The Genesis of Change

Across the UK, the health and care system is facing a very particular and acute challenge: how to support people with Primary Autism and complex needs (often with associated mental-health problems) so that they are no longer held in secure forensic or mental-health inpatient settings when that is not necessary, and how to ensure the discharge pathway is safe, robust and truly person-centred.

This is especially timely given the major policy shift underway via the new Mental Health Bill [HL] 2024‑25, which proposes to make it unlawful to detain autistic people and people with a learning disability solely based on autism or a learning disability without a co-occurring psychiatric disorder.
Mental Health Bill [HL] 2024-25

It is in this exact space, where individuals are Currently Restricted in units such as a Medium Secure Unit, Low Secure Unit or Special Rehab Unit, or restricted via DoLS (Deprivation of Liberty Safeguards) or under the Mental Health Act, where “The HCD Genesis Model” comes into play.

The Problem: Secure Settings, Stalled Discharge and the Hidden Population

There are approximately 200 to 2,000 people in England with Primary Autism with complex needs and associated mental-health problems in secure inpatient settings.
Many of these individuals are in what can be described as Stalled Discharge positions; they are clinically ready for a move to a less restrictive setting or to the community, yet the pathway and infrastructure simply don’t exist.
Tackling detention

For example, the Mencap/ITV analysis shows over 2,000 people with autism and learning disabilities detained in inpatient units, many of whom do not need to be there. Family's hurt as thousands with learning disabilities locked up

In many cases, these individuals are either:

• Currently restricted under the Mental Health Act 1983 (for example, under Section 3 or other relevant sections) and therefore entitled to certain aftercare rights via Section 117. Section 117 aftercare
• Or they are detained under other frameworks such as DoLS (Deprivation of Liberty Safeguards) which often complicates discharge and oversight (Restricted via DoLS).
• Or held in Medium Secure Units, Low Secure Units, Special Rehab Units or Non-Secure Units but still under locked or highly restrictive conditions.

This situation creates enormous human cost, system cost (the average cost of detention is extremely high) and a moral imperative: individuals with Primary Autism and complex mental-health needs often would be better supported in the community if the right model existed.

The Legal and Policy Context: Section 117 Aftercare and the Bill

Under Section 117 of the Mental Health Act 1983, when someone is detained under certain sections (for example, Section 3, or under a hospital order under Section 37, etc.), they are eligible for free after-care services when they leave hospital. Mind - Section 117 aftercare

For instance:

“Some people who have been kept in hospital under the Mental Health Act can get free help and support after they leave hospital.
The law that gives this right is Section 117 of the Mental Health Act 1983.”

The new Mental Health Bill 2024-25 aims to reform the Act so that autistic people (and people with a learning disability) cannot be detained under certain parts of the Act unless there is a co-occurring psychiatric disorder. Mental Health Bill [HL] 2024-25

This means commissioners, including ICBs, must prepare for a future where the default of holding people in Medium Secure Units or Low Secure Units simply because of Primary Autism will increasingly be untenable. Instead, models for safe discharge and community-based care become essential.

A New Approach:
“The HCD Genesis Model” for Primary Autism with Complex Needs

“The HCD Genesis Model” has been developed precisely for this tightly defined problem: people held in secure or semi-secure settings (Medium Secure Units, Low Secure Units, Special Rehab Units) due to Primary Autism with complex needs and associated mental-health problems, not general support.
Its purpose is to enable discharge home to appropriate, supported, community-based living (Non-Secure Units, or supported community settings) with robust safeguards and outcomes-focused commissioning.

Key features of “The HCD Genesis Model” include:

• The HCD Genesis Model is ‘The Home of Personalisation’ where:
  • HCD works in true partnership with the client and family to choose and select their own support team, just for them, and to choose who and when people come into their home.
  • The support team can include family members, with the NHS Commissioners’ agreement, with a selected local support team, just and only for the one single person.
  • HCD then employs and trains the team, with RM Nurse support, to CQC standards to meet the specific assessed needs of the individual.
• A pathway designed to address Stalled Discharge by providing a clear plan, multidisciplinary support, behavioural frameworks, and wrap-around services.
• Legal and operational frameworks aligned with Section 117 aftercare duties and the Mental Health Act, ensuring ICBs and local authorities meet statutory obligations.
• Options for individuals coming out of Medium Secure Units, Low Secure Units, Special Rehab Units or other restricted settings to transition to a community setting (Non-Secure Units) with appropriate safeguards, closing the loop between the secure estate and community.
• A commissioning model that allows ICBs to redirect funding from expensive secure stays into high-quality community placements, supporting the shift envisaged under the Mental Health Bill and national policy.

In short, this is not a model for general home care or standard learning-disability support.
It is laser-focused on a particular cohort: people with Primary Autism, complex needs, currently held in secure or semi-secure settings, whose discharge is legally and clinically feasible but systemically stalled.

Why This Matters for ICBs and Patients

For ICBs and local systems, “The HCD Genesis Model” offers a timely and cost-effective solution:

• It tackles the problem of Currently Restricted individuals in secure settings, who represent high-cost, high-risk service users.
• By providing clear pathways for Stalled Discharge, systems can free up secure-bed capacity (Medium Secure Units, Low Secure Units) and reduce reliance on forensic hospital beds.
• It aligns with the direction of the Mental Health Bill and national policy to reduce inappropriate detention of autistic people and those with learning disabilities.
• It ensures compliance with Section 117 obligations — meaning ICBs and local authorities are able to commission after-care services that allow individuals to live more independently in Non-Secure Units with the right support.

For patients and families, “The HCD Genesis Model” means:

• A chance to move from a locked, secure environment into a supported home setting that recognises their unique needs as someone with Primary Autism and associated mental-health issues.
• Greater autonomy, tailored support, and the dignity of living in a community rather than being in a long-term secure unit.
• Support that is specialist and appropriate, rather than a generic placement that doesn’t reflect complex needs.

A Call to Collaborate

At a time when reform is accelerating, and the imperative to bring people out of inappropriate secure settings is clearer than ever, “The HCD Genesis Model” offers a highly specific, high-impact route forward.

ICBs, NHS trusts, local authorities and commissioners looking to move individuals with Primary Autism and complex needs out of Medium Secure Units, Low Secure Units or Special Rehab Units, and into supported homes and community-based placements, should engage with “The HCD Genesis Model” now.

Because the future of care for this cohort isn’t about more secure beds, it’s about the courage to bring people home, build the right infrastructure, and commission wisely for the needs that have been mostly overlooked.

If you are an ICB or system partner responsible for transforming your secure-bed estate, enabling discharge home for people with Primary Autism and complex needs, let’s connect and explore how “The HCD Genesis Model” can work for your system.

Read our earlier blog on this subject -
https://homecaredirect.co.uk/2025/03/28/locked-up-for-45-years/