PurposeThe purpose of this paper is to describe the profile of community members admitted to the first high secure Therapeutic Community (TC) for males with learning disability and personality disorder.Design/methodology/approachThis paper presents descriptive data.FindingsThe characteristics of the men admitted to a TC in the National High Secure Learning Disability Service are likely to present considerable challenges to the development and delivery of the service.Originality/valueThere is very little literature describing interventions for offenders with learning disability and personality disorder. This paper is one of a series that will describe the effectiveness of a TC for men with such difficulties.
Purpose -A significant number of people held within the secure forensic hospital estate in this country suffer from neuropsychological deficits (e.g. Lowings, 2010;Williams et al., 2010). These deficits, many of them cognitive, have a detrimental impact on patient's abilities to benefit from psycho-educational materials thereby slowing the progress of their rehabilitation. Understanding these difficulties enables interventions to be more effectively targeted and facilitated to the patients' cognitive strengths. It was against the backdrop of the evidence that a review was commissioned into neuropsychological activity at Rampton Hospital. Design/methodology/approach -The review of the neuropsychological assessment activity was confined to the male patients residing within Mental Health Services (MHS) and the National High Secure Learning Disability Service (NHSLDS) of the hospital. With regards to the MHS, 129 patient files were examined in order to identify the volume of neuropsychological assessment previously undertaken and the make up of the neuropsychological test batteries administered with the current patient group. With regard to the NHSLDS 48 files were similarly examined. In addition, MHS psychologists were surveyed to assess their knowledge of patients within that service who to their knowledge had previously suffered an acquired brain injury (ABI) or had suffered a significant neurological illness likely to have resulted in cognitive impairment. Findings -A scoping exercise identified that a significant amount of neuropsychological assessment was being undertaken, albeit in an unstructured way. This led to a number of patients being subjected to a significant delay before the need for neuropsychological testing and rehabilitation possibilities became apparent. There was a huge variance on when a patient was tested ranging from one month to 14 years and the size of the test battery used, with the number of tests conducted per patient ranging between one single test to 16 tests during a patients stay at the hospital. Practical implications -Opportunities to more appropriately place patients based upon their abilities could be achieved if the hospital were to adopt a policy of conducting neuropsychological assessments, including cognitive functioning, for all patients upon admission to the hospital. A proportion of patients were known to have had a ABI or a significant illness likely to have resulted in cognitive impairment. This was considered to be an underrepresentation and the taking of a thorough history specifically covering ABI and specific illnesses known to have an impact on cognitive ability and behaviour was also recommended. Originality/value -In light of this review, services are to take a more systematic approach to assessing neuropsychological difficulties. Consideration is being given to neuropsychological screening becoming part of the admission process.
Purpose -This paper seeks to explain the reasons for use of a therapeutic community for personality disorder in a high secure intellectual disability service.Design/methodology/approach -The paper describes the rationale for, and early experiences of, a therapeutic community intervention for people with mild intellectual disability and personality disorder in a high secure setting. Findings -No empirical findings are reported. Evaluation is being undertaken and will be reported in due course.Originaiity/vaiue -The therapeutic community approach has not been applied in forensic intellectual disability before, and this paper therefore describes an original and, in many ways, radical intervention.
Purpose -The aim of this paper is to provide an overview of the experiences of nursing staff providing a residential treatment programme for high risk offenders with an intellectual disability and personality disorder.Design/methodology/approach -The paper's approach is thematic analysis of focus groups, repeated measures EssenCES.Findings -Nursing staff report increased insight into patients' risk factors, improved relationships with patients and enhanced team working.Practical implications -This descriptive paper will be of interest to clinicians working with offenders with intellectual disability and personality disorder. Improvements in team functioning may be of interest to managers. Originality/value -There are few published papers concerning treatment approaches with offenders with intellectual disability and personality disorder. This paper fills some of the gaps.
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