The clinical profiles of forensic inpatients with intellectual disabilities in a specialized unit

Palucka, Anna M.; Raina, Poonam; Liu, Shi‐Kai; Lunsky, Yona

doi:10.1108/20420921211327365

Cited by 8 publications

(3 citation statements)

References 20 publications

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“…55,77,79,102,108 The remaining 15 papers reported data about in-patients with intellectual disability and/or autism in specialist intellectual disability services only (Table 3). 1,3,4,6,8,14,35,[73][74][75]78,104,[109][110][111] The mean and the average median length of stay within specialist in-patient intellectual disability services was longer compared with GMH inpatient services, but was shorter when those identified as long stay were removed (Table 4).…”

Section: Length Of Staymentioning

confidence: 99%

A systematic review of in-patient psychiatric care for people with intellectual disabilities and/or autism: effectiveness, patient safety and experience

et al. 2022

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Background An increasing number of children, adolescents and adults with intellectual disabilities and/or autism are being admitted to general psychiatric wards and cared for by general psychiatrists. Aims The aim of this systematic review was to consider the likely effectiveness of in-patient treatment for this population, and compare and contrast differing models of in-patient care. Method A systematic search was completed to identify papers where authors had reported data about the effectiveness of in-patient admissions with reference to one of three domains: treatment effect (e.g. length of stay, clinical outcome, readmission), patient safety (e.g. restrictive practices) and patient experience (e.g. patient or family satisfaction). Where possible, outcomes associated with admission were considered further within the context of differing models of in-patient care (e.g. specialist in-patient services versus general mental health in-patient services). Results A total of 106 studies were included and there was evidence that improvements in mental health, social functioning, behaviour and forensic risk were associated with in-patient admission. There were two main models of in-patient psychiatric care described within the literature: admission to a specialist intellectual disability or general mental health in-patient service. Patients admitted to specialist intellectual disability in-patient services had greater complexity, but there were additional benefits, including fewer out-of-area discharges and lower seclusion rates. Conclusions There was evidence that admission to in-patient services was associated with improvements in mental health for this population. There was some evidence indicating better outcomes for those admitted to specialist services.

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Section: Length Of Staymentioning

confidence: 99%

A systematic review of in-patient psychiatric care for people with intellectual disabilities and/or autism: effectiveness, patient safety and experience

et al. 2022

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“…Participation in psychological interventions was already fairly well established in this forensic group due to a willingness to adapt existing mental health programmes and optimise treatment, yet the impact of such interventions is under‐reported. Other similar forensic services in Ontario, Canada have different challenges, in that they have forensic in‐patient psychiatry services, but no psychological services specific to in‐patients with ID (Palucka et al, 2012). Since the therapeutic emphasis in the programmes is targeted towards higher functioning individuals, it makes it difficult for people with ID to participate fully in treatment.…”

Section: Discussionmentioning

confidence: 99%

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

Walker

Mann

Pitcairn

et al. 2021

Policy Practice Intel Disabi

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A national census was undertaken for the first time to establish number of patients with ID in secure forensic in‐patient services in Scotland and identify their treatment needs. All forensic mental health units were identified and contacted with a request to contribute. Response rate was 100%. Initial results in 2013 revealed 89 patients with ID, 83 male and six female. This group contributes to 17% of the overall forensic in patient population (n = 522). A higher proportion are from the North of Scotland. Key characteristics include an average age of 22 at first admission, history of violent offending, drug and alcohol abuse and self‐harm. Patients with ID in high secure services had significantly higher risk and total Historical Clinical Risk‐20 scores than those in a lower level. A range of significant health needs were identified enabling clinicians to build a profile of the population. A variety of medical, psychological and occupational interventions were utilised. Delivery seemed consistent across services, although poor recording made accurate assessment difficult. Nine percent were re‐admitted to a higher level of security within a 5‐year period (2013–2018). Repeated annual census findings revealed a slight decline in in‐patient numbers over a 5‐year period, although the proportion of ID patients (17%) remains constant. Data for 2018 indicate 85 people with ID, from a total in‐patient population of 490; female population increased to 10 (12%). Forty one (46%) patients either moved to a lower level of security or were discharged to community within a 5‐year period, indicating treatment success. This census provides unique evidence highlighting modest numbers of patients with ID, the majority of whom are cared for in low secure services. The populations' needs are considerable, but it is unclear if individual needs are being addressed. This requires further exploration, as does efficacy of interventions, in order to address the burden of psychological morbidity.

