Mixed-methods evaluation of a rights-based intervention to reduce long-term segregation in mental health services: the HOPE(S) National Programme in England

This publication is included in the Autistic Autism Scholarship Project. one author of this publication is identified as autistic in the project.

About the autistic author marker

Metadata sources used for this reference

OpenAlex Crossref
Learn more about the sources used

Haines-Delmont, A., Fradley, K., Rajan, D. G., & Cavanagh, D. (2026). Mixed-methods evaluation of a rights-based intervention to reduce long-term segregation in mental health services: the HOPE(S) National Programme in England. BMJ Open, 16(10), e115706. https://doi.org/10.1136/bmjopen-2025-115706

Publication date: 1 Oct 2026 Added to AutiHub: 25 Oct 2026 Type: Article Article language: English
Publisher source (DOI) Full text OpenAlex source

This publication is integrated into AutiHub through:

Authors

Publication authors
4
Publication authors identified as autistic
1 / 4 (25.0%)
  1. Alina Haines-Delmont
  2. Kathryn Fradley
  3. Dineesha Georgeena Rajan
  4. Dawn Cavanagh *

Abstract

Objectives To evaluate the implementation and outcomes of HOPE(S), a national rights-based intervention designed to reduce long-term segregation (LTS) for autistic people, people with a learning disability and children and young people in mental health inpatient services in England. Design Pre-post, single-group mixed-methods evaluation combining quantitative analysis of routine clinical and self-report outcomes with qualitative interviews, focus groups and written submissions. Reflexive thematic analysis was undertaken with co-production and lived experience sense-checking. Setting National Health Service (NHS)-commissioned inpatient mental health services across England, delivered across multiple secondary and tertiary care providers between May 2022 and March 2025. Participants The quantitative cohort comprised 122 individuals in LTS who received HOPE(S) support, 11 family members who engaged in trauma-informed therapy and 388 clinical staff who completed at least part of the Professional Quality of Life; paired staff analyses included 64-68 participants. Qualitative data were collected from 73 stakeholders, including individuals with lived experience, family members, clinical staff, intervention practitioners, commissioners and regulators. Participants were identified through routine service referral and professional networks. Intervention HOPE(S) is a multi-component intervention comprising practitioner training in rights-based and trauma-informed care, structured assessment of barriers to change and ongoing therapeutic and practice-leadership support for individuals in LTS and their clinical teams. Family members were offered trauma-informed therapy and access to peer support. Duration of involvement varied according to clinical need and service context. Primary and secondary outcome measures Quantitative outcomes included quality of life, use of restrictive practices, access to fresh air, engagement in meaningful activity, staff well-being and family functioning. Qualitative outcomes focused on experiences of LTS, perceived impacts of HOPE(S) and contextual factors influencing implementation. Results Of 122 individuals who received HOPE(S), 83 (68%) moved out of LTS at least once during the evaluation period, with 24 discharged into the community. Among those with paired data, physical restraint decreased from 14.62 to 6.23 incidents/month (n=58, t(57)=2.73, p=0.008), chemical restraint decreased according to the Wilcoxon signed-rank test (n=57, z=2.01, p=0.045; median=0 at both time points) and seclusion decreased from 0.53 to 0.22 incidents/month (n=59, t(58)=3.01, p=0.004). Mechanical restraint decreased from 0.34 to 0.07 incidents/month, but this was not statistically significant (n=59, t(58)=1.17, p=0.247). Access to fresh air increased from 7.69 to 14.09 days/month (n=57, t(56)=4.18, p<0.001) and meaningful activities increased from 3.11 to 21.70 /month (n=56, t(55)=5.79, p<0.001). Quality-of-life scores improved from 25.33 to 17.56 among nine individuals with complete paired Mini Maslow Assessment of Needs Scale for Learning Disabilities (Mini-MANS-LD) data (t(8)=3.32, p=0.011), although this finding should be interpreted cautiously given the small sample. Among staff with paired Professional Quality of Life (ProQOL -5) data, compassion satisfaction increased from 38.13 to 40.31 (n=64, t(63)=4.20, p<0.001), burnout decreased from 24.66 to 22.28 (n=68, t(67)=4.71, p<0.001) and secondary traumatic stress decreased from 22.47 to 19.93 (n=68, t(67)=3.25, p=0.002). Among eight family members with repeated 15-item Systematic Clinical Outcomes and Routine Evaluation data, none met the criteria for reliable or clinically significant improvement in family functioning. Qualitative findings described LTS as a profoundly isolating experience and HOPE(S) as supporting relational safety, shifts in care culture and renewed hope for families and staff, while also identifying persistent systemic and organisational barriers to sustaining change. Conclusions This is the first large mixed-methods study exploring at length the phenomenon of LTS, suggesting that a rights-based, relational intervention can lead to reductions in restrictive practices, alongside improvements in some individual and staff outcomes. The findings highlight the importance of system-level approaches that prioritise relational safety, dignity and least-restrictive practice. Further research is required to examine the sustainability of change, longer-term outcomes and transferability across settings. Trial registration Not applicable.

