Out of sight, out of mind: explaining and challenging the re-institutionalisation of people with learning disabilities and/or autistic people

During the twentieth century, many countries underwent processes of ‘de-institutionalisation’—closing ‘asylums’ for people with mental health problems, learning disabilities and dementia. Despite this, the UK has witnessed a subsequent process of ‘re-institutionalisation’ with the creation of new public/private sector facilities providing ‘secure’ care to large numbers of people, who can be residents for many years with no sense of when they may leave. In 2023, 2035 people with learning disabilities and/or autistic people were receiving inpatient hospital care in England, with 54% in hospital for over two years. Drawing on the lived experience of people in hospital/families, and the practice knowledge of front-line staff, this paper critically analyses why this process of re-institutionalisation may be taking place. Our argument is that institutional forms of care have gradually been re-introduced—despite the influence of neoliberal health policies that have previously aimed at deinstitutionalisation and self-care—because some people are viewed as ‘too difficult’ to govern through the prevailing dispositive of self-care, and therefore become the subjects of more disciplinary forms of power. Once in hospital, the primary routes to ‘escape’ require performative acts of ‘good conduct’ that give confidence to professionals of a person’s capacity for self-government.