and as a consequence I was ‘placed in a video cell on half hourly checks’. Again, my behaviour was found to be atypical.

During the police interview, some questions about my laptop, such as ‘has it got anything on there about plans for any terrorism act?’ and ‘has it got anything on there that might be construed as causing a public nuisance?’, particularly bothered me. The correct answers would have been ‘yes’ as I have a word processor, an email client, etc. that could all be useful to a terrorist and most likely can be construed to be of use for anything including causing a public nuisance, however, I realised that such answers would not have been been helpful to me and challenged the questions when the investigating officer just wanted answers.

Since the arrest I have become alcohol and fructose intolerant and I suspect this was a reaction to the stress. Policing in London and what happens to innocent individuals when they encounter the police became one of my special interests and I have researched, written and campaigned on civil and human rights issues such as the National DNA Database and the stop and search powers.

A year after my diagnosis, I publicly ‘outed’ myself and started some autism activism: I sent a contribution to a Home Affairs Committee inquiry into policing and mental health calling for police officers to realise that an atypical behaviour can be just different rather than suspicious; to consider hyper- and hypo-sensitivities that individuals may have; and to use clearer interviewing questions.

I am glad I sought out a diagnosis as it has been very helpful, but paradoxically this journey has helped me realise that for what is a neurodivergence, we should not need a medical validation. The medical pathway is not the best one, what we need is more legitimisation of self-diagnoses and acceptance of neurodiversity.

Being Autistic – Nine adults share their journeys from discovery to acceptance is published AutAngel, a community interest company. To find out more about the book and get your copy, visit AutAngel’s website.

Bootnote

Here are some related posts:

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Fri, 24 Jul 2015

Autistic behaviour considered suspicious

A year ago, I was interviewed for an Ask Autism e-learning module on policing made by the National Autistic Society. This module, aimed at an audience of police officers, has just been completed and published, and can now be purchased on the Autism and the police service web page. I made the point that police should consider atypical behaviours as just different and not suspicious; that they should take into account the hyper- or hypo-sensitivities that people might have, in particular to sound, light and touch; that they should ask clearer questions; and, that they should have better training. Here's as a my interview:

Bootnote

Here are some related posts:

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Wed, 22 Jul 2015

‘Being Autistic’ - terminology

I contributed two chapters to the recently published book Being Autistic – Nine adults share their journeys from discovery to acceptance. This book is aimed at adults having recently identified as autistic. To help readers reflect on the terminologies used by most autistics and most of those referring to us, and what are some of the implications of these choices, I wrote the following chapter:

Being Autistic cover

I am not a person with autism. I am an autistic person.

Receiving a diagnosis or identifying as autistic – can be very empowering and often entails talking and/or writing about autism. There are many words and expressions to choose from. You might have noticed that the contributors to this book express different preferences in their writing. To help you navigate your way through this terminology, here are a few of my choices and their implications.

You can choose whether to use identity-first (I am an autistic person) or person-first (I am a person with autism) language. As autism is an integral part of who we are – the way our brains and bodies work – many autistics are keen on the use of identity-first language and refer to themselves as ‘autistics’. I find person-first language (being called ‘a person with autism’) offensive as it implies that we should strive for a state when we are ‘without autism’. A useful way to think about this is that you would say a person with a cold, but not someone with Jewishness, or with left-handedness. Of course I also respect each individual’s choice of the language they use to refer to themselves.

This distinction is linked to how you consider our differences and how we fit in society. I know of two basic models. The medical model, the most common in our society, explains the difficulties we may have as caused by us not fitting in. To improve our lives, we must change (e.g., forcing ourselves to look others in the eyes, not stimming,1 etc.). The social model,which I and many other autistics prefer, considers that if someone has difficulties fitting in that is because there are barriers that should be removed; society must work to eliminate discrimination and accept us as we are in all our diversity. While the medical model finds autism to be a problem that must ideally be cured and suggests interventions, the social model promotes equality, respect and inclusion.

Autism Spectrum Disorder (ASD), on the spectrum, Asperger’s Syndrome or type, Aspie, high (HFA) and low functioning and classic autism, etc. – a great many terms are used to label us, but we tend to use fewer to express our identities. One reason for so many is to reflect the diversity of autistics. A common saying, attributed to Lorna Wing, is that once you’ve met one autistic, you’ve met one autistic. Several of these words classify us along a spectrum with abilities ranging from very poor (low-functioning autism and classic autism) to above average (high-functioning autism and Asperger). This neat continuum, however, does not match the more complex reality. Some autistics will find some tasks very easy some days and impossible to do at other times; individual profiles tend to be spiky and changeable. Although my diagnosis was ‘on the autistic spectrum – of the Asperger’s type’, I feel that it is more inclusive to identify simply as autistic and support everyone in this constellation of diagnoses and identities.

