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The purpose of this paper is to describe the evolution of legislation relevant to people with intellectual disabilities (IDs) since the Scottish Parliament came into being in 1999; this will be particularly relevant to practitioners working with people with IDs within mental health and forensic mental health services.

A descriptive review of the relevant legislation, setting this out in the chronological order in which the legislation was enacted.

The paper demonstrates that legislative reform is a dynamic and evolving process, responsive to social, political and legal agendas.

The paper is limited to a description of the relevant legislation in only one part of the UK (Scotland).

A helpful summary of the relevant legislation is provided which should be of particular value to readers/practitioners from outwith Scotland.

The paper provides an up to date account of the legislative reform in Scotland during the period 1999-2015.

The Forensic Mental Health Services Managed Care Network is described, including the School of Forensic Mental Health. The purpose of this paper is to outline background, it details successes and challenges, focuses on links to clinical practice for Learning Disabilities (LD) service development, describes education and training, multi-disciplinary and multi-agency working and quality improvement. Findings from a small scale brief educational study undertaken in the high-secure service are included as an example of good practice.

Specific features relating to LD are highlighted. Comparisons are made with other managed clinical and managed care networks.

The Forensic Network has evolved over time. It has played a crucial role in shaping Scotland’s approach to Forensic Mental Health and LD. Central to its success is active involvement of key stakeholders, a multi-agency approach and collaborative working practice. Future plans include formal evaluation of impact.

This paper offers an interesting perspective from a forensic mental health managed care network; the existing literature is limited.

There is a general consensus that healthcare for people with intellectual disabilities should be provided by multi-disciplinary teams. Within a forensic setting, recommendations are often made for separate or “parallel” forensic teams, operating independently of generic mental health or intellectual disability teams. An alternative to this model is an “integrated” service, where specialist forensic clinicians work within the general intellectual disability service, to provide support for clients with forensic needs. For clients with intellectual disabilities and forensic needs, there may be advantages to providing access to a wider multi-disciplinary team, through the application of an integrated model. The purpose of this paper is to illustrate the working of an integrated forensic service within a learning disability team, to identify positive aspects of this model, and how potential shortcomings may be overcome.

Literature review, description of service outline with case example.

Although some studies have compared parallel and integrated forensic models within mental health services, there are no evaluations that compare models of forensic services for individuals with intellectual disabilities. However, specific advantages of an integrated model may include availability of multi-disciplinary clinicians, development of forensic skills across wider groups of clinicians, reduction in stigma and avoidance of delay in transfer of care between services. In addition, in areas with smaller populations, parallel services may not be feasible due to low case numbers.

There has been no formal evaluation of parallel vs integrated forensic services within an intellectual disability setting. However, the authors describe a fully integrated service and suggest means by which the potential shortcomings of an integrated model may be overcome.

The purpose of this paper is to show the development of Appropriate Adult services in Scotland over the past nine years and considers how this differs from the rest of the UK.

New analysis of existing statistical information is provided to show pattern of demand, type of interview, nature of mental disorder involved and regional differences.

Growth in demand for services is identified for both suspect and witness interviews, with people with learning disabilities most frequently receiving support. There is significant variation in the pattern of referrals across Scotland.

The results reflect heightened awareness amongst police officers of the need for Appropriate Adults, but there should be examination of the different types of provision to promote equity of service.

This is the first time that these figures have been collated and subject to analysis. They provide comparative information within Scotland that is also of relevance to the rest of the UK.

In Scotland, following the closure of long stay learning disability hospitals in 2005, focus has shifted on to developing robust community services/resources to cater for the healthcare needs of people with learning disabilities. In the absence of robust in‐patient services, a small number of individuals with learning disabilities and associated severe challenging behaviours, despite not being regarded as “forensic” cases, do inappropriately get referred and sometimes admitted to forensic learning disability services. This study aims to explore this area of clinical practice in the context of referrals to the high secure forensic setting of The State Hospital, Carstairs, Scotland and in light of key UK and Scottish Government policies.

All referrals made to the State Hospital's forensic learning disability service between August 2005 and July 2010, which met the criteria, were reviewed (n=5) and common determinants leading to these referrals identified and thematically analysed.

The identified determinants leading to the making of these referrals were broadly classifiable into psychiatric, environmental and staffing themes.

In Scotland, there does appear to be a requirement for a specialist in‐patient service to meet the needs of this complex and challenging group of patients. There is a need for effective supra‐regional planning to meet the needs of similar “high cost, low volume” patient groups.

