A busy time…

Citation

Dale, C. and Moore, D. (2011), "A busy time…", Journal of Learning Disabilities and Offending Behaviour, Vol. 2 No. 2. https://doi.org/10.1108/jldob.2011.55402baa.001

A busy time…

Article Type: Editorial From: Journal of Learning Disabilities and Offending Behaviour, Volume 2, Issue 2

Since our last edition, we have seen coalition government publish a number of policy papers and good practice guides across a range of health and social care issues. In this editorial, we have highlighted three recent documents that have a particular relevance to people with learning disabilities who have offended or are at risk of offending.

The first document is the new mental health policy for England No health without mental health (DH, 2011a). This cross government, all age strategy was published on 2 February 2011 and contains the coalition’s vision for improving mental health and the delivery of mental health services.

It aims to put mental health on an equal footing with physical health. It has an emphasis on tackling the inequalities that lead to poor mental health and those that arise from experiencing mental health problems.

It sets out six shared objectives:

1. 1.

   More people will have good mental health.

2. 2.

   More people with mental health problems will recover.

3. 3.

   More people with mental health problems will have good physical health.

4. 4.

   More people will have a positive experience of care and support.

5. 5.

   Fewer people will suffer avoidable harm.

6. 6.

   Fewer people will experience stigma and discrimination.

It highlights the recommendations of Lord Bradley’s review and makes a commitment to improving mental health and learning disability outcomes for offenders. Much of this is focused on diversion schemes and identifying and supporting people early in their contact with the criminal justice system.

Importantly, in relation to offenders with learning disabilities, it stresses the “interconnections between mental health, housing, employment and the criminal justice system” and places the mental health of offenders as a critical priority area. It also contains a specific goal to ensure that by 2014 people in contact with the criminal justice system will have improved access to mental health services. How this will happen has been outlined in the Green Paper Breaking the Cycle which we highlighted in the previous edition of this journal.

What this will mean for offenders with learning disabilities in reality remains to be seen. In many areas there is little or no specific resource or expertise within diversion schemes to support this group. If they are to benefit from new initiatives then there will need to be clear and definable reference to their inclusion and eligibility to such services.

The strategy also talks about the need for choice and control over support services for ex-offenders, drug users and other socially excluded groups. This is admirable but for offenders with learning disabilities the paucity of appropriate provision in some localities means that the concept of choice becomes no more than an illusion.

Overall, the new strategy offers a promising vision for future mental health service that has a good fit with the learning disability policy “Valuing People Now” (DH, 2009). It identifies similar priorities such as supporting employment, improving physical health, challenging discrimination and increasing choice and control.

Importantly, it stresses that better mental health for the population must mean for everyone. A key test a few years down the line will be to see if people with learning disabilities have benefited from mental health programmes such as improving access to psychological therapies. Current work on improving the identification of people with learning disabilities within the criminal justice system is vital in helping to make sure they receive appropriate support. However, the information gained on population need and experience will also be valuable in comparing their experiences to their non-disabled peers and ensuring they enjoy equal access and outcomes in areas such as mental health care.

The mental health strategy also signals an intention on the part of government to reshape services for offenders with personality disorder as outlined in the recent Green Paper.

This leads us to us to the first of two new guides to support professionals within the criminal justice system.

“Working with personality disordered offenders – a practitioners guide” was published by in February 2011 and is designed to support offender managers although it is likely to be of use to other groups of frontline staff. It offers practitioners clear information including “tops tips” when working with different groups. It is estimated that personality disorder affects between 60 and 70 per cent of people in prisons (DH, 2011c).

The second guide is a revised edition of the Positive Practice Positive Outcomes handbook for professionals in the criminal justice system working with offenders with learning disabilities. It is accompanied by an easy read guide for people with learning disabilities who find themselves in contact with the criminal justice system (DH, 2011b).

These three publications are welcome as they focus on, and highlight, the needs of people who are known to be vulnerable within the criminal justice system and wider society. However, they have also been published at a time of unprecedented change in health, social care and the criminal justice system and within a climate of financial austerity. Delivering on the objectives within the new mental health strategy and achieving better outcomes as described in the good practice guides will without doubt be a real, albeit worthwhile, challenge for all of us.

This edition of the journal features articles on: increasing community access for sex offenders during and post treatment; details of the evaluation of a sex offender’s treatment programme; an analysis of the Novaco Anger scale in relation to differences for men and women; and ten top tips for effectively involving people with a learning disability in research.

Brandie Stevenson, Luke Lynn, Katelyn Miller and Dave Hingsburger look at community-based treatment programmes for people with intellectual and learning disabilities. Using case examples, the paper demonstrates how community-based treatment programmes give individuals “real life” opportunities to practise skills and thus generalize what is learned in therapeutic sessions into practical application.

Julia Large and Cathy Thomas describe a study which investigated the diverse needs of multiple stakeholders in an adapted sex offender treatment programme (ASOTP) and then evaluated a pilot programme set up to respond to the identified needs.

The multiple views of stakeholders were identified by means of questionnaires and semi-structured interviews in order to ascertain the key issues necessitating change. Stakeholders included purchasers of care, referred clients, internal and external clinicians involved in their care, group facilitators and, in some cases, clients’ families or advocates.

An innovative rolling format ASOTP (based on the content of the prison and probation service ASOTP) was designed and piloted to address highlighted needs, including time frames for the commencement and completion of treatment.

Initial feedback from all stakeholders has been positive. In particular, participants have shown an increase in motivation, knowledge and unexpectedly, enhanced levels of risk disclosure. Facilitators have reported increased satisfaction and decreased stress levels.

Jane Chilvers and Cathy Thomas present an article which identifies that the presence of anger and aggression in forensic learning disabled populations is high. They explain that female forensic populations are smaller than male ones but reportedly account proportionally for higher levels of aggression. The role of anger within this is not clear. Females with learning disabilities represent a minority group and consequently the research base supporting needs assessment is limited. This study used an established psychometric measure designed for assessing various components of anger, the Novaco Anger Scale and Provocation Inventory (NAS-PI) (Novaco, 2003) to compare scores obtained by 12 females with 23 males within a forensic psychiatric service for learning disabled patients. Significant differences were found between the scores, indicating that the female patients demonstrated elevated scores on a number of the component scales compared to males. Possible explanations for these findings and recommendations for future research are discussed.

Pamela Inglis and Tina Cook present an article with the intriguing title of ten top tips for effectively involving people with a learning disability in research. They explain how people with a learning disability have historically been the subjects or recipients of research, rather than true participants or contributors. They outline a number of common approaches used to inform people with a learning disability about research such as simplifying information sheets and reading out the information; but observe that the literature to date suggests that little is known about what people with a learning disability understand about research.

Their study set out to discover how men with a learning disability living in a Medium Secure Unit understand research, consent and ethics and what enables them to learn about these concepts. Seven men and ten staff were invited to become co-researchers with two academic researchers from Northumbria University, over twenty months. The study involved enabling collaborative discussions, using multiple ways of engaging with presenting and collecting information. It used a longitudinal rather than one off approach, which allowed for repetitions of information and the revisiting of thoughts and ideas (a recursive process) to add breadth and depth to the data, and to have fun. The results suggest that the fun, longitudinal, recursive and collaborative approach, was key to developing understandings of research for the men.

Colin Dale, Debra Moore