What about everyone else – the non-autistics? A word often used by autistics (and others) to describe most of those who are not is ‘neurotypical’ (i.e., have a typical brain), abbreviated as NT. The world is made up of neurodiverse individuals: people with a variety of brains and minds, most are neurotypical and some are neurodivergent including autistics and everyone else whose brain is not typical (e.g., epileptic, dyslexic, etc.). Being neurodivergent is not intrinsically positive or negative. The social model celebrates a neurodiverse world in which autistics are fully accepted with all our differences, a world I want to live in.

To explore some of these issues in more depth, here are two good starting points:


1 ‘Stimming’ is self stimulatory behaviour such as hand flapping or spinning.

Being Autistic – Nine adults share their journeys from discovery to acceptance is published AutAngel, a community interest company. To find out more about the book and get your copy, visit AutAngel’s website.

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Thu, 18 Jun 2015

Celebrate neurodiversity

Some people do notice

Happy autistic pride day 2015

Being Autistic cover

Being Autistic, Nine adults share their journeys from discovery to acceptance is a book about to be published by AutAngel. You can pre-order your copy at a discount for a few more days.

I contributed one of the journeys and I am celebrating autistic pride day by reviewing what should be the final proof of the book

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Sat, 09 May 2015

Met Police and mental health trust of racist cover-up makes national news

When I sent in a freedom of information request, in October 2012, asking for the South London and Maudsley NHS Foundation Trust investigation report into an incident involving a massive police deployment that happened earlier that month at one of the Trust's mental health ward, I expected to receive the report within a few months. It took close to two and half years and involved sending a dozen of freedom of information requests to the Trust, the Metropolitan Police, the Independent Police Complaints Commission, Monitor and the Care Quality Commission as well as requesting many internal reviews and making several complaints to the Information Commissioner’s Office who issued two related decision notices.

Here’s a brief chronology of the reports I received from the Trust (the Metropolitan Police after many searches cannot find its own report):

The full report lists what the Trust and the Metropolitan Police have been covering up during all this time. My investigation has been written up in the Saturday 9 May editions of The Independent (pdf and below) and i (pdf). Note that, at the time of writing, the online version of The Independent's article is abruptly cut in the middle of the article (surprisingly where the text finishes on the first page of the article in the print edition, as if the online version was created from the printed paper).

The Independent p. 31 Campaigners accuse Met Police and mental health trust of racist cover-up

By Paul Gallagher, The Independent, Saturday 9 May 2015

A mental health trust and the Metropolitan Police have been accused of trying to cover up alleged racism towards patients during an extraordinary night when 48 officers – some in riot gear – were deployed to deal with disturbances in a ward of vulnerable adults.

Campaigners have spent three years trying to uncover what happened at the River House facility at Bethlem Royal Hospital, part of the South London and Maudsley NHS Foundation Trust, on 1 October 2012.

Several days of disturbances escalated into a riot, the ringleaders of which were four patients, three black and one white. They had placed staff under siege which required police intervention before control could be regained.

The Met sent in 48 officers, including armed and dog units. More than 20 officers entered the ward including several Tactical Support Group (TSG) officers in “strict, compact riot formation” armed with Tasers, shields, visors and batons.

An independent report into the disturbances commissioned by the trust said: “According to staff statements, the police, after entering the unit, ignored the request of staff to treat Patient C (a white patient) the same way as they had treated the three black patients.

“Staff state that the police made no attempt to coordinate their actions with [hospital] staff as is standard practice during a siege, to gain information and to help them plan their strategy in order to minimise disruption to the unit.”

Police, assisted by hospital staff, escorted the three black patients (Patients A, B and D) to solitary confinement, handcuffing two of them. Officers also placed a clear plastic cover over Patient B’s head preventing him from moving his head and shoulders. “He was initially ignored by police until several promptings by staff,” the trust report said.

Patient C, the only white patient of the four, was not handcuffed and allowed to stay in the television lounge despite staff insisting to police he was also “a significant player in the disturbance” and that being left on the ward could lead to another disturbance – which it did.

