Development and implementation of a discharge pathway protocol for detained offenders with intellectual disabilities

Abstract

Background. Building the Right Support, a national plan for people with intellectual disabilities in England aims to avoid lengthy stays in hospital for such people. Discharge planning is understood to be helpful in facilitating successful transition from hospital to community services, however there is little guidance available to help those working with detained patients with intellectual disabilities and offending histories to consider how to effect safe and effective discharges. Method. In this paper the development and implementation of a multi-faceted and systemic approach to discharge preparation and planning is described. The impact of this intervention on a range of outcomes was assessed and the views of stakeholders on the process were sought. Results. Initial outcome data provides support for the effectiveness of this intervention in terms of increased rates of discharge, reduced lengths of stay and low readmission rates. Stakeholders viewed the intervention as positive and beneficial in achieving timely discharge and effective post-discharge support. Conclusions. People with intellectual disabilities are more likely to be detained in hospital and spend more time in hospital following admission. A planned, coordinated and well managed approach to discharge planning can be helpful in facilitating timely and successful discharges with low risks of readmission.

‘Why are we stuck in hospital?’ Understanding delayed hospital discharges for people with learning disabilities and/or autistic people in long‐stay hospitals in the UK

“…Length of stay ranged significantly between settings—ATUs or similar had shorter lengths of stay than secure settings, ranging from weeks (Nawab & Findlay, 2008 ) to median stays of 3–6 months (Oxley et al, 2013 ; Washington et al, 2019 ). Notably, a large proportion of people stay in secure settings for many years: for example, 42% of people stayed over 5 years and 11% over 10 years in a medium secure setting (Alexander et al, 2011 ), mean lengths of stay in a locked rehabilitation unit were over 6 years (for those now discharged, Taylor et al, 2017 ) and mean lengths of stay reached over 10 years in a high secure setting (Thomas et al, 2004 ).…”

“…Even professionals' voices (nurses, doctors, ward managers etc) were only found in five of the 13 academic papers included. These were included either to assess the appropriateness of the level of security for patients (Beer et al, 2005 ; Thomas et al, 2004 ), give further detail as to the reasons for delay (Cumella et al, 1998 ; Kumar & Agarwal, 1996 ) or, in one case, give feedback on a new discharge protocol (Taylor et al, 2017 ). However, these sometimes seemed like ‘add ons’ to the ‘main’ finding—the overall prevalence of delays (usually defined via bed census/case notes and based ultimately on the opinion of a lead researcher, usually a medic).…”

“…Finally, there are specific recommendations for changes to the management and delivery of services for people with learning disabilities, and specific calls for improved discharge processes. Almost all of the papers included call for more high‐quality research—some specifically for studies comparing different sites, settings and approaches rather than studies of singular sites or interventions (Alexander et al, 2011 ; Taylor et al, 2017 ). Only one paper (Taylor et al, 2017 ) specifically recommends more focus on service user and family experiences and perspectives.…”

“…Almost all of the papers included call for more high‐quality research—some specifically for studies comparing different sites, settings and approaches rather than studies of singular sites or interventions (Alexander et al, 2011 ; Taylor et al, 2017 ). Only one paper (Taylor et al, 2017 ) specifically recommends more focus on service user and family experiences and perspectives. In relation to services or the system, MWCS ( 2016 ), Perera et al ( 2009 ) and CQC ( 2020 ) suggest a standard reporting and monitoring system for delayed discharges, including reasons for delays (and admissions), whether or not reviews have taken place and protocols been followed.…”

“…MWCS ( 2016 ) call for specific training in positive behaviour support (PBS), specialist support for co‐existing autism and specific support for families and carers in times of crisis, located in the community. Others call for dedicated rehabilitation spaces during any transition (Cumella et al, 1998 ; Taylor et al, 2017 ), or models which seek to reduce risk and readmissions by continuing clinical support from the current hospital team during and after the move to the new setting (Oxley et al, 2013 ; Washington et al, 2019 ).…”