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“…18 One of the few non-UK studies reported 'any criminal justice involvement', which included arrest without charge following discharge from an Australian hospital unit, arrest data being likely to be a better reflection of offending behaviour than conviction. 36 Only one linked series of studies attempted to address change in offending behaviour as a result of treatment, comparing the number of formal incidents in the 2 years before referral to a community FIDDs service with those in a follow-up period. 26,28,29 Five studies examined and attempted to measure 'offending-like' behaviour in the community that had not been officially recorded.…”

Section: Reoffending/'offending-like' Behaviour/incidentsmentioning

confidence: 99%

Researching outcomes from forensic services for people with intellectual or developmental disabilities: a systematic review, evidence synthesis and expert and patient/carer consultation

Morrissey

Geach

Alexander³

et al. 2017

Health Serv Deliv Res

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BackgroundInpatient services for people with intellectual and other types of developmental disabilities (IDD) who also have forensic or risk issues are largely provided in secure hospitals. Although this is a health service sector with high levels of expenditure, there is limited empirical information on patient outcomes from such services. In order for a future substantive longitudinal outcomes study in forensic IDD services to be informed and feasible, more needs to be understood about the outcome domains that are of relevance and importance and how they should be measured. A preliminary series of studies was therefore undertaken.ObjectivesTo synthesise evidence in relation to the outcome domains that have been researched in the existing literature from hospital and community forensic services for people with IDD, within the broad domains of service effectiveness, patient safety and patient experience. To identify a definitive framework of outcome domains (and associated measures and indicators) based both on this research evidence and on the views of patients, carers and clinicians. To synthesise the information gathered in order to inform design of future multisite longitudinal research in the sector.DesignThree linked studies were conducted. Stage 1 was a systematic review and evidence synthesis of outcome domains and measures as found within the forensic IDD literature. Stage 2 was a consultation exercise with 15 patients with IDD and six carers. Stage 3 was a modified Delphi consensus exercise with 15 clinicians and experts using the information gathered at stages 1 and 2.ResultsAt stage 1, 60 studies that researched a range of outcomes in forensic IDD services were identified from the literature. This resulted in the construction of an initial framework of outcome domains. The consultation with patients and carers at stage 2 added to these framework domains that related particularly to carer experience and the level of support post discharge in the community. The Delphi process at stage 3 confirmed the validity of the resulting framework for clinician. This survey also identified the outcome measures preferred by clinicians and those that are currently utilised in services. Thus, indicators of appropriate measures in some important domains were identified, although there was a paucity of measures in other domains.ConclusionsTogether, these three linked studies led to the development of an evidence-based framework of key outcome domains and subdomains. A provisional list of associated measures and indicators was developed, although with the paucity of measures in some domains development of specific indicators may be required. With further refinement this could eventually be utilised by services and commissioners for comparative purposes, and in future empirical research on outcomes in forensic IDD services. An outline research proposal closely linked to recent policy initiatives was proposed. Limitations of the study include the relatively small number of carers and patients and range of experts consulted.Future workThis would comprise a national longitudinal study tracking IDD in patients through hospitalisation and discharge.Study registrationThis study is registered as PROSPERO CRD42015016941.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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The clinical profiles of forensic inpatients with intellectual disabilities in a specialized unit

Cited by 8 publications

References 20 publications

A systematic review of in-patient psychiatric care for people with intellectual disabilities and/or autism: effectiveness, patient safety and experience

A systematic review of in-patient psychiatric care for people with intellectual disabilities and/or autism: effectiveness, patient safety and experience

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

Researching outcomes from forensic services for people with intellectual or developmental disabilities: a systematic review, evidence synthesis and expert and patient/carer consultation

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