Immediately after police left, around 3am, another patient, E, demanded an explanation as to why Patient C had remained on the ward. The report said: “Patient E believed that there was a racial motive which led to staff assisting the police to place three black patients in supervised confinement, while a white patient was treated more favourably.”

Despite explanations, Patient E became increasingly agitated and hostile and threatened to kill staff and patient C. “This led to a second siege when staff lost control of the ward for a second time. Police assistance was required again before staff could regain control of the clinical area,” said the report.

Eleven officers returned and “dealt with the situation promptly”. By 5am full control was restored.

The Independent p. 32

A 111-page report was completed in May 2013 and a summary published that August. An “unreadable” version was only made public in May 2014 following Freedom of Information requests made by David Mery on behalf of the charity Black Mental Health UK. Almost all the allegations of racism and the patients’ ethnicity had been censored.

Mr Mery appealed and the trust was forced to publish the report again earlier this year detailing the accusations of racism as well as Scotland Yard’s refusal to engage with hospital staff. Around 30 pages remain completely redacted.

A paragraph initially redacted said: “It took eight weeks to secure material from the Metropolitan Police. Requests for further and better particulars have been unsuccessful, despite reminders on matters which were explored at interview with an inspector from Bromley borough police.”

Mental health campaigners say it was only luck that prevented staff or patients being injured that night.

The Met Police had previously been heavily criticised for their actions at the same hospital in September 2010. Then, Olaseni Lewis, a 23-year-old Kingston University postgraduate student, died after being forcibly restrained by up to 11 officers while seeking help as a voluntary patient. Five years on his family are still waiting to hear when an inquest into his death will be held.

Addressing the 2012 incident, Mr Mery told The Independent: “The cover up, with the trust releasing conflicting statements and deliberately attempting to avoid the release of its investigation report (and still refusing to name its authors), and the Metropolitan Police losing its own report, demonstrate that neither organisation is keen to take responsibility for what happen and ensure that it won’t happen again.

“Surprisingly, there doesn’t appear to have been a specific investigation into the racist behaviour described in the report. NHS trusts and police forces should have an obligation to publish reports into serious incidents publicly, promptly and in their entirety. However, the police have lost the incident management log for what they have classified as a critical incident.”

The police have said they were concerned that the staff on the ward that night were unaware of any contingency plan other than to call them on such an occasion. Operation Metallah, a new way of the Met to work with the mental health trust, was launched a few months later.

Mr Mery said: “The tactics that resulted in the deployment at a mental health unit of armed officers, dog units, and TSG officers with Tasers drawn are clearly wrong. Such tactics cause distress to the vulnerable individuals housed there. The apparently racist behaviour of TSG officers involved is unacceptable.

"It is lucky this time no one died or was seriously injured. Olaseni Lewis and Sean Rigg [whose death in police custody in Brixton, south London, in 2008 led to widespread campaigns on how officers treat suspects with mental health issues] were not so lucky.”

i p. 27

A trust spokeswoman said the report had been redacted on legal advice "for reasons of patient and public safety, and patient confidentiality… to maintain security arrangements used in a forensic mental health facility and to protect patient and public safety”.

She said: "The report published on the trust website provides a clear and independent account of what happened on 1 October 2012. The trust's intention was to publish the report in the interests of transparency while using the correct application of the FoI Act to ensure that the identity of patients and their security was not compromised.

"Following the investigation in 2013, the trust has taken action to address all recommendations made in the report to prevent a similar incident recurring.

A Met spokeswoman said: "The location is known to officers as housing high-risk mental health patients. There was a serious threat to staff safety, and some patients, whose medical history was not known to officers, were unsupervised and believed armed with furniture and access to a kitchen area containing knives.”

She said the response was based on "using the widest range of resources available during a highly charged incident by deploying resources appropriate to bring the situation under control, while ensuring the safety of staff and patients. The Metropolitan Police Service has received no complaint in relation to the incident. Should any complaint be received it would be thoroughly investigated."

She added that since the May 2013 publication of Lord Adebowale's report into how the Met responds to mental health incidents: "The MPS has fundamentally looked at how we work as an organisation, and with partner agencies, to improve services, share information and better understand the needs of people with mental ill health.”

