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The aim was to determine the number of referrals of people aged 55 and over to three forensic and psychiatric intensive care unit (PICU) services in Scotland, and to describe their demographic, criminological and psychiatric characteristics. Of a total of 1838 referrals, 63 (3.4%) were aged 55 and over. Of these, 35 were referred for court reports or prison assessment and half had been charged with violent or sexual offences. Most were diagnosed as suffering from a psychiatric disorder at the time of assessment, 11 (31.4%) were admitted for further assessment. There were a further 28 admissions to PICU beds. Older adults form a small but important minority of referrals to forensic and PICU services. A single case register would aid further study in this area. Further exploration of the clinical needs of these patients would be useful.

An audit of 100 referrals made to anger management groups provided by a forensic community mental health team over a four‐year period was carried out to help identify the characteristics of those who benefit from the group programme. It was hypothesised that certain factors might predominate in unsuitable referrals. Only 43 individuals actually attended the initial assessment, and 17 completed the group. Chisquare tests of association established no association between attendance and any of the variables identified. Clinical assessment suggested some differences between those who completed the groups and those who did not, but the numbers were small. Given the low completion rate and the fact that variables which characterise unsuitable referrals have not been identified, it is concluded that it may be more useful to use resources in other ways.

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 study is to analyse the characteristics of all the referrals to the forensic MHIDD service over the past five years and to compare these characteristics to the cohort of service users attending the three general MHID services based in Dublin which are Service 1, Service 2 and Service 3.

This is a cross-sectional study of adults attending the three generic MHID services and the national forensic MHIDD service. The medical files of service users attending the MHID services were reviewed, and data such as age, gender, level of intellectual disability and psychiatric diagnoses were extracted and compiled into a database. The forensic MHIDD service has since its inception maintained a database of all referrals received and reviewed. The characteristics data needed were extracted from the forensic MHIDD database. All these data were then analysed using the Statistical Package for Social Sciences (SPSS).

The majority of the three MHID service users were in the moderate to profound range of intellectual disability, while the majority of the cases assessed by forensic MHIDD had normal IQ, borderline IQ and mild intellectual disability with 66.1%. The prevalence of neurodevelopmental disorder, schizophrenia and emotionally unstable personality disorder in the forensic MHIDD is comparable to the three MHID services. The prevalence of depression, bipolar affective disorder (BPAD), anxiety disorder and obsessive-compulsive disorder (OCD) is higher in the three MHID services than in the forensic MHIDD service.

The FHMIDD received referrals at a greater level of overall ability, with two-thirds of the service users having mild intellectual disability to normal IQ. The prevalence of neurodevelopmental disorder such as ASD and schizophrenia is comparable between the forensic MHIDD and the three MHID services. There is a higher prevalence of depression, BPAD, anxiety disorder and OCD in the three MHID services as compared to the forensic MHIDD service.

This paper reports on the first eight years of a community‐based forensic team for people with learning disabilities. The authors give an overview of current research and government guidance regarding the prevalence, care pathway and treatment of people with learning disabilities who offend. The role and function of the community forensic team is described and an analysis of referrals to the service is given. The authors reflect on the frustrations as well as the achievements associated with providing this service.

This paper aims to determine any barriers and gaps within one community Forensic Child and Adolescent Mental Health Service (FCAMHS) provision for young people presenting with risk of harm to others or involvement with the youth justice system, from Black, Asian and Minority Ethnic (BAME) backgrounds.

This study presents a systematic review of literature into the barriers and gaps within community FCAMHS, which showed little research in the area. Because of this, referral numbers for five major cities within the Yorkshire and Humber community FCAMHS region were compared to population statistics and youth justice caution and sentencing data.

Comparison suggests that BAME young people are under-represented across referrals to community FCAMHS. Also, there were differences in the representation of BAME young people when compared to youth justice data across the five major cities.

The lack of literature, combined with disparities in proportional representation of BAME young people within the Yorkshire and Humber FCAMHS, shows the need for a detailed study and analysis within national community FCAMHS.

More needs to be done within community FCAMHS to ensure that services are meeting the needs of young people at risk of criminalisation.

To the best of the author’s knowledge, there is currently no published literature that explores ethnic representation and access to community-based FCAMH services. Exploration within one regional service suggests that young people from BAME backgrounds may be under-represented within such services, whilst at the same time being over-represented within formal criminal justice.

This survey describes the socio‐demographic, clinical and forensic variables of all patients referred to a medium secure unit in the psychiatry of learning disability. Of the sample, 67.5% were referred following an index offence and 76.6% had at least one previous conviction. Just over half (50.6%) came from either prisons, special hospitals or medium secure units and the remainder from mental health/learning disability hospitals or community resources. The majority (91.7%) had prior contact with a mental health or learning disability team. Most (81.5%) had a mild or ‘borderline’ learning disability, 46.8% had either a psychosis or major mood disorder, 58.4% had personality disorders and 56.6% had a history of illicit substance abuse. Of the 79 referrals 29.1% were accepted for admission. Arson as an index offence and a previous conviction for arson were significantly associated with being accepted for admission.

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.

Traditionally, services for people with learning disabilities (LD) and forensic needs are underdeveloped. This paper aims to describe the setting up of a tiered model of LD forensic service provision in Leicester, Leicestershire and Rutland, facilitated and driven by a core team of professionals who have the skills and expertise in this area.

With no dedicated funding, this team is virtual in nature and provides support for the community and in‐patient teams in the assessment and management of offenders with LD. A care pathway including a process map is included to represent a visual idea of the referral, assessment, intervention and disposal strategies across the four tiers of service delivery. The service has a unique partnership arrangement with the independent sector that allows for staff training in order to deliver quality outcomes. The virtual team can support patients with learning disabilities and forensic needs in the community and in‐patient settings, both by avoiding unnecessary in‐patient admissions and by improving the treatment outcomes of those discharged from in‐patient settings.

Further research is required to demonstrate the clinical and social outcomes for offenders with LD using the tiered model of care and care‐pathway.

The virtual team and the LD forensic care pathway were developed because of a gap in service that was identified as part of a mapping exercise and stakeholder discussion. In the current economic climate, additional resources to address this gap in service may not be readily available; therefore, an innovative way of addressing this gap in service was by developing a care pathway for use by community LD teams based on lean principles and evidence‐based medicine and the pooling of specialist skills to develop the virtual team to enable and support the implementation of the care pathway.

This study was carried out as part of a larger study commissioned by the UK Department of Health to investigate the service pathways for offenders with learning disabilities (LD). The study covered three health regions in the UK and included 477 people with LD referred to services because of antisocial or offending behaviour during a 12‐month period. Data were collected concerning demographic, individual, offending behaviour and service characteristics. The findings of the study are broadly consistent with contemporary research concerning this population, particularly in relation to the nature and frequency of offending, history of offending, psychopathology, age and gender distribution. However, very few of those referred had any form of structured care plan, despite having significant offending histories, and this may have compromised early identification of their needs and communication between the health, social and other services involved.