A programme offering alternatives to long-term segregation for children and young people, autistic people, and those with a learning disability detained in mental health hospitals is a significant success, new research shows.
A study carried out by Manchester Met researchers which evaluated the HOPE(S) national programme to reduce long-term segregation – developed and implemented by Mersey Care NHS Foundation Trust – has shown that three quarters of all supported people have successfully transitioned out of segregated environments under highly specialist care.
HOPE(S) is an acronym setting out how people detained in secure sites are helped to live out of long-term segregation.
As part of the programme, 3,500 staff were trained to deliver highly specialist care by Mersey Care NHS Foundation Trust over the past two years.
Long-term segregation is often used when people are seen as a risk to others, but the research study shows it can cause profound psychological, emotional, and physical harm, leaving people isolated for months or even years.
The study reports significant improvements in people’s quality of life, including reduced use of restraint and increased access to fresh air and meaningful activities, which was perceived to give people in segregation a renewed sense of hope, personal identity and autonomy.
Family members described a renewed sense of hope, emotional safety and trust, as they observed their loved ones begin to engage meaningfully with HOPE(S) practitioners. For many, this was the first time in years they felt clinical staff were advocating alongside them.
This study provides rights-based evidence to support national reform of restrictive practices in mental health and related services. The HOPE(S) model is scalable, impactful, and aligned with international human rights frameworks, including the UN Convention on the Rights of Persons with Disabilities (CRPD) and WHO guidance.
The research calls for the approach to be made universally available to all individuals in segregation, backed by mandatory staff training, and for the integration of long-term segregation oversight into national quality frameworks.
Principal Investigator for the study, Dr Alina Haines-Delmont, Reader/Associate Professor in Mental Health and Coercion at Manchester Metropolitan University, said: “This research was urgently needed. For too long, long-term segregation has been used in services, despite the serious harm it causes. Our study provides the first robust, national evidence that it does not have to be this way.
“HOPE(S) is a rights-based, trauma-informed intervention that delivers real change: it improves quality of life, reduces restrictive practices, and transforms how services understand and respond to distress. The evidence is strong and points clearly to what good care looks like — relational, human, and grounded in dignity. This is not just about better practice; it is about policy reform and accountability at a national level.”
Trish Bennett, Mersey Care’s Chief Executive Officer, said: “This study strongly supports the work of our experts. This independent evaluation is a powerful endorsement of our commitment to human rights and compassionate care. Restrictive practices can have devastating effects – not only on individuals, but also on their families and staff teams.
“These practices are intended to protect people from harm but too often what we see are increasingly cycles of distress and restriction which is concerning. There are so many powerful stories of HOPE(S) working in partnership with people, their families and staff teams and as a result, we’re proud to see people’s lives have been transformed by this pioneering programme of work.”
Following the nationally funded HOPE(S) pilot, NHS trusts are able to work with Mersey Care NHS Foundation Trust to support work in their own areas.
The research team at Manchester Metropolitan, led by Dr Haines-Delmont, will continue their research in this area of work, with studies aimed at improving care for people with a learning disability and autistic people detained in mental health hospitals, and their families, by impacting policy and practice.
The report can be downloaded here:
