Date published: 16 July 2025
A major national programme of support for people with the most complex needs in secure hospitals has been assessed as a significant success in an independent evaluation from Manchester Metropolitan University.
The HOPE(S) programme has seen three quarters of all supported mental health in-patients successfully transition out of segregated environments. HOPE(S) is an acronym setting out how people detained in secure sites are helped to live out of long-term segregation. Nationally 3,500 staff have been trained to deliver highly specialist care by the programme’s founders, Mersey Care NHS Foundation Trust, in the last two years.
Trish Bennett, Mersey Care’s Chief Executive Officer, explained: “This study is a strong vindication of the work of our experts. This independent evaluation is a powerful endorsement of our commitment to human rights and compassionate care. Restrictive practices can have devastating effects—not only on individuals, but also on their families and staff teams.”
Long term segregation (LTS) is a practice where people are isolated from others because of concerns about the person’s risk to others. The research confirmed it was traumatic and harmful to those subject to such restrictions. Crucially it also indicated the HOPE(S) model offered effective alternatives.
Ms Bennett added: “These practices are intended to protect people from harm but too often what we see are increasingly cycles of distress and restriction which is concerning. There are so many powerful stories of HOPE(S) working in partnership with people, their families and staff teams and as a result, we’re proud to see people’s lives have been transformed by this pioneering programme of work.”
Concerns about people caught in long term segregation (LTS) led NHS England to fund a series of projects to improving the experiences of people who are being cared for in LTS in hospital. Mersey Care, as one of only three providers of High Secure care in England, was already advanced in its programme of support and trauma informed therapy. The Trust was commissioned to support a national rollout of its work. This included 17 new national practitioners across 40 organisations, supporting 93 adults and 29 young people over the last two years.
The programme was overseen by a national steering group, co-chaired by former Liberal Democrat MP Sir Norman Lamb, one of many in the group with lived experience of people with complex needs and has consistently backed the HOPE(S) model.
“The HOPE(S) programme is a landmark in the journey toward a more humane, rights-based mental health system,” he said. “It demonstrates that with the right support, people can thrive outside of segregation. This is about dignity, justice, and doing what’s right for some of the most excluded and vulnerable people in our health system.”
Patients who present with behaviours that challenge the system, and those with offending histories, are often supported in secure settings. Sometimes the trauma of their past histories, and the complexities of how they present, can lead to incidents. Practitioners have looked to the HOPE(S) model to help them work through. Patients, and their families, report hopelessness and fear, and feel they are not just segregated but completely excluded. Specially trained practitioners are able to work with clinical teams to build trust, develop peer support and improve staff confidence and skills.
The study by researchers at Manchester Metropolitan University reports significant improvements in people’s quality of life observed through validated outcome measures. They saw significant lived improvements such as greater autonomy, re-engagement with meaningful activities and renewed personal identity.
Across the evaluation period, 68.03 percent of those supported by HOPE(S) were able to leave segregated care at least once and almost two thirds remained out of LTS at the end of the programme.
The University team concluded that Mersey Care’s work should continue to be rolled out and enable people whose care requires secure setting be able to access the HOPE(S) model. The report recommends building LTS oversight into national quality frameworks and provide mandatory training for clinical and support staff working with people who might previously have needed to be excluded from a regular secure ward.
Family members described a renewed sense of hope, emotional safety and trust, as they observed their loved ones begin to engage meaningfully with practitioners. For many, this was the first time in years they felt professionals were advocating alongside them.
“This research was urgently needed,” said Dr Alina Haines-Delmont, who led the independent study at Manchester Metropolitan University. “For too long, long-term segregation has been used in services, despite the serious harm it causes. Our study provides the first robust, national evidence that it does not have to be this way.
“HOPE(S) is a rights-based, trauma-informed intervention that delivers real change: it improves quality of life, reduces restrictive practices, and transforms how services understand and respond to distress. The evidence is strong and points clearly to what good care looks like — relational, human, and grounded in dignity. This is not just about better practice; it is about policy reform and accountability at a national level.”
Following the nationally funded pilot, providers and commissioners are able to continue to work with Mersey Care to support the work in their own areas.