Scotland · 29-30 October 2026 · Scottish Government consultation · Mental health, restraint and seclusion
On 29 October 2026, the Autistan Diplomatic Organization submitted an evidence-informed study to the Scottish Government consultation on updates to the Code of Practice for the Mental Health (Care and Treatment) (Scotland) Act 2003. The study focuses principally on restraint and seclusion affecting autistic people, while also addressing the consultation’s chapters on cross-border transfers and detention in conditions of excessive security.
The current public version is V13, dated 30 October 2026. It contains 97 pages, twelve proposed additions or clarifications for the Scottish Code, direct responses to all fifteen consultation question groups, and a proposed causal incident-review record. V13 replaces the earlier submitted PDF only to make Appendix A more directly usable: the body of the study is unchanged in substance.
Full study (97 pages, V13, 30 October 2026): Read or download the complete PDF. A document reader is also available at the end of this article.
What the study examines
The study starts from three different questions that should not be confused: why a situation reached the point of restraint, what the intervention itself does to the person, and what could have prevented the apparent need for coercion. Physical control, immediate protection from harm and genuine relief of distress are treated as separate outcomes.
Its central methodological distinction is between directly observed facts, interpretations of those facts, inferred intention and actual current risk. A person may look angry or be perceived as aggressive without having committed an aggressive act; even an aggressive act does not automatically establish a continuing danger. The study therefore argues that coercive restriction must rest on specifically described present facts meeting the applicable legal threshold, rather than on diagnosis, appearance, staff unease or speculative dangerousness.
The analysis also reconstructs what happened before the final incident: sensory conditions, communication barriers, interpersonal dynamics, institutional rules, attempts to escape or self-regulate, pain or illness, and the responses of staff. This causal approach is intended to prevent a person’s visible reaction from being treated as though it arose in isolation.
Protection now, but replacement of coercion as the objective
The study supports strong safeguards while restraint and enforced seclusion continue to occur, but it does not treat those safeguards as acceptance of coercive crisis management as a normal model of care. Its stated direction is prevention and replacement by non-coercive responses.
Autistan considers restraint and enforced isolation, when used as coercive psychiatric crisis-management practices, to be barbaric and degrading and incompatible with respect for physical and psychological integrity. The study therefore asks Scotland to evaluate not only whether coercion becomes safer or less frequent, but whether services are genuinely moving toward crisis support without force or coercion.
Autistic experience, communication and self-regulation
For autistic people, the study gives particular attention to the risk that unfamiliar movement, tone, withdrawal, insistence, visible distress or refusal may be misread through non-autistic expectations and converted into assumptions about hostility or dangerousness.
It proposes a presumption in favour of preserving harmless autistic self-regulation. Walking, rocking, repetitive movement, changing position, vocalising, withdrawing to a chosen quiet place or using an individual communication method should not become grounds for restriction merely because they are unusual or inconvenient. Necessary supports should remain supports rather than rewards made conditional on appearing calm or non-autistic.
The study also insists that autism and intellectual disability must not be conflated. Communication, sensory experience, movement, agency, individual preferences and environmental conditions need to be examined person by person.
Physical and psychological harms
The medical analysis addresses breathing, airway and swallowing risks, immobility and thromboembolic complications, sedation and medication, hydration, vigilance, access to help and the possibility that a restrained person may be less able to detect or communicate deterioration. It also argues that restraint, medication and seclusion should be reviewed as a complete sequence rather than as unrelated interventions.
Psychological consequences receive equal attention. The study examines powerlessness, humiliation, fear, trauma, resignation, loss of trust and what Autistan describes as psychological suffocation: an experience in which effective routes of escape, movement, protest, self-protection or influence over what happens to one’s body appear closed. Outward stillness should therefore never be assumed to prove recovery or relief.
Prevention and practical alternatives
The study treats the organisation of services as part of the evidence. It examines staffing, continuity, freedom of circulation, outdoor access, meaningful activity, sensory options, movement, communication, trusted relationships and ordinary sources of comfort. An alternative that was not actually available at the moment of need should not be recorded as though it had been tried and failed.
Among several practical proposals is a dedicated single-person crisis regulation and expression room designed as a direct alternative at the point when bodily restraint might otherwise be considered. The voluntary version would preserve a genuine ability to leave, space for movement and vocal expression, and access to chosen sensory or relational supports. If departure were prevented, the situation would have to be recognised and governed as seclusion rather than relabelled as voluntary use.