The fudge report: Crucial details obscured

[NB xxxx represents details such as names mentioned in the copy but redacted in the ‘Final 10th May 2010 Report’]

‘Staff under siege’

Incident 1: escalated to a riot (as defined by BDP CAG – Major Incident Protocol and Procedures, February 2012), involved xxxxxxxxx who opportunistically placed staff under siege in the nursing station which required police intervention before nursing staff could regain control of the clinical environment. The antecedent to this incident stemmed from one patient, xxxxxxxxx. This incident resulted in damage to property but no physical injury to staff. Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx. The fourth patient, xxxxxxxxx, was initially left on the ward, despite concerns raised by staff that this could lead to further disturbance.

‘Increasingly agitated’

Incident 2: followed on almost immediately from the first incident, when xxxxxxxxx approached staff demanding an explanation as to why xxxxxxxxx had remained on the ward. Xxxxxxxxx believed that there was a racial motive xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx. Notwithstanding explanation from staff, xxxxxxxxx became increasingly agitated and hostile and threatened to kill staff and xxxxxxxxx. This led to a second siege when staff lost control of the ward for a second time. Police assistance was required again before staff could regain control of the 12 Independent Report – Norbury incidents, night of 1st October 2012 clinical area. This incident also resulted in damage to property. Xxxxxxxxx sustained minor injury to his hand. There were no physical injuries to staff.

‘Threatening and abusive’

Xxxxxxxxx had, by this time, calmed down considerably and although remained verbally threatening and abusive, obeyed police instruction, sitting on the floor with his arms above his head allowing the police to handcuff him. Xxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx. He was initially ignored by the police until several promptings by staff. He was escorted by xxxxxxxxx on Norbury Ward.

Bootnote

Here are my previous posts about this incident:

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Sun, 03 May 2015

Epic interview of the National Autistic Society’s Chief Executive

Autistic British journalist/author and advocate Lydia Andal has just published an epic interview of Mark Lever, Chief Executive of the National Autistic Society. It is a revealing interview. Mark Lever admits ‘I think we’ve got to get much better at communicating with, engaging with autistic people. And I know that sounds crackers – it’s the National Autistic Society, but I’m just being honest.’ You can start with a guide to the six parts.

The first instalment is about the Ask Autism training programme, created by autistics. In it, Lydia Andal questions Mark Lever about contributors to Ask Autism not having been paid and not having been given access to these modules. To provide a reality check to Mark Lever’s answers, this section includes a case study of my experience of being video recorded for one of the training module:

What Happened Next?

During the Interview: When asked if he will commit to sending the autistic contributors to the Ask Autism programme an access code – Mark says he will.

After the Interview: Mark did not deliver on this commitment.

Instead the NAS subsequently issued the following statement: “Everyone who developed the modules has been offered free access to Ask Autism.” (bold emphasis added).

This statement highlights that in contrast to Mark’s commitment in the interview – access continues to be restricted to the small number of people who actually developed the training materials – a policy which was already in place at the time I met Mark.

As such the rest of the autistic contributors continue to be barred from accessing the online training programme they helped to create.

During the Interview: Mark states several times that he is committed to ‘significantly reducing’ the price of the Ask Autism programme so that those most in need of the training tool – autistic people and their families – are not priced out of accessing it.

After the Interview: The following enquiry was sent “Can Mark confirm the new pricing policy for Ask Autism for members? There was talk of it being free or at a heavily discounted rate during our discussion.”

Five weeks later the NAS provided the following statement:

“Prices for the Ask Autism service can be downloaded from our website here: http://www.autism.org.uk/our-services/training-and-consultancy/ask-autism/online-modules.aspx

Members are able to claim a 20% discount for individual modules. There are on-going discussions about how the modules could be further discounted for members and others where price is a significant barrier to accessing them.”

The 20% member discount was already in place at the time of the interview and remains unchanged. At time of writing (six weeks after the interview) – the pricing policy remains unchanged.

This article will be updated if and when the NAS change their pricing policy – until then it could be considered that Mark has not delivered on his commitment to reduce the pricing of Ask Autism.

During the Interview: Mark states he wasn’t aware that some contributors had not been paid.

After the Interview: The following enquiry was sent “Can Mark confirm how many of the 70 contributors to the Ask Autism training modules have been paid.”

The NAS subsequently confirm the following “28 of the 74 contributors to the Ask Autism training modules were paid. Others contributed via Survey Monkey and so were not paid.”

