Making a difference? Ten years of managing people with intellectual disability and forensic needs in the community

Abstract

Purpose – Nationally community services for patients with intellectual disability and forensic needs are limited, and research to guide service development for this patient group with highly complex needs is sparse. The purpose of this paper is to provide an overview of referrals to and case management by the multi-agency Fife Forensic Learning Disability Service (FFLDS), including demographic data, treatment, risk assessments and outcomes. Design/methodology/approach – All referrals received between 2004 and 2014 were reviewed to identify key demographic factors and to clarify the outcome of the referrals. Risks levels and presence of factors related to ongoing risk management were identified. For those accepted, final outcomes were noted. Findings – In total, 145 referrals were received by FFLDS between 1 January 2004 and 31 December 2014. Of these 117 were accepted for ongoing case management. In total 106 patients were discharged from FFLDS over the review period, with the vast majority remaining in community settings. Patients were overwhelmingly male, with an age range of 16-79 (mean age of 30). Approximately half of referrals were from criminal justice agencies, and sexual and violent offences predominated. Alcohol and/or illicit substance use was problematic in 49 per cent of patients. Research limitations/implications – FFLDS needs to consider building links with Drug and Alcohol Services, for assistance in developing expertise in managing problematic alcohol and/or illicit substance use. Links with professionals working with female offenders may increase the rate of referral of female patients. Originality/value – Policy and legal frameworks emphasise the need to manage people with learning disabilities and forensic needs in the least restrictive environment possible. This paper provides information on a cohort of forensic patients over a ten-year period, including characteristics and outcomes, to inform the evaluation of these frameworks and the planning of both community and in-patient services for this patient group.

Learning disability, autism and the Criminal Procedure (Scotland) Act

“…In this study, most patients with LD alone and all the patients with Autism had been convicted. This is similar to findings in forensic services elsewhere in Scotland (de Villiers and Doyle, 2015), and in England (Glover and Brown, 2015). The convicted patients could have received a punitive disposal.…”

“…However, unlike the findings by Welsh and Morrison, 2007 in civil legislation, where 68.1% had another type of mental disorder, most people with LD managed under "criminal" orders do not have a comorbid MI or PD. Indeed, evidence from other studies in Scotland also indicates that co-morbid MI is less common in people with LD managed in a community forensic service (de Villiers and Doyle, 2015), and that the rate of major MI was similar to the rate in our study (Lindsay, et al, 2013). Evidence from England would also suggest that co-morbid MI is less common in people with LD who are on Section III (criminal) orders compared to civil orders (Glover and Brown, 2015).…”

“…Only 13% of the LD patients in this study had a co-morbid PD diagnosis which is similar to the 10% found by Welsh and Morrison, 2007 in those on civil detention. Other research has indicated a low prevalence of PD in Scottish forensic LD populations with one community service having no referrals with a documented diagnosis of PD in ten years (de Villiers and Doyle, 2015). A rate of 10% was found by O'Brien et al, 2010 in 3 services across the UK to whom people with LD and offending/antisocial behaviour had been referred.…”

A national census of forensic in‐patients with intellectual disability and five‐year follow‐up

“…A small proportion of these, around 2.8% (Fazel et al, 2008), are likely to end up in Forensic Mental Health Services, due to committing a violent crime (Salekin et al, 2010). The overwhelming majority of people with ID and mental health problems are living in the community, yet a number of important factors drive the need for ID forensic services, including in‐patient services (de Villiers & Doyle, 2015; Royal College of Psychiatrists, 2013). These factors include: the increased societal aversion to any degree of risk (Carroll et al, 2004); the lack of specialist skills in the diagnosis and treatment of mental disorders in people with ID (Cumella, 2009); and in‐patient ID services providing an environment that emphasises care and treatment rather than punishment (Hollins, 2000; Kingdon, 2005).…”