Autistan’s Contribution to Scotland’s Consultation on Restraint and Seclusion in Mental Health Care (2026)

Scotland · October 2026 · Scottish Government public consultation · Mental Health Code of Practice

The Scottish Government consulted on changes to the Code of Practice for the Mental Health (Care and Treatment) (Scotland) Act 2003. A major part of the proposed update concerns restraint and seclusion in mental-health care: interventions that can physically limit a person’s movement or keep a person alone in a place they are not free to leave. The consultation also addresses cross-border transfers and detention in conditions of excessive security.

The Autistan Diplomatic Organization submitted a 97-page evidence-informed study. Its position is not that restraint and enforced seclusion should simply be managed more carefully. Autistan considers these practices, when used as coercive psychiatric crisis-management methods, to be degrading and incompatible with the direction of modern rights-based mental-health care. Strong safeguards remain necessary while they still occur, but the objective should be to prevent crises and progressively replace coercive responses with safer, non-coercive forms of support.

Illustration combining Edinburgh and the Scottish flag with a contrast between a restrained person in an institutional room and a calmer protected environment where a person sits with a dog beside an Autistan disk. — Illustration for the Autistan Diplomatic Organization’s study on restraint and seclusion in Scottish mental-health care.

Full study: Read or download the complete 97-page study (PDF). The full document is also available in the reader at the end of this article.

Executive Summary

The Scottish draft already contains important safeguards. It states, among other things, that autism by itself is not a reason for restraint, and that sensory overload or communication difficulties should not automatically be interpreted as aggression. It also emphasises prevention, environmental adjustment, communication support, recording and review. Autistan’s study asks how these principles can be made more precise and more effective in real situations.

A central problem is the way a crisis is interpreted. Someone may look angry, frightened, agitated or unusual without presenting a serious current danger. An autistic person’s movement, tone of voice, withdrawal, refusal, insistence on a precise answer or attempt to leave may be misread as aggression. The study therefore insists on separating what was actually observed from interpretations such as “aggressive”, assumptions about intention, and predictions about what might happen next.

The same approach applies to the causes of a crisis. A restrictive intervention should not be examined in isolation from what happened beforehand. Sensory overload, pain, inaccessible communication, conflicting demands, loss of control, staff behaviour, crowding, misunderstanding or institutional rules may all contribute to distress. If the service itself helped create the crisis, using more force can intensify the very problem staff are trying to stop.

The study also examines the harm that restraint and seclusion can themselves cause. These harms are not limited to visible injury. They can include respiratory and circulatory risks, pain, sensory distress, fear, humiliation, trauma, loss of trust, helplessness and the experience of being unable to protect or reposition one’s own body. A person becoming still does not necessarily mean that the person has become safe or calm; it may reflect exhaustion, medication, fear, shutdown or resignation.

For Autistan, the practical question is therefore not merely how to perform restraint or seclusion with fewer immediate complications. It is how services can make them progressively unnecessary. That requires environments and staffing that allow real alternatives to exist at the moment of crisis, not merely lists of alternatives written in a policy document.

The contribution combines peer-reviewed research, first-person testimony, independent investigations, human-rights material and Scottish guidance. It translates that analysis into concrete proposals for the Code, staff practice, incident review, monitoring and future research.

Priority requests

Require evidence of a real, current danger. A diagnosis, unusual appearance, staff unease, previous incidents or a statement that someone “could become aggressive” should not replace facts showing the specific danger that is said to justify restricting liberty.
Look at what caused the crisis before judging the person’s reaction. The review should examine sensory, physical, interpersonal, communication and institutional conditions, including the actions and decisions of staff.
Preserve harmless autistic self-regulation. Rocking, pacing, vocalising, changing position, withdrawing voluntarily or using an individual way of communicating should not be suppressed simply because it is unusual or inconvenient.
Make alternatives genuinely available. A service should not claim that less restrictive options failed if they were unavailable because of staffing, rules, lack of space, lack of preparation or permission barriers.
Assess the harm caused by the intervention itself. Physical, sensory and psychological effects should be considered together, including delayed effects and the person’s own account.
Record facts separately from interpretations. Incident records should distinguish what was seen or heard from labels such as “aggressive” or “dangerous”, and should preserve disagreements rather than converting one interpretation into an unquestioned fact.
Use safeguards as part of a transition away from coercion. Monitoring, training, review and legal protections are necessary while restrictive practices continue, but they should support a measurable move toward non-coercive crisis care.