The above NAS statement seeming to confirm that only those who contributed to Ask Autism via Survey Monkey have not been paid does not seem to be accurate as Ask Autism contributor David Mery explains below.

Ask Autism Contributor Case Study

“In August last year [2014] I was contracted as a ‘consultant’ to be filmed for an Ask Autism training module. As this module has still not yet been published, I will not mention its topic. It is an area where much training is required so I am very keen for this module to be completed and for it to be of a good standard. When I was initially contacted to be asked if I was interested in participating in this module, I was told that the Ask Autism budget was stretched and that the NAS could only pay expenses. I expressed my unhappiness about this, but this was not open for negotiation although it was suggested there may be some money for reviewing the module.

The impression I got was that the Ask Autism staff was not given a budget to pay contributors and did not have the power to get one. The contract I was sent offered only expenses. I did reluctantly accept it as I very much want training on this topic to be widely disseminated, but it was a difficult decision. An hour was scheduled on August 12th to do the filming. Two NAS staff and two videographers were present, probably paid.

After an initial editorial interest in the topic of the module, all the emails I received were about administrative issues. The most time spent was on negotiating usage permissions for the video for which I was asked to give away many rights that had little to do with Ask Autism and its promotion. As I was volunteering my time and expertise, I was not willing for the NAS to make more money outside of the sales of this Ask Autism module without any sharing. I wished the same amount of energy spent by NAS arguing this release form had been spent discussing the editorial content.

When in September I received a reminder to send in my travel expenses – which I had said I would waive as I had travelled to the filming by bus and on the way back by foot – I asked if this was an invitation to re-open the discussion about a fair payment for my time, and was told ‘In regards to payment for your time, unfortunately we are unable to do this as discussed before the interview and noted in your contract.’

I was not given access to any of the existing Ask Autism modules, which would have been useful to ensure consistency of style across the modules; I have been promised access to the module I contributed to when it is published.

In March I was eventually invited to a closed testing of the module and I discovered I was the only interviewee in this module. There were some serious editorial issues on which I provided feedback and I believe these are being worked on before the module is finalised, but communication has been limited. With some other autistics, I was promised in January, independently of my discussions with the Ask Autism team, that all the 70+ contributors to Ask Autism would be given access to all the modules; this has not yet happened and the only module I’ve seen so far was the one I was given five days to review.

I regularly volunteer for several other charitable projects and am very happy to do it for the good of the community. However when income is generated as part of the activity it should be shared fairly. For example, one of the charities I volunteer for also occasionally has paid events; for these the charity pays ‘volunteers’ a very reasonable one-off fee. As the Ask Autism training modules are a commercial offering of the NAS, even for its members, I would have expected some payment.

The NAS has in its vision a world where an autistic ‘lives with dignity and as independently as possible’, along with a mission to ‘involve, inform and empower people living with autism’. For the NAS not to pay fairly all its autistic contributors to reflect their expertise and the work they have done, to help them make a living and have an independent life is hypocritical as it goes against the NAS mission and vision.”

The sixth and last instalment touches upon the NAS position on the proposed autism marker on the Police National Computer:

Mark Lever: ’I know there’s talk about markers on some databases so that they can provide better support to people. […] I imagine [the information is] going to be self-disclosed, it would have to be self-disclosed I would think. I know there is talk in some systems about having autism flags so that they can better support people with autism but that would have to come from self-disclosure I would think.’

I wrote a detailed analysis about this proposed autism marker in the post Police marking of autistics.

It is well worth reading the full interview and what happened after, when Lydia Andal was checking information with the National Autistic Society’ PR team. In one of the changes to a quote by Mark Lever requested by the PR team (in part 5), they asked to remove

‘[W]e’ve never been a bio-med type charity […] people on the spectrum deserve to have all the support they can get to achieve their potential. That’s where we come from and that is no different to anybody else actually that they should have the right to get that support to achieve their potential.’

No similar statement or an endorsement of the social model of disability is available on the website of the National Autistic Society.

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Mon, 06 Apr 2015

What did the SLaM NHS Foundation Trust and the police cover up at River House

The South London and Maudsley NHS Foundation Trust (SLaM) has attempted to cover up what happened during two related incidents on a mental health ward. On the night of 2012–10–01, at its River House facility, 48 Metropolitan Police Service (MPS) officers were deployed, including officers from armed and dog units, and four Territorial Support Group (TSG) officers drew their Tasers on the mental health ward. The police cannot find its own investigation report. SLaM has eventually published a version of its investigation report with many fewer redactions remaining, in response to my multiple freedom of information requests and an eventual decision notice of the Information Commissioner’s Office.

