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“Why can’t they be in the community?” A policy and practice analysis of transforming care for offenders with intellectual disability

Regi Alexander (Partnerships in Care Learning Disability Services, Norfolk, United Kingdom AND Norwich Medical School, University of East Anglia, United Kingdom.)
John Devapriam (Leicestershire Partnership NHS Trust, Leicester, United Kingdom AND Care Quality Commission, Leicester, United Kingdom.)
Dasari Michael (Learning Disability, Humber NHS Foundation Trust, Hull, United Kingdom.)
Jane McCarthy (East London NHS Foundation Trust, Kings College, London, United Kingdom AND Psychiatry of Intellectual Disability, Royal College of Psychiatrists, London, United Kingdom.)
Verity Chester (Partnerships in Care Learning Disability Services, Norfolk, United Kingdom.)
Rahul Rai (Hertfordshire Partnership NHS Foundation Trust, Colchester, United Kingdom.)
Aezad Naseem (Hertfordshire Partnership NHS Foundation Trust, Colchester, United Kingdom.)
Ashok Roy (Coventry & Warwickshire NHS Foundation, Brooklands Hospital, Birmingham, United Kingdom AND Psychiatry of Intellectual Disability, Royal College of Psychiatrists, London, United Kingdom.)

Advances in Mental Health and Intellectual Disabilities

ISSN: 2044-1282

Article publication date: 5 May 2015

Abstract

Purpose

The purpose of this paper is to describe key policy and practice issues regarding a significant subgroup of people with intellectual disability – those with offending behaviour being treated in forensic hospitals.

Design/methodology/approach

The reasons why psychiatrists continue to be involved in the treatment of people with intellectual disability and mental health or behavioural problems and the factors that may lead to patients needing hospital admission are examined. Using two illustrative examples, three key questions – containment vs treatment, hospital care vs conditional discharge and hospital treatment vs using deprivation of liberty safeguards usage in the community are explored.

Findings

Patients with intellectual disability, mental health problems and offending behaviours who are treated within forensic inpatient units tend to have long lengths of stay. The key variable that mediates this length of stay is the risk that they pose to themselves or others. Clinicians work within the framework of mental health law and have to be mindful that pragmatic solutions to hasten discharge into the community may not fall within the law.

Originality/value

This paper makes practical suggestions for the future on how to best integrate hospital and community care for people with intellectual disability, mental health and offending behaviours.

Keywords

Citation

Alexander, R., Devapriam, J., Michael, D., McCarthy, J., Chester, V., Rai, R., Naseem, A. and Roy, A. (2015), "“Why can’t they be in the community?” A policy and practice analysis of transforming care for offenders with intellectual disability", Advances in Mental Health and Intellectual Disabilities, Vol. 9 No. 3, pp. 139-148. https://doi.org/10.1108/AMHID-02-2015-0011

Publisher

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Emerald Group Publishing Limited

Copyright © 2015, Emerald Group Publishing Limited