Assessment and treatment units and mental health hospital stays

What is an assessment and treatment unit?

An assessment and treatment unit, often called an ATU, is a specialist inpatient service. Some support people with a learning disability and autistic people. Other people receive inpatient mental healthcare on a general or specialist psychiatric ward. Names vary. Ask what the service actually provides, which clinicians will help and what needs it can meet. Learning disability and autism are not themselves mental illnesses. A person may also have a mental health condition.

Ask why hospital is needed

NHS England guidance says admission should have a specific mental health assessment or treatment purpose that requires inpatient care. A diagnosis of learning disability or autism alone is not a reason for admission. Ask for the purpose, expected benefits, possible harms and signs that hospital care is no longer needed. Admission should be a last resort when appropriate community support cannot safely meet the need. A care provider giving notice does not, by itself, establish a clinical reason for psychiatric admission. Urgent assessment or treatment should not be delayed while meetings are arranged.

Explore help in the community

Ask the community learning disability team and mental health crisis service about intensive support, home treatment, adapted psychological support and extra support at home. Review staffing skills, communication, housing, sensory needs and support for family carers. Ask which options have been tried, why they were unsuitable and what could change. Use the urgent health help guide when someone needs urgent assessment. Community alternatives must be adequate and safe for that person; they should not simply transfer an unsafe burden onto family members.

Look for pain and unmet needs

A change in behaviour can communicate distress or physical illness. Ask for assessment of pain, constipation, infection, epilepsy, sleep, eating and drinking, medicine effects and other physical health needs. Consider trauma, abuse, sensory overload and communication barriers alongside mental health. Record the person’s usual presentation and what has changed. Do not assume all distress is psychiatric or part of a learning disability. Hospital teams should maintain existing physical healthcare and respond promptly to deterioration.

Request a Care (Education) and Treatment Review

Ask the ICB or responsible commissioner for a Care (Education) and Treatment Review, also called a C(E)TR. This brings independent clinical and lived-experience input to questions about safety, care, hospital need and discharge barriers. Ask about the Dynamic Support Register and what consent or capacity process applies. A review should normally happen before a planned admission. Urgent situations have emergency arrangements and reviews after admission. A C(E)TR makes recommendations; it does not itself authorise detention or order discharge. Ask who owns each action and when it will happen.

Understand consent and your legal status

Ask whether admission is voluntary, under a Mental Health Act section, or subject to another legal authority. Ask for the exact power and an explanation you can understand. An adult’s capacity is assessed for the particular decision, with communication support; a diagnosis does not establish incapacity. Family agreement alone does not authorise detaining an adult. An informal patient can generally leave, but staff may use a lawful holding or detention power where its conditions are met. Ask for specialist advice if someone is being stopped from leaving without a clear legal explanation.

Make support fit the person

Take a communication or hospital passport and record how the person expresses pain, agreement, refusal and distress. Ask for familiar communication aids, predictable routines, accessible information, time to process questions and sensory adjustments. Explain important foods, cultural needs, interests and relationships. Ask for a named nurse and access to relevant learning disability and therapy expertise. The person should help shape care; behaviour plans should not punish disability-related needs or demand compliance for its own sake.

Keep contact and question restrictions

Agree visits, private conversations, phone or video contact and support to keep relationships and activities. Ask for reasons, legal authority and review dates for any restriction, including restrictions on leaving, contact or belongings. Care should use the least restrictive lawful approach. Ask how staff prevent distress and reduce restraint, seclusion or segregation. Record concerns and raise possible abuse through safeguarding. An independent mental health advocate can support eligible patients. A mental-health solicitor can explain detention challenges and deadlines.

Start the discharge plan immediately

From admission, ask for a named discharge coordinator, an expected discharge date and an agreed destination. Plan housing, trained support staff, medicines, physical healthcare, communication, meaningful activities and crisis support. Include the person and the people they want involved. Arrange introductions and transition visits where appropriate. Ask whether section 117 aftercare applies and who will arrange funding. A funding dispute should be escalated between organisations rather than left for the person to resolve.

If discharge is delayed

Ask for a meeting with the hospital, commissioner, council and community team. Request written reasons for each delay, a named person responsible and a completion date. Ask what is preventing the person leaving when they no longer need hospital treatment. Request a C(E)TR or follow-up of its recommendations, advocacy and an accessible care plan. Use the complaints routes for unresolved service failures. A complaint does not replace an urgent legal challenge to detention.

Children and young people

The same focus on suitable community support and early discharge planning matters for children. Ask for age-appropriate care, education during admission and coordinated planning with children’s services and the school or college. Ask about the ICB’s learning disability and autism keyworker service and a Care, Education and Treatment Review. Consent, parental responsibility and detention rules need individual advice; adult consent rules should not simply be applied to every child.

Use the hospital meeting worksheet

The worksheet below is an original Clearer conversation aid. Take it to admission or review meetings and record answers, names and dates. It is not an official clinical assessment or discharge plan. Share only the information needed for the meeting.

Ask about peer support and community-focused resources

BILD’s Buddies Project connects some people detained in mental health hospitals with trained peer volunteers who have experienced detention themselves. Ask the ward or BILD about local availability and how to take part. Peer befriending is different from independent advocacy and does not replace it. BILD’s Homes Not Hospitals work shares learning about community support, discharge and preventing unnecessary admission. These resources do not replace an individual care plan or a route to challenge a detention decision.

Going into a mental health hospital

Peer support in hospital

What you can do next

More useful links