You can now find out much of what they didn’t want you to know.

The mostly underacted 105-page report, released on 2015–02–25 is available here (in case this redacted report is updated or removed, a copy, as originally published, is available here). For comparison, the extensively redacted version, released on 2014–05–28, is available here (and a safe copy of it, here)

p. 29 of the 2014 version of the report p.29 of the 2015 version of the report

p. 29 in the 2014 and 2015 versions of the report.

What follows are excerpts from the SLaM investigation report which were blacked out in the earlier more extensively redacted release.

Apparently racist behaviour by TSG officers

‘Three patients (patients A, B, and D; all black) out of the four patients involved were placed in SC [Supervised Confinement]. The fourth patient, (patient C; a white patient), was initially left on the ward, despite concerns raised by staff that this could lead to further disturbance.’ p. 11 (first incident)

‘Incident 2: followed on almost immediately from the first incident, when patient E (a black patient) approached staff demanding an explanation as to why patient C had remained on the Ward. Patient E believed that there was a racial motive which led to staff assisting the police to place three black patients in supervised confinement, whilst a white patient was treated more favourably.’ p. 11 (Emphasis added)

’The UC confirmed that patients A, B, C, and D were involved and that prominent amongst these patients was patient C [a white patient].’ p. 24

’Patient B [a black patient], had by this time, calmed down considerably and although remained verbally threatening and abusive, obeyed police instruction, sitting on the floor with his arms above his head allowing the police to handcuff him. The police placed a clear plastic cover over his head to prevent him from moving his shoulders and elbows. He was initially ignored by the police until several promptings by staff. He was escorted by the first on-call CAG [Clinical Academic Group] manager and the police to SC on Norbury Ward.

Patient C [a white patient] was left sitting in the day area, as if he had played no part in the riot, despite all earlier insistence from staff that he had been a significant player in the disturbance. He was not handcuffed, as patients B and D had been and he was not taken off the ward. He was allowed to continue to remain in the TV lounge.

Patient A was considered by staff to be a behind-the-scenes orchestrator and manipulator.

According to staff statements, the police, after entering the unit, ignored the request of staff to treat patient C (a white patient) the same way as they had treated the other three black patients.’ p. 29 (Emphasis added)

‘Just before the police finally retired staff complained again about patient C [a white patient] remaining on Spring Ward. Therefore, a decision was taken to nurse patient C in the ICA on Spring Ward and to offer him prn medication. Two staff were were deployed on 2:1 observations with this patient.’ p. 30

‘These patients asked staff why one of the main activists [sic] (patient C) in the earlier incident, was left on the unit, while three other patients (all black) had been handcuffed and taken off the unit, accusing them of being racist for transferring three black patients into SC and leaving the white patient on the ward. Patient E (a black patient) approached staff around the nursing station demanding an explanation as to why patient C remained on the ward. Notwithstanding explanation from staff, patient E believed there to be a racist motive in the way black patients had been treated, accusing staff of assisting the police.’ p. 31 (Emphasis added)

Massive police presence causing distress to vulnerable patients not involved in the disturbance

’At 2347 the incident was considered by xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx to be “otherwise so dangerous” that Trojan (armed police officers), Dog Units and London Ambulance Service (LAS) were requested.’ p.23

’At 0052 there were in excess of 20 police officers on site; some in standard police uniform and others in tactical wear, carrying Tasers, shields and batons.’ p. 24 (Emphasis added)

’On arrival of Trojan [armed police officers] (unspecified in the police log), tactical advice was given, as per standard practice, with regard to use of fire arms. However, Trojan was stood down, as was the Bromley Borough Response team, as TSG [Territorial Support Group] would take the lead in entering Spring Ward.’ p. 27

’TSG entered Spring Ward from the fire road entrance via the airlock leading to the ICA and to the main ward in “strict compact riot formation (regimented crowd control)” armed with shields, visors, batons and Taser guns. Taser guns were not used.