Bibliography cited by this reference

Cited references are imported from external metadata sources when they are available. The list may be partial.

Cited bibliography overview

These indicators describe the bibliography cited by this publication. An author name is counted each time it appears in one cited reference, so the same person can be counted more than once. Names not yet linked to an author already present in AutiHub are treated as unknown, not as non-autistic. Last computed: 27 Oct 2026 01:01.

Cited references
36
With a DOI
22
Without a DOI, from raw bibliography text
14
1 / 36 (2.8%) cited references include at least one author identified as autistic.
References with data to complete
15 / 36 (41.7%)
References with detected author names
21 / 36 (58.3%)
Without detected author names
15
Without a structured title
14
Without a stable identifier
14
References with raw author names still to review
15
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
94
From DOI or external metadata
94
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
21
18 / 94 (19.1%) names are linked to an author already present in AutiHub. 76 / 94 (80.9%) names are not yet linked.
Names linked to a person identified as autistic
3 / 94 (3.2%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 3 / 18 (16.7%). Distinct people identified as autistic: 3 / 91 (3.3%).
  1. Peter Stratton , Julia Bland , Emma Janes , Judith Lask (2010). Developing an indicator of family function and a practicable outcome measure for systemic family and couple therapy: the SCORE . J Fam Ther, 32(3), 232. Wiley.
    Type: Article DOI: 10.1111/j.1467-6427.2010.00507.x OpenAlex: https://openalex.org/W1593447589
    Crossref OpenAlex
  2. Lisa M. Brophy , Catherine E. Roper , Bridget E. Hamilton , Juan José Tellez , Bernadette M. McSherry (2016). Erratum to: Consumers and their supporters’ perspectives on poor practice and the use of seclusion and restraint in mental health settings: results from Australian focus groups . Int J Ment Health Syst, 10(1), 7. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1186/s13033-016-0039-9 OpenAlex: https://openalex.org/W2903523960
    Crossref OpenAlex
  3. L. Nicholson , M. Colyer , Sally-Ann Cooper (2013). Recruitment to intellectual disability research: a qualitative study . Journal of Intellectual Disability Research, 57(7), 647-656. Wiley.
    Type: Article DOI: 10.1111/j.1365-2788.2012.01573.x OpenAlex: https://openalex.org/W1833779814
    Crossref OpenAlex
  4. Brid Hennessy , Andrew Hunter , Annmarie Grealish (2023). A qualitative synthesis of patients’ experiences of re-traumatization in acute mental health inpatient settings . J Psychiatr Ment Health Nurs, 30(3), 398. Wiley.
    Type: Article DOI: 10.1111/jpm.12889 OpenAlex: https://openalex.org/W4311574792
    Crossref OpenAlex
  5. Elena Hamilton , Alan Carr , Paul Cahill , Ciara Cassells , Dan Hartnett (2015). Psychometric properties and responsiveness to change of 15- and 28-item versions of the SCORE: a family assessment questionnaire . Fam Process, 54(3), 454. Wiley.
    Type: Article DOI: 10.1111/famp.12117 OpenAlex: https://openalex.org/W2078023576
    Crossref OpenAlex
  6. Tamara Power , Ashley Baker , Debra Jackson (2020). “Only ever as a last resort”: Mental health nurses’ experiences of restrictive practices . Int J Ment Health Nurs, 29(4), 674. Wiley.
    Type: Article DOI: 10.1111/inm.12701 OpenAlex: https://openalex.org/W3005815488
    Crossref OpenAlex
  7. Amartya Sen (2005). Human Rights and Capabilities . Journal of Human Development, 6(2), 151-166. Informa UK Limited.
    Type: Article DOI: 10.1080/14649880500120491 OpenAlex: https://openalex.org/W2096196718