This study highlights the wider issue of “gaps” within services in Scotland for individuals with severe challenging behaviours and autism and the requirement for a national specialist service.

UK best practice guidelines for the treatment for people with schizophrenia recommend the use of psychoeducational approaches. The purpose of this paper is to describe the introduction of psychoeducational groups for people with an intellectual disability and co-morbid mental illness within forensic settings.

“Staying Well”, a psychoeducational programme for people with an intellectual disability and co-morbid mental illness was based in part on a group programme from Ashworth Hospital, but adapted and developed to be suitable for people with intellectual disability. Input from a very experienced speech and language therapist was of great importance. Five groups with a total of 20 participants (15 different individuals) with mild to moderate intellectual disability and co-morbid mental illness were run over a two-year period. At the end of each group, an individualised “Staying Well Plan” was devised, to reduce the risk of future relapses.

The group was very positively welcomed in the two pilot hospitals, by participants and members of the clinical teams. The key measure of the success of the programme is that the “Staying Well Plans” developed for the individuals are still in place two years after the completion of the first groups.

The authors believe that this approach is of benefit to both the participants and their carers, stimulating positive engagement, open discussion about mental illness and reinforcing strategies for “Staying Well”.

This paper shows how a psychoeducational approach to severe mental illness in individuals with an intellectual disability is both possible and well received.

Nationally community services for patients with intellectual disability and forensic needs are limited, and research to guide service development for this patient group with highly complex needs is sparse. The purpose of this paper is to provide an overview of referrals to and case management by the multi-agency Fife Forensic Learning Disability Service (FFLDS), including demographic data, treatment, risk assessments and outcomes.

All referrals received between 2004 and 2014 were reviewed to identify key demographic factors and to clarify the outcome of the referrals. Risks levels and presence of factors related to ongoing risk management were identified. For those accepted, final outcomes were noted.

In total, 145 referrals were received by FFLDS between 1 January 2004 and 31 December 2014. Of these 117 were accepted for ongoing case management. In total 106 patients were discharged from FFLDS over the review period, with the vast majority remaining in community settings. Patients were overwhelmingly male, with an age range of 16-79 (mean age of 30). Approximately half of referrals were from criminal justice agencies, and sexual and violent offences predominated. Alcohol and/or illicit substance use was problematic in 49 per cent of patients.

FFLDS needs to consider building links with Drug and Alcohol Services, for assistance in developing expertise in managing problematic alcohol and/or illicit substance use. Links with professionals working with female offenders may increase the rate of referral of female patients.

Policy and legal frameworks emphasise the need to manage people with learning disabilities and forensic needs in the least restrictive environment possible. This paper provides information on a cohort of forensic patients over a ten-year period, including characteristics and outcomes, to inform the evaluation of these frameworks and the planning of both community and in-patient services for this patient group.

The purpose of this paper is to describe the unique and independent role of the Mental Welfare Commission for Scotland.

The paper takes the reader through the history of the Commission, its changing status, roles and responsibilities, its influence and impact, and current priorities. It is based on details of the Commission ' s development, narrative from current employees and published investigations and advice.

The Mental Welfare Commission has advanced significantly since its original establishment. It plays a vital role in protecting the human rights of people in Scotland with learning disabilities and mental illness, by visiting those who are in receipt of care or treatment, investigating situations of concern, providing advice and guidance, monitoring the Mental Health (Care and Treatment) (Scotland) Act 2003 and Adults with Incapacity (Scotland) Act 2000 and shaping relevant policy and legislation.

This paper provides an introduction to the work of the Commission, which will be of value to readers in Scotland and beyond. It illustrates its importance in preserving the rights of individuals with learning disabilities and mental illness in line with the UN Convention on the Rights of Persons with Disabilities and other legislation.

The Purpose of this paper is to identify and explore the views and experiences of specialist learning disability (LD) health service professionals regarding the management of and support offered to people with LD when they come into contact with the Scottish criminal justice system (CJS).

A qualitative design was adopted for this study due to the limited existing evidence in the area and the need to start to build and develop understanding of the phenomena under study. A purposive sampling procedure was used to select participants from an accessible population within one Scottish NHS Health Literature review, qualitative research, semi-structured interviews and thematic analysis.

The findings identified three key themes challenges in practice; the need for additional resources; and the ability of services to provide management and support.

The findings serve to contribute to the understanding of the role and contributions made by and required from specialist LD health services to manage and support people with LD in the Scottish CJS.