Comment: According to some statements, patients who were already asleep and who were in no way connected to the disturbance were forced to leave their bedrooms by police officers, even though staff kept signalling to the officers that the real culprits were in the corridor and in the TV lounge.’ p. 28 (Emphasis added)

Comment: Most patients played no part in the riot. Nevertheless they were forced to leave their rooms (with the exception of patient F who was SC) as part of the tactical intervention made by the TSG. Some patients subsequently reported their sense of distress to xxxxxxxxxxxxxxxxxxxxxxxx but there is nothing recorded in the notes to this effect, even though there were potential safeguarding issues at stake. Attempts to secure further and better particulars about the methods used by the TSG have been unsuccessful.’ pp. 28–29 (Emphasis added)

Communication between SLaM and Bromley Borough Police lost in translation

‘It took eight weeks to secure material from the Metropolitan Police. Requests for further and better particulars have been unsuccessful, despite several reminders on matters which were explored at interview with an Inspector from Bromley Borough Police.’ p. 15

‘Although, according to some evidence, an agreement had been reached with Bromley Police Station that there would be police presence at the point of patient F’s transfer. When this was requested on 29/09/12, it was not forthcoming.’ p. 15

’At 2317 a third call was made to request ‘riot police support’ - CAD 9864. This was recorded on the police log as three patients had started rioting in the first instance and that all thirteen (patients) had now joined in; that suspects had metal poles and were trying to break the windows where the staff had retreated for security and that if the patients broke the windows, the staff would all be killed because patients had committed murder before.

Comment: This account is inaccurate, either because of what the police were told or because it was misconstrued in the translation. Most of the patients were sleeping or at least in their own bedrooms. There were no metal poles involved, although three patients were continually throwing a large metal bin with force at the window of the nursing station.’ p. 22 (Emphasis added.)

‘When the police declared incident 1 to be a Critical Incident’ p. 80

SLaM’s staff attempts to conceal intramuscular injection from patients

’A decision was taken to prepare oral prn midazolam 10mg as well as to draw up 7.5mg of midazolam for intramuscular injection. This was because the team determined there be to be a likelihood of patient D refusing oral medication. This was based on previous knowledge of him.

Comment: Preparing intramuscular medication at the same time as oral medication falls outside the ideal standard of practice. Whilst the Trust policy does not give guidance on this matter, NMC guidance (Standard 14: Standards for medicines management (NMC 2007)) is clear. However, under the circumstances and on balance, the Independent Team acknowledge that the specific situation required a degree of flexibility and staff initiative. The Independent Team accept that in some circumstances both oral and injectable medicines can be prepared simultaneously but that the injectable form of the medicine should then be stored in a readily accessible place and not handled in front of the patient at the same time that the oral medication is handled.’ p. 17 (Emphasis added)

’patient B smashed the oral medication out of the hand of the UC, spilling all the medication and water on the floor, along with the intramuscular medication, which according to some statements was concealed out of sight when it had been taken as a contingency measure, should patient D refuse oral medication.

Patient B accused the staff of bullying patients.’ p. 18 (Emphasis added)

‘The HCA [Healthcare Assistant] told the Independent team that as the ‘triggers’ associated with incident 1 were known to staff, that arguably, it was possible to foresee what would happen, once a decision was taken to offer patient D prn medication and how patient B would react to this. Patient B is known to object to the use of medication and tends to act as an intermediary between a patient and a staff member, often to try to ‘whip’ the situation up. In the opinion of the HCA, the situation could have been pre-empted and the police should not have been called.’ p.19 (Emphasis added)

SLaM staff appears to have been confused, lost control of the situation and retreated to the nursing station abandoning some vulnerable patients

‘The UC [Unit Coordinator] advised some staff to withdraw and to assemble in the nursing station for safety, as the situation was getting out of hand.’ p. 18

‘staff retreated to the nursing station’ p.19

‘Patient F remained unsupervised in SC [Supervised Confinement] once staff in the ICA [Intensive Care Area] and the nursing station had been evacuated from the ward. The first on-call CAG manager (a Registered Nurse) saw patient F on two brief occasions, with a police escort, to establish that he was breathing and not in too much distress.’ p. 28 (Emphasis added)

‘According to a statement from an Inspector from the Metropolitan Police, numerous requests were made to ascertain the names of those involved and risk assessment details, but there were no staff on duty able to provide such information, with no contingency plan, other than calling the police for dealing with such a disturbance. There was discrepancy between this statement and the evidence given by the UC.’ p. 21 (Emphasis added)

‘The UC and three other staff retreated to the nursing station to summon help.’ p. 31