    Crossref OpenAlex
  8. Angela Sweeney , Beth Filson , Angela Kennedy , Lucie Collinson , Steve Gillard (2018). A paradigm shift: relationships in trauma-informed mental health services . BJPsych Adv, 24(5), 319. Royal College of Psychiatrists.
    Type: Article DOI: 10.1192/bja.2018.29 OpenAlex: https://openalex.org/W2886031807
    Crossref OpenAlex
  9. Vikki Entwistle , Danielle Firnigl , Mandy Ryan , Jillian Francis , Philip Kinghorn (2012). Which Experiences of Health Care Delivery Matter to Service Users and Why? A Critical Interpretive Synthesis and Conceptual Map . Journal of Health Services Research & Policy, 17(2), 70-78. SAGE Publications.
    Type: Article DOI: 10.1258/jhsrp.2011.011029 OpenAlex: https://openalex.org/W2103344471
    Crossref OpenAlex
  10. Sanne Oostermeijer , Catherine Brasier , Carol Harvey , Bridget Hamilton , Cath Roper , Andrew Martel et al. (2021). Design features that reduce the use of seclusion and restraint in mental health facilities: a rapid systematic review . BMJ Open, 11(7), e046647. BMJ.
    Type: Article DOI: 10.1136/bmjopen-2020-046647 OpenAlex: https://openalex.org/W3180186138
    Crossref OpenAlex
  11. Vikki A. Entwistle , Ian S. Watt (2013). Treating patients as persons: a capabilities approach to support delivery of person-centered care . Am J Bioeth, 13(8), 29. Informa UK Limited.
    Type: Article DOI: 10.1080/15265161.2013.802060 OpenAlex: https://openalex.org/W2141291036
    Crossref OpenAlex
  12. Kathryn Fradley , Alina Haines-Delmont (2026). Long-term segregation in mental health hospitals: qualitative study of its impact and human rights implications . BJPsych Open, 12(2), e93-e93. Royal College of Psychiatrists.
    Type: Article DOI: 10.1192/bjo.2026.10996 OpenAlex: https://openalex.org/W7141200323
    Crossref OpenAlex
  13. Brody Heritage , Clare S. Rees , Desley G. Hegney (2018). The ProQOL-21: A revised version of the Professional Quality of Life (ProQOL) scale based on Rasch analysis . PLOS ONE, 13(2), e0193478. Public Library of Science (PLoS).
    Type: Article DOI: 10.1371/journal.pone.0193478 OpenAlex: https://openalex.org/W2791061394
    Crossref OpenAlex
  15. Roman Raczka , Kate Theodore , Janice Williams (2020). An initial validation of a new quality of life measure for adults with intellectual disability: the Mini-MANS-LD . J Intellect Disabil, 24(2), 177. SAGE Publications.
    Type: Article DOI: 10.1177/1744629518787895 OpenAlex: https://openalex.org/W2884112810
    Crossref OpenAlex
  16. (n.d.). Department of Health. The mental health act 1983: code of practice. 2015.
    Type: Other
    Crossref
  17. (n.d.). Hollins. Thematic review of the independent care (education) and treatment reviews. 2021.
    Type: Other
    Crossref
  18. (n.d.). Hollins. Baroness hollins’ final report: my heart breaks - solitary confinement in hospital has no therapeutic benefit for people with a learning disability and autistic people. In: Department of Health and Social Care. 2023.
    Type: Other
    Crossref
  19. Marie Chieze , Samia Hurst , Stefan Kaiser , Othman Sentissi (2019). Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review . Frontiers in Psychiatry, 10, 491-491. Frontiers Media SA.
    Type: Article DOI: 10.3389/fpsyt.2019.00491 OpenAlex: https://openalex.org/W2952719582
    Crossref OpenAlex
  20. (n.d.). Care Quality Commission. Out of sight - who cares?: restraint, segregation and seclusion review. 2020.
    Type: Other
    Crossref
  21. (n.d.). Care Quality Commission. Who I Am Matters, 2022.
    Type: Other
    Crossref
