Dale, C. (2015), "Editorial", Journal of Intellectual Disabilities and Offending Behaviour, Vol. 6 No. 1. https://doi.org/10.1108/JIDOB-07-2015-0015
Emerald Group Publishing Limited
Article Type: Editorial From: Journal of Intellectual Disabilities and Offending Behaviour, Volume 6, Issue 1.
Winterbourne View – Time is Running Out
July 2015 saw the publication of the 6 month independent review of the Transforming Care and Commissioning Steering Group, chaired by Sir Stephen Bubb (Winterbourne View – Time is Running Out). The report acknowledges that the pace of change remains slow and the Transforming Care programme has not yet delivered anything tangible in terms of new community facilities or closures. The report identifies key failures in leadership and little attention to the need for gearing up the capacity and response of providers.
In relation to the criminal justice system (CJS) the report refers to the “Bradley Report five years on” (Durcan et al., 2014) which made it clear that there is still progress to be made for people with learning disabilities (LD) and/or autism in courts and prisons. The Bubb report reiterates the call for a cross-government response, from the Ministry of Justice to Department of Health. Without this, Bubb believes, people with LD and/or autism will not receive the support they need at all stages of the CJS. However, whilst this is commendable and should receive widespread support the report fails to address the “forensic” issues within the current LD hospital population.
To the uninformed reader the reports from Bubb give the impression that the current hospital population consist of people who could easily be relocated from their current hospital placements. The Health and Social Care Information Centre (2015) states that on census day (October 2014), 2,585 (80 per cent) of the people with a LD in hospitals were subject to the Mental Health Act (MHA) of which 1,460 patients (45 per cent) were detained under Part II, 425 patients (13 per cent) were detained under Part III without a restriction order, and 635 patients (20 per cent) were detained under Part III and subject to Ministry of Justice restriction order (this is important since these patients cannot be discharged from hospital even for periods of extended leave or transferred to another hospital without the agreement of the Ministry of Justice). In all, 65 patients (2 per cent) were classified as “Other” which includes the use of Guardianship and DoLS. The use of the MHA as reported in 2014 was in line with the results for the 2013 Learning Disability Census collection where 2,536 patients (78 per cent) were subject to the MHA.
The Health and Social Care Information Centre statistics are important as they present definitive and comprehensive information about the population size, characteristics, and experience of care, of people whose treatment, care, and support needs may be similar to those treated in Winterbourne View.
The data in the 2013 and 2014 census confirm that the targets set for relocating people may have been over-ambitious given the complexity of needs of patients using diverse inpatient settings. The number of patients subject to formal detention has remained comparable between both censuses, the impact being that transferring or discharging patients who are detained may be more difficult. Despite this the Bubb report (Transforming Care and Commissioning Steering Group, 2015) remains silent on the complexity and needs of this group. This is despite the fact that:
for 2,545 patients (79 per cent), the main treatment reason for being in inpatient care on census day was either due to a continuing behavioural treatment programme (21 per cent), the continuing need for inpatient care of mental illness (42 per cent), or where current behaviour has been assessed as being too high risk for the Ministry of Justice to agree any reduction in security level (15 per cent); and
totally, 2,310 patients (72 per cent) were recorded to have behaviour that presented a risk of violence or threats of violence to others.
It is also the case that 2,970 patients (92 per cent) had their care plan agreed with the commissioner of their care.
The 2014 Learning Disability Census asked six new questions on whether a patient was recorded to be at risk of certain behaviour types and whether the risk was absent, present or severe enough to require hospital treatment. On census day, 2,775 patients (86 per cent) were recorded as being at risk of at least one of the behaviour traits including:
2,310 patients (72 per cent) were recorded as at being at risk of violence or threats of violence to others;
1,595 patients (49 per cent) were recorded as being at risk of self-injury;
1,555 patients (48 per cent) were recorded as being at risk of damage to property
1,180 patients (37 per cent) were at risk of sexual behaviour constituting risk to others;
810 patients (25 per cent) were at risk of sexual behaviour constituting risk to themselves; and
455 patients (14 per cent) were at risk of fire setting.
Unsurprisingly services have struggled to relocate people with this complexity of need particularly given the unrealistic time-scales set. It gives little confidence in a succession of groups who have continued to give promises to close beds in services when for a high percentage of people they would require to be relocated to premises which have been registered with the Care Quality Commission for the purpose of the MHA. There needs to be some realistic conversations about how the needs of the people described can be best met going forward and stop presenting unrealistic targets and denying the extent of the problems that people are facing. Where the real gaps lie are in the skills necessary to work with people with complex needs as much as the buildings that they will inhabit; there is scant acknowledgement of this. Winterbourne View wasn’t a fault of the buildings but the people who were employed to provide care there; the people who should have been supervising and managing the care and those who should have been regulating it. Providing new accommodation does not solve the problem but is only a piece in the jigsaw; focusing solely on this element will mean another Winterbourne View will be exposed in a smaller more local service replicating the inappropriate culture, poor supervision, and poor regulation sometime in the future.