’Comment: Given the severity of the situation the presence of an RC [Responsible Clinician] would have been appropriate. There was no senior medical presence for either incident 1 or 2.’ p. 33

Eight patients, including patient I, deemed very vulnerable, were left without access to any staff or care.’ p. 34 (Emphasis added)

Operation Metallah

‘Operation Metallah, a joint BRH/RH - Bromley Metropolitan Police protocol, with an operational implementation date of 20/04/13 – document received.’ p. 84

‘Operation Metallah, undertaken with the Bromley Metropolitan Police, in recognition that a new way of working was required to ensure optimal coordination and management of resources and sharing of information when police assistance is required, whilst not directly commissioned as a result of events on the night of 1st October 2012, has been influenced by it.’ p. 85

‘Operation Metallah - Joint Trust/Bromley Metropolitan Police protocol for responding to requests for police assistance at BRH, April 2013’ p. 104

The definition of the following terms in ‘Appendix 4 – Acronyms, abbreviations and terms’ had been redacted

‘Operation Metallah - Joint Trust/Bromley Metropolitan Police protocol for responding to requests for police assistance at BRH, April 2013’ p. 104

‘SC - Supervised confinement (seclusion)’ p. 105

‘Trojan - Metropolitan Police Firearms Unit’ p. 105

‘TSG - Tactical Support Group (Metropolitan Police)’ p. 105

p. 41 of the 2015 version of the report It would have been useful to get the Metropolitan Police Service (MPS) version of their intervention at River House that night, especially as from SLaM’s investigation report it would appear some TSG officers behaved in a racist way and caused undue distress to several vulnerable patients. An internal MPS email explains that ‘I have been informed that on [sic] Incident Management Log was created however despite searches on [Bromley] borough and with the senior investigating officer I have not been able to locate this document. Furthermore one document refers to a meeting in which this matter was to be discussed , again no further information could be found in respect of this meeting which may or may not have occurred.’ Following a complaint about the loss of this important document, the investigation log at an incident declared to be critical, the Information Commissioner’s Office wrote that ‘I have been advised by the MPS that searches for the log, which would be in hard copy rather than electronic, have failed to locate anything. Senior Officers connected to the event have been contacted but to no avail. The MPS have stated to me: “Unfortunately, in this instance the log in question cannot be located and is therefore, on the balance of probability not held”.’

So far, it has taken eleven freedom of information requests (to SLaM, the MPS, the Independent Police Complaint Commission, the Care Quality Commission and to Monitor), too many complaints to the Information Commissioner’s Office and a decision notice to uncover what has just been exposed that the South London and Maudsley NHS Foundation Trust and the police didn’t want us to know.

Some of these revelations are shocking.

There are still some redactions, which are likely unwarranted and, if so, in breach of the the decision notice of the Information Commissioner’s Office. The only valid exemption, agreed by the Information Commissioner’s Office, is for third party personal data which explains that most names are still redacted. It is more difficult to understand how the use of this exemption can be justified to miss pp. 39–67 from the table of content (on p. 2), and that from the middle of p. 40 to the middle of p. 65 the content is still entirely blacked out. From the headings just before and after these redactions, the redacted text must concern some of the findings of the investigation.

[Update 2015-04-24] The Information Commissioner’s Office has now compared the redactions made by SLaM with the steps prescribed in the decision notice and concludes:

‘From my analysis of the redacted and unredacted versions of the report, I am satisfied that SLAM has generally acted in accordance with the Commissioner’s instructions and therefore complied with the decision notice. This finding also applies to SLAM’s decision to withhold pages 40 – 65 in their entirety.’

Bootnote

Here are my previous posts about this incident:

And also some of the internal SLaM correspondence and internal MPS correspondence about my earlier FoI requests.

First published on 2015-04-06; last updated on 2015-06-24 to add details about compliance of remaining redactions.

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Mon, 30 Mar 2015

Surveillance in Trafalgar Square and the UK

Deutsche Welle filming crew German broadcaster Deutsche Welle was filming earlier this month a segment in Trafalgar Square for its series Focus on Europe - Spotlight on People.

The topic was how pervasive video surveillance is in the UK and the opposition to it by organisations such as No CCTV:

No other European country keeps as close a watch on its citizens as the UK. For years, the government has been broadening its powers of surveillance in the name of security. In other nations, its laws would long since have been considered breaches of privacy. Now opposition has also been growing in Britain.

I was interviewed for it and briefly appear 3’10" in the short programme.

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