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A region’s transforming care partnership identified that autistic adults without an intellectual disability (ID) may be falling through gaps in services when presenting with a significant emotional and/or behavioural need in the absence of a mental health diagnosis. The region’s intensive support teams (ISTs) for adults with ID therefore piloted a short-term “behavioural support service” for this population. The purpose of this paper is to evaluate this pilot.

This study represents a mixed-methods service evaluation over a four year pilot period. The quantitative component examined referral rates and demographic data of accepted and declined referrals; and length of referral episodes and Health of The Nation Outcomes Scores (HoNOS) for accepted referrals. The qualitative component used thematic analysis to identify key themes relating to reasons for referral, clinical/therapeutic needs, and the models of support that most informed assessments and interventions at individual and systems levels.

The ISTs accepted 30 referrals and declined 53. Most accepted referrals were male (83%), and under 24 years old (57%). Average HoNOS scores were above the thresholds generally associated with hospital admission. Key qualitative themes were: transitional support; sexual risks/vulnerabilities; physical aggression; domestic violence; and attachment, trauma and personality difficulties. Support mostly followed psychotherapeutic modalities couched in trauma, attachment and second- and third-wave cognitive behavioural therapies. Positive Behaviour Support (PBS) did not emerge as a model of preference for service users or professionals.

This project represents one of the first of this type for autistic adults without an ID in the UK. It provides recommendations for future service development and research, with implications for Transforming Care policy and guidance.

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.

In recent years there has been growing interest in the fate of those women with mental disorder who come into contact with the criminal justice system. This interest has stemmed from growing recognition that traditional forensic services could not offer the appropriate care required by this group in a conventional mixed‐gender environment. Women‐only services have begun to be developed in generic psychiatric settings, spurred on by the national service framework (NSF) which set a time limit for the development of segregated in‐patient facilities. Forensic services for those with learning disability have been slower to take up the challenge of how best to place women with learning disability who offend and require an in‐patient secure environment. This article describes how one such service attempted to rise to this challenge and build a service for this often neglected group

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.

Several studies have related diagnostic information and adversity in childhood to criminal careers and risk of recidivism. Notably, ADHD and conduct disorder in childhood, schizophrenia, sexual abuse and physical abuse have been associated with offences in adulthood. This study investigates these variables in relation to large cohorts of offenders with learning disabilities. A case note review was undertaken for 126 individuals referred but not accepted into forensic learning disability services and 197 individuals accepted for such services. Results are reported on diagnostic information and experience of adversity in childhood. ADHD/conduct disorder featured prominently in both groups. Autistic spectrum disorders were not particularly over‐represented. For adversity in childhood, general socioeconomic deprivation featured prominently in both groups. This also increased significantly for those accepted into services. Sexual abuse and non‐accidental injury were featured at around 13‐20% for both groups. These results are broadly consistent with the mainstream literature on offending, ADHD/conduct disorder and general deprivation featuring significantly in all groups and rising for those accepted into offender services. It is important to deal with these aspects during assessment and to provide appropriate psychotherapeutic services for these individuals.

With permission, this paper is an edited and abridged version of an article written by Richards, Doyle and Cook for The British Journal of Forensic Practice (Richards et al, 2009), detailing their literature review on family interventions in dual diagnosis and with reference to forensic mental health care. There appeared to be limited direct evidence, therefore various domains were examined and extrapolated to a forensic setting as appropriate. The review indicates the potential for positive outcomes for families following family interventions in dual diagnosis, which may be beneficial in a forensic setting in lowering risk.

This paper aims to review the need for and development of specialist deaf secure mental health services.

The paper is a review article; it begins by giving a brief overview of deafness and the relationship between deafness, mental health problems and offending. Following this, relevant literature and Department of Health (DoH) guidance is summarised and a description of the current UK services is given.

In 2001, Young et al. highlighted the needs of deaf mentally disordered offenders and the requirement for specialist forensic mental health services for this group. Since then several DoH guidance documents have been published that, amongst other things, highlighted the need to develop deaf forensic mental health services. There have now been substantial service developments in this area but substantial gaps remain – most notably, a lack of specialist mental health provision for deaf prisoners.

The paper offers insights into the development and future of deaf forensic mental health services.

Dual‐diagnosis strategies are developing in medium secure services in response to both government policies and clinical need and there has been a move towards integrated services for this patient group. Substance use that has been a feature of the index offence must be taken into account as much as psychosis or the offending behaviour. Treatment of dual diagnosis relies heavily on cognitive‐behavioural therapies. Relapse in either psychosis or substance use increases risk and re‐admission rates to medium security. This paper reviews the literature on family interventions in dual diagnosis and its applicability to forensic mental health inpatient services. As there appeared to be limited direct evidence, various domains were examined and extrapolated to a forensic setting as appropriate. The review indicates the potential for positive outcomes for families following family interventions in dual diagnosis, which may be beneficial in a forensic setting in lowering risk.

This article reviews the literature on personality disorder in offenders with learning disabilities, using Medline, PsychoInfo and CINAHL databases, and search terms ‘offending’, ‘personality disorder and intellectual disabilities’, ‘learning disabilities’ and related terms. Methods of defining offending population, personality disorder and learning disabilities vary greatly, and few studies focus specifically on personality disorder, learning disability and offending. The definition of learning disability often encompasses both borderline learning disability and low average intelligence. Personality disorder, especially anti‐social personality disorder, is prevalent in offenders with learning disabilities, but less than in the general population, and is associated with higher levels of security and poorer outcomes. The study concludes that there is a continuum of offenders with borderline and mild learning disabilities, reflected in learning disability forensic services.

This paper describes an innovative, multi‐modular group therapy programme based on cognitive‐behavioural principles and psycho‐education. It introduces participants to strategies and skills to assist with deficits such as poor social skills, low self‐esteem, poor emotional regulation and problematic inter‐personal relationships. The manual‐based format of this programme enables members to be introduced to working in a group, and enables facilitators to obtain qualitative information about group members to promote existing skills in future treatment programmes. The core deficit areas targeted by the programme are not by any means exclusive to individuals in in‐patient forensic learning disability settings, so the programme can be useful for clients with learning disability and offending behaviours who are resident in the community.