National Preventive Mechanism Fourth Annual Report 2012–13 unlawfully detain an individual who has been placed there by, or with the permission of, a state authority) • whether the person is free to leave • duration of the measure • physical restraint • sedation • contact with the outside world • the overall purpose of measures to control or restrict the individual’s movements • whether there is relevant comparator. In order to address these concerns, NPM members submitted reports on action taken during the year to identify and challenge de facto detention. The greatest challenges identified – where individuals were subject to apparent deprivation of liberty without proper legal authorisation, and situations where the legal framework did not offer individuals appropriate protection – occurred in health and social care settings, including settings in the community, where individuals were receiving care and treatment because of health and social care needs. The situations in which NPM members identified de facto detention were as follows: • people with dementia in mental health care, general hospitals and care homes – individuals may be prevented from leaving the facility for reasons of safety, but may consequently be thwarted from going where they want and confined to an enclosed space • people with mental illness or learning disabilities where they are not formally detained but are in locked facilities or are regarded as ‘detainable if wishes to leave’ • people with any of these conditions receiving care and treatment in community settings, including individual or shared 28 tenancies, day care or respite care in small community settings – they may have 24-hour care that exercises great control over their movements or even be locked into their own homes or rooms for periods • children receiving care in residential or hospital settings – a particular issue is consent to restrictive measures or forcible treatment by parents or others exercising parental responsibilities. In total, 19 cases of apparent de facto detention were reported. The following settings and client groups were identified. Settings where de facto detention was reported Care home Hospital 4 12 Low secure unit 1 Supported living service 1 Supported living for children or adolescents 1 Total 19 Client group identified by report Alcohol-related brain damage 1 Mental illness 7 Dementia 6 Learning disability 4 Neurological 1 Total 19 The most common issue was apparent de facto detention in hospital. Three reports refer to individuals in community placements where they have individual or shared tenancies.