  22. Martha C. Nussbaum (2020). The Capabilities Approach and the History of Philosophy . In The Cambridge Handbook of the Capability Approach (pp. 13-39). Cambridge University Press.
    Type: Book chapter DOI: 10.1017/9781316335741.003 OpenAlex: https://openalex.org/W3103873004
    Crossref OpenAlex
  23. (n.d.). Care Quality Commission. The report of the independent care (education) and treatment reviews (ic(e)tr) oversight group. july 2026. Care Quality Commission; 2026. Available: https://www.cqc.org.uk/publications/icetr/oversight-group/findings [Accessed 18 Sep 2026].
    Type: Other
    Crossref
  24. (n.d.). Mencap. Government must not waste any more time" following “disturbing” findings in independent report on long-term segregation in modern-day asylums. 2021.
    Type: Other
    Crossref
  25. (2019). Solitary Confinement . Oxford University PressNew York.
    Type: Book DOI: 10.1093/oso/9780190947927.001.0001 OpenAlex: https://openalex.org/W4252443684
    Crossref OpenAlex
  26. John Baker , Kathryn Berzins , Krysia Canvin , Sarah Kendal , Stella Branthonne-Foster , Judy Wright et al. (2022). Components of interventions to reduce restrictive practices with children and young people in institutional settings: the Contrast systematic mapping review . Health Soc Care Deliv Res, 10(8), 1. National Institute for Health and Care Research.
    Type: Article DOI: 10.3310/yvkt5692 OpenAlex: https://openalex.org/W4280652115
    Crossref OpenAlex
  27. (n.d.). World Health Organization. Guidance on community mental health services: promoting person-centred and rights-based approaches. 2025.
    Type: Other
    Crossref
  28. (n.d.). Nations U. Convention on the Rights of Persons with Disabilities. 2006.
    Type: Other
    Crossref
  29. Virginia Braun , Victoria Clarke , Nikki Hayfield , Louise Davey , Elizabeth Jenkinson (2022). Doing Reflexive Thematic Analysis . In Supporting Research in Counselling and Psychotherapy (pp. 19-38). Springer International Publishing.
    Type: Book chapter DOI: 10.1007/978-3-031-13942-0_2 OpenAlex: https://openalex.org/W4317823576
    Crossref OpenAlex
  30. Kathryn Amy Rowsell , Ayodele Akinbola , Mark Hancock , Tsitsi Nyambayo , Zoe Jackson , David Francis Hunt (2024). Reducing use of seclusion on a male medium secure forensic ward . BMJ Open Quality, 13(1), e002576. BMJ.
    Type: Article DOI: 10.1136/bmjoq-2023-002576 OpenAlex: https://openalex.org/W4391888799
    Crossref OpenAlex
  31. (n.d.). Fradley K, Rajan DG, Haines-Delmont A. Evaluation of the National HOPE(S) Programme to End Long-Term Segregation (LTS) for Children and Young People, Autistic Adults and/or Adults with Learning a Disability in Inpatient Hospital Settings. Manchester Metropolitan University. 2025,
    Type: Other
    Crossref
  32. (n.d.). Kilcoyne J, Angus D. HOPE(s) model: copyright jennifer kilcoyne and danny angus @mersey care nhs foundation trust. All rights reserved. 2023.
    Type: Other
    Crossref
  33. Virginia Braun , Victoria Clarke (2021). Thematic Analysis . In Thematic analysis: a practical guide. SAGE Publications Ltd.
    Type: Book chapter DOI: 10.4135/9781036232078.n9 OpenAlex: https://openalex.org/W7165805879
    Crossref OpenAlex
  34. (n.d.). Skirrow P, Perry E. The Maslow Assessment of Needs Scale (MANS). Liverpool: Mersey Care NHS Trust, 2009.
    Type: Other
    Crossref
  35. (n.d.). Stamm B. The concise manual for the professional quality of life scale. 2010. Available: https://www.illinoisworknet.com/WIOA/Resources/Documents/The-Concise-ProQOL-Manual.pdf
    Type: Other
    Crossref
  36. (n.d.). Corp IBM. IBM SPSS Statistics for Windows, Version 29. 0. 2. 0. Armonk, NY: IBM Corp, 2023.
    Type: Other
    Crossref