In this issue:
Ruth Howard, Emma Phipps, Jane Clarbour and Kelly Rayner explore the support needs of people with LD in the CJS. They explain that people with LD often lack necessary support in navigating and coping within the CJS. This research explores their experiences, from their own perspective, and identifies the supports which need to be implemented. Four themes are identified: negative feelings, professional attitudes, suitability of the CJS, and supports needed.
This is a timely piece of research in the current landscape of the CJS, and so these findings may be of practical value to the implementation of supports, particularly the liaison and diversion schemes.
Karina Louise Hepworth and Helen Williams explore the role of LD nursing in a multi professional Youth Offending Team (YOT). They argue that the role enables the recognition, acknowledgement and understanding of the needs of people entering the CJS and provides a platform to ensure appropriate identification, assessment, planning and delivery of care ensuring successful completion of the treatment plan and subsequent recidivism and reduction in reoffending.
Deborah Morris and Nathalie Gray describe the evaluation of the “Living with a personality disorder” group (Morris, 2011). This intervention is a psycho-education group for women with an Intellectual Disability (ID) and a Personality Disorder (PD). It draws on psycho-education, biosocial theory (Linehan, 1993) and compassionate mind approaches (Gilbert, 2009). It aims to increase knowledge of personality, PDs, to increase awareness of the “non-disordered” parts of self and to increase knowledge of psychological treatments for PDs.
The intervention was delivered to women detained in a specialist women’s LD forensic service. It was delivered over 12 group and two individual sessions. The intervention was piloted between 2012 and 2014 in a series of small groups. Completing the intervention resulted in an increase in knowledge of PD, treatments, increased self-compassion and therapeutic optimism and awareness of the limitations of a PD diagnosis.
Daniel Silva, Karen Gough and Hannah Weeks review existing measures within Liaison and Diversion Services for the screening for LD in the CJS. The review found that there is a significant body of research defending the need for LD screening in the CJS across the UK. The aim of a screening process would be to identify individuals who possibly have LD and ensure that the correct measures are in place to assess and manage these individuals, including appropriate diversion to specialist LD services. Screening for LD is being discussed across the UK as part of Liaison and Diversion Services. This paper highlights the need for a reliable and valid screening tool and provides support for the use of the Learning Disability Screening Questionnaire (LDSQ).
Erik Søndenaa, Richard Whittington, Christian Lauvrud and Kåre Nonstad consider job stress, burnout and job satisfaction in staff working with people with IDs: community and criminal justice care. This study examined and compared levels of burnout, traumatic stress and resilience amongst Norwegian nursing care staff in two ID services. Two groups were compared; staff in the national forensic ID services and staff in the community ID caring services. The study found that nursing staff in the community ID caring services had significantly more signs of stress and burnout compared to the comparison group. At the same time they were more compassionate.
The study indicated that the forensic ID staff tended to focus on the physical aspects of the caring role whilst the community ID staff tended to focus on the relational issues. The impact of serious events resulted in a higher level of stress and burnout symptoms, however, the community carers showed more compassion to their work.
Durcan, G., Saunders, A., Gadsby, B. and Hazard, A. (2014), “The Bradley Report five years on: an independent review of progress to date and priorities for further development”, Centre for Mental Health, London.
Gilbert, P. (2009), The Compassionate Mind, Constable, London
Health and Social Care Information Centre (2015), “Mental Health and Learning Disability Statistics: monthly report October 2014”, January, available at: www.hscic.gov.uk/mhldsmonthly
Linehan, M.M. (1993), Cognitive Behavioural Treatment of Borderline Personality Disorder, Guilford Press, New York, NY
Morris, D.J. (2011), “Living with a Personality Disorder” Facilitator Manual, St Andrews Healthcare, Northampton
Transforming Care and Commissioning Steering Group (2015), Winterbourne View – Time is Running Out, ISBN: 1-900685-76-0, the 6 month independent review of the Transforming Care and Commissioning Steering Group, chaired by Sir Stephen Bubb, ACEVO, London
Health and Social Care Information Centre (2014), “Learning disabilities census report”, January, available at: www.hscic.gov.uk/mhldsmonthly (accessed 15 July 2015).