Why this matters particularly for autistic people

Autistic expression can be misunderstood when it is judged through ordinary non-autistic expectations. A person may communicate very directly, repeat a question, avoid eye contact, move intensely, withdraw, cover their ears, refuse an unnecessary demand or try to escape an overwhelming environment. None of these things, by themselves, proves an intention to harm anyone.

The study therefore proposes a disciplined sequence of reasoning: first describe what actually happened; then distinguish interpretation from observation; then identify the concrete harm that is feared; and finally ask whether the legal threshold for restricting liberty is really met. This is intended to reduce decisions based on appearance, prejudice, diagnostic labels or speculative dangerousness.

It also asks services to recognise that some apparently “challenging behaviour” may be an attempt to regulate sensory overload, communicate distress, obtain a clear answer, escape pain or regain control. Preventing those harmless responses can aggravate the crisis instead of resolving it.

Prevention and practical alternatives

The study does not promote one universal technique. It proposes that services maintain a range of options adapted to the person and the situation: accessible communication, quieter or lower-stimulation spaces, movement, pacing routes, outdoor access where safe, familiar objects, music or silence, meaningful activity, warm water where appropriate, contact with a trusted person, and other individually useful ways of regulating distress.

The important point is availability. An alternative that exists only on paper, requires staff who are not present, depends on inaccessible permission procedures or cannot be used on the relevant shift is not an alternative that has genuinely been tried.

Among several design ideas, the study explores a protected crisis-regulation and expression space that could sometimes avoid bodily restraint by reducing environmental hazards while allowing the person to move, vocalise and regulate themselves. In a voluntary version, the person must genuinely be free to leave. If departure is prevented, the situation must be recognised and governed as seclusion rather than being renamed as something less restrictive.

From individual incidents to service accountability

A major practical proposal is a causal incident-review record. Instead of starting only with the moment when restraint or seclusion began, the review would reconstruct the whole sequence: what was happening before the crisis, what the person was trying to communicate or do, what risk was actually identified, what alternatives were available, how staff and the environment contributed, what restrictions were imposed, what the person experienced, and why the intervention ended.

The purpose is not to produce a better justification after an incident. It is to learn whether the same situation can be prevented from recurring. Corrective measures should therefore be followed up later to see whether they actually changed practice.

The study also argues that psychological harm should be taken seriously in review and monitoring, not only physical injury. The person’s own account should be preserved, including where it conflicts with the institutional account.

Training, oversight and the wider direction of reform

Autistan supports staff training, but not training that treats restraint and seclusion as ordinary clinical techniques to be mastered. The essential competence is prevention: understanding communication, sensory needs, trauma, interactional escalation, false assumptions about intention, and the difference between outward compliance and actual wellbeing.

The study also calls for stronger independent oversight and accessible routes for complaint and review. A safeguard is not effective merely because a law names a complaint body, lawyer or court; the person must actually be able to reach it, obtain evidence and be heard while dependent on the institution.

More broadly, the contribution asks Scotland to measure success not only by whether restraint becomes safer or less frequent, but by whether people experience greater freedom, safety, trust and access to support, and whether services are genuinely moving toward crisis care without coercion.

Other parts of the Scottish consultation

The consultation also includes cross-border transfers and detention in conditions of excessive security. On transfers, the study argues that continuity should mean more than moving a clinical file: communication methods, sensory needs, trusted relationships, preferences and preventive arrangements should travel with the person, and the effects of distance from family or support should be considered.

On excessive security, the study asks for clear information about the different remedies available, practical access to independent assessment and advocacy, and decisions based on current evidence rather than historical labels or speculative risk.

Read the full study

The complete 97-page document contains the evidence base, first-person accounts, human-rights analysis, proposed wording for the Scottish Code and implementation tools. Readers who want to go further can open the main parts directly: