Getting to grips with the new Code of Practice

Colin Dale (Caring Solutions, UK)

Journal of Intellectual Disabilities and Offending Behaviour

ISSN: 2050-8824

Article publication date: 8 December 2014



Dale, C. (2014), "Getting to grips with the new Code of Practice", Journal of Intellectual Disabilities and Offending Behaviour, Vol. 5 No. 4.



Emerald Group Publishing Limited

Getting to grips with the new Code of Practice

Article Type: Editorial From: Journal of Intellectual Disabilities and Offending Behaviour, Volume 5, Issue 4.

January 2015 saw the publication of a revised “Code of Practice” for the Mental Health Act for England and Wales (1983). The Code was revised to take account of stakeholders’ views during consultation, and reflects changes in legislation, case law, policy and professional practice since its last revision in 2008. Depending on Parliamentary approval, the Code of Practice will come into force on 1 April 2015.

The importance of the Code for the population of people that this Journal concerns itself with is that it safeguards patients’ rights, ensures compliance with the law and must be considered by health and social care professionals. The Code is used by patients in hospital and those in the community, their families, carers and advocates. It is there to help make sure that anyone experiencing mental disorder and being treated under the Act gets the right care, treatment and support. In 2013-2014 there were more than 53,000 detentions in England under the Act.

This revised Code reflects and embeds developments since 2008 in areas including the use of restrictive interventions, seclusion, use of police powers to detain people in places of safety, and the use of community treatment orders.

The introduction contains information about the purpose and status of the Code, the role of the Care Quality Commission, what to do if you think the Code is being inappropriately applied and information about safeguarding and whistleblowing. Chapters have been grouped into seven clusters relating to common themes and topics. Colour coding has been used so these groups can be recognised. Comprehensive cross-referencing, annexes and an index have been included to ensure that users can readily find related material.

As well as providing guidance for professionals, the revised Code of Practice also guides patients, their families and carers on their rights.

The main changes include:

  • five new guiding principles;

  • new chapters on care planning, human rights, equality and health inequalities;

  • consideration of when to use the Mental Health Act and when to use to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and information to support victims;

  • new sections on physical healthcare, blanket restrictions, duties to support patients with dementia and immigration detainees;

  • significantly updated chapters on the appropriate use of restrictive interventions, particularly seclusion and long-term segregation, police powers and places of safety; and

  • further guidance on how to support children and young people, those with a learning disability or autism.

This update should be welcomed by all involved in our speciality but at 438 pages the Code is a lengthy document and will be challenging for services to fully adapt to.

In this issue

Alyssa Cox, Hayley Simmons, Ginny Painter, Pippa Philipson, Rachel Hill and Verity Chester describe their work on “Real Work Opportunities: establishing an accessible vocational rehabilitation programme within a forensic intellectual disability service”.

This paper is a reflective account of the development and implementation of the “Real Work Opportunity programme” with a forensic intellectual disability (ID) population.

The authors explain that patients treated within secure/forensic settings experience numerous barriers to meaningful vocation, including restrictions under the Mental Health Act, which limit community access. The development of Real Work Opportunities within a forensic ID service involved setting up employment and interview workshops, interviews, and interview feedback, and job roles to simulate the real work process.

The described evaluation of the programme demonstrated that it was well received by the patients involved and a high attendance rate was maintained over time despite the demands that were expected. Roles have been advertised for two employment periods and have had two sets of successful candidates. Patients demonstrated skills development throughout the employment process, including general work based skills, punctuality and time management, managing duties, responsibility, specific role-related skills, interpersonal skills and personal presentation.

Despite limited experience of work prior to admission, many patients were enthusiastic and motivated to work. Future developments will include widening the number and types of opportunity offered by the programme.

Mark Dalgarno and Sharon Riordan present their research on “Forensic learning disability nursing – what's it really like?”.

This research was conducted to explore the lived experiences of learning disability nurses working within forensic services, and their views on their practice as a specialty.

A qualitative, semi-structured interview-based design was used and participant's voices were examined through interpretive phenomenological analysis.

Nurses explored a range of topics related to their practice and overall, five themes were developed. Forensic nursing as being both the same and different to generic nursing, the journey, and the emotional challenge of forensic nursing, the balancing act of everyday practice and the role of language within forensic nursing practice.

Very little research has examined the views of learning disability nurses within the forensic field. This study gives both a voice to these nurses and suggests areas of interest both for research and for clinicians to consider in their practice.

Jenna McWilliams, Ian de Terte, Janet Leathem, Sandra Malcolm and Jared Watson describe “Transformers: a programme for people with an intellectual disability and emotion regulation difficulties”.

The Transformers programme is a community-based intervention for people with an ID who have emotion regulation difficulties, which can manifest as aggressive and challenging behaviour. The programme was adapted from an emotion regulation programme for offenders with an ID who live in an inpatient setting. This paper describes the development of the Transformers programme that has been implemented at an ID service, which provides secure and supervised care to people who have been convicted of an imprisonable offence or have high and complex behaviour needs.

The Transformers programme is delivered in weekly sessions over a six-month period in a group format. The focus is on helping group members to develop skills in recognising and understanding negative emotions and learning skills to cope effectively with such emotions. Treatment covers a variety of modules including relaxation, goal setting, chain analysis, emotion recognition, and emotion regulation. Specific strategies used include role-plays, DVDs, and quizzes.

This paper presents the rationale, developmental history, and description of a specific approach to the treatment of emotion regulation difficulties.

Mathew Raymond and Susan Hayes from the University of Sydney introduce the “Importance of locus of control in offenders with intellectual disability”.

The authors describe that “Locus of control (LOC)” is the manner in which a person attributes their ability to make change in life. This could be through others, fate or chance (externalised), or through oneself (internalised). An internalised LOC results in greater self-belief in the ability to change one's behaviour. Non-disabled offenders with an internalised LOC are more likely to benefit from treatment through therapy and in turn have reduced rates of re-offending. The authors describe that the relationship between LOC and response to treatment is only understood in a limited way for offenders with ID who participate in treatment programmes.

To better understand LOC for offenders with ID, this paper investigates its role in community-based therapy outcomes along with its use as a common pre/post measure of treatment success in mainstream offender populations. Drawing upon these findings information more specific to people with ID is discussed. This paper then explore the importance of LOC in treating offenders with ID through a review of the current published literature, which generally indicates offenders with ID demonstrate a tendency towards an external LOC in comparison with non-disabled or non-offender groups.

Given the negative implications for treatment that external LOC may play, several significant therapeutic strategies that can contribute to development of internalised LOC are discussed, in addition to a consideration of other possible variables separate from ID that may play a role in both developing or perpetuating an external LOC.

Colin Dale

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