We agree with the Committee that admissions into mental health inpatient settings for people with a learning disability and autistic people should be for the shortest time possible, however we do not agree that admissions should be banned altogether. We do not intend to implement the Trieste model of care although our reforms to the Mental Health Act seek to prevent non-therapeutic, long term admissions. For this reason, we do not accept this recommendation. Wherever possible, we want people to have access to the right care at the right time in their community, close to home. This is the ambition we have set out in the Building the Right Support action plan, and we are investing in and improving the provision of adequate, preventative community support as set out in Chapter 3. We recognise that there will be times when people with a learning disability or autistic people with a mental health condition, as with any person with a mental health condition, would benefit from high-quality inpatient care. When this is the case, we want to ensure that this option is available so that people, and those around them, have safe, therapeutic care that is right for them. However, we want much less reliance on inpatient care than at present. We are taking action to reduce the overall admissions of people with a learning disability or autistic people, which we set out below. We are taking extensive action to ensure that admissions from the community are only ever therapeutic and for as short a time as possible through proposed reforms to the Mental Health Act, set out in our draft Mental Health Bill. We are proposing to limit the scope to detain people with a learning disability or autistic people for treatment under section 3 of the Act without a co-occurring mental health condition. This means that a person with a learning disability or an autistic person will only be able to be detained for treatment under section 3 of the Act if they have a co-occurring mental health condition that requires treatment in hospital. Where somebody with a learning disability or an 10 The treatment of autistic people and people with learning disabilities: Government Response autistic person is detained for assessment under section 2 the Act, this can only be for up to 28 days where they do not have a co-occurring mental health condition that justifies a longer stay. This reform will help reduce the number of people with a learning disability and autistic people subject to lengthy detentions under Part II of the Act. Under our proposed reforms for all detentions under the Act, a clinician will need to justify that the individual presents a risk of ‘serious harm’. This is a higher bar than at present, which currently states that detention should be in the interests of ‘own health or safety’ or ‘with a view to protection of other persons’. This takes into account that in some cases there may be a need to detain an individual if there is a substantial risk of serious harm to the individual or others, while recognising that detention in itself could be harmful to people’s mental health and should be taken into account as a risk. Requiring that the potential harm is significant will mean detention will only be permitted in the most serious of cases. As we implement the Building the Right Support action plan, we continue to consider best practice across systems, including international examples of good care. We will consider any emerging evidence which indicates success in different contexts and in particular, positive outcomes for people with a learning disability and autistic people. In relation to the Trieste model of care, we are mindful that attempts to replicate the approach outside of its particular geographical, political, and socio-cultural context have not been successful. We are also aware of the contextual and operational differences between systems in Trieste and systems in England. Implementation of the Trieste model would require a whole-system change beyond care and support for people with a learning disability and autistic people which is a complex consideration beyond the immediate scope of Building the Right Support. In order to be effective, tthe Trieste model would require changes across all aspects of health and social care, education, voluntary and community sector, communities, and society. This would need to be supported with robust evidence.