The study also discusses a legally distinct crisis-containment variant for a narrower situation in which an immediate serious danger still meets the applicable legal threshold. Even then, the objective would be to preserve movement and meaningful choice and to restore wider freedom progressively according to the disappearance of the specific danger, not according to social conformity or apparent calm.
Twelve proposed additions or clarifications for the Scottish Code
Section 12 of the study proposes the following twelve additions or clarifications:
- Direct observation, interpretation and justified risk assessment.
- Harm caused by the intervention itself.
- Do not infer recovery from stillness.
- Preserve harmless autistic self-regulation.
- Alternatives must be available, not merely listed.
- Reconstruct the full chain of events.
- Preserve the person’s account and factual disagreements.
- Psychological harm should trigger critical review.
- Clarify thresholds and prevent relabelling.
- Support must not become normalisation.
- Minimum competencies and independent oversight.
- A route towards ending coercive responses.
Direct responses to the fifteen consultation question groups
Appendix A, pages 67-70, reproduces the subject of each official consultation question before giving Autistan’s direct response. The main positions are:
- Q1 – General principles and purpose: No – Strongly disagree.
- Q2 – UN Convention on the Rights of the Child: clarity and accuracy – Agree; usefulness – Disagree.
- Q3 – Definitions: No – Disagree.
- Q4 – Lawful limits: No – Disagree.
- Q5 – Future care planning: Yes – Agree, with qualification; planning should prevent crises, not pre-authorise coercion.
- Q6 – Children and young people: No – Strongly disagree.
- Q7 – Autistic people and people with learning disabilities: No – Strongly disagree.
- Q8 – Nasogastric tube feeding: the question cannot adequately be reduced to a simple Yes/No answer.
- Q9 – Monitoring and recording: Yes – Strongly agree as a safeguard while these practices continue.
- Q10 – Staff planning, training and welfare: No – Disagree with the present framing.
- Q11 – Other groups or clinical contexts: Yes; the study identifies several groups requiring specific attention.
- Q12 – Further detailed guidance: Agree as transitional protection within the objective of eliminating coercive practices.
- Q13 – Other comments: Scotland should move beyond better-managed coercion toward prevention and non-coercive crisis support.
- Q14 – Cross-border transfers: clarity, accuracy and usefulness – Agree, with additions on continuity of support and the effects of distance.
- Q15 – Excessive security: clarity and accuracy – Agree; usefulness was not rated as worded because the questionnaire’s usefulness item appears to refer mistakenly to cross-border transfer processes.
A causal incident-review record
Appendix B proposes a fifteen-part incident-review record intended to learn rather than merely justify. It starts before the restrictive intervention and records the situation, the person’s requests and self-regulation, directly observed actions, the specific risk alleged, staff and environmental contributions, alternatives and their actual availability, decision and authority, the complete restrictive sequence, physical monitoring, psychological and sensory experience, the person’s own account and disagreements, delayed effects, corrective action and verification that prevention measures worked.
Why V13 replaced the earlier PDF
The study was initially submitted to the Scottish Government on 29 October 2026. On 30 October, V13 replaced the earlier PDF. No substantive content outside Appendix A was changed. Appendix A was expanded from two pages to four so that a reader no longer has to reconstruct the Organisation’s answers by moving between the questionnaire and different sections of the study. Each of the fifteen question groups is now identified directly, followed by the corresponding response and a concise explanation.
Read the full study
The complete 97-page study contains the evidence, first-person testimony, human-rights analysis, proposed wording and implementation tools supporting the positions summarised above. These links open selected sections directly:
- Executive Summary
- Physical harms, medication and the loss of ordinary self-protection
- Practical prevention framework for Scottish services
- Dedicated crisis regulation and expression room instead of restraint
- Survivor knowledge, international human rights and remedies
- Twelve proposed amendments to the Scottish Code
- Implementation, evidence quality and additional consultation chapters
- Appendix A – direct responses to Q1-Q15
- Appendix B – proposed causal incident-review record
Full PDF reader:
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The study was prepared for the Scottish Government consultation Updates to the Code of Practice for the Mental Health (Care and Treatment) (Scotland) Act 2003, concerning proposed guidance on restraint and seclusion together with revisions on cross-border transfers and detention in conditions of excessive security.
Institutional author: Autistan Diplomatic Organization · contact@autistan.org
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