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Article
Publication date: 4 March 2014

Ian Hall, Evan Yacoub, Neil Boast, Robert Bates, Rebekah Stamps, Sarah Holder and Matthew Beadman

The purpose of this paper is to complete a thorough needs assessment that would enable the development of a robust pathway of care for adults with a learning disability

Abstract

Purpose

The purpose of this paper is to complete a thorough needs assessment that would enable the development of a robust pathway of care for adults with a learning disability requiring secure care, and to assist commissioners to make informed planning decisions.

Design/methodology/approach

The paper identified people with a learning disability originating from London who were in secure care, and collected data about them. The paper used reference groups to inform the analysis.

Findings

The paper identified 249 people in secure services and was able to include 136 patients in the analysis. In all, 64 were in NHS provision and 72 in independent sector provision; 109 (80.1 per cent) were male and 27 (19.9 per cent) female; on average, patients were cared for 61.5 miles away from their homes; NHS patients were far closer to home; 69.1 per cent had a mild learning disability; 82.3 per cent had a history of violence; approximately one in six patients could not progress due to a lack of an appropriate ward, facility, resource and/or intervention.

Practical implications

Secure care for this population is a major public health issue. Many are placed a long way from home. Local services should be developed, and there should be sufficiently robust “step down” places for patients to be discharged to.

Originality/value

Systematic identification of the needs of a marginalised group to enable better more appropriate care pathways to be developed in the future.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 5 no. 1
Type: Research Article
ISSN: 2050-8824

Keywords

Article
Publication date: 22 March 2010

Mick Burns, Wendy Silberman and Ged McCann

This article describes a process undertaken to develop a set of commissioning principles to support the commissioning of secure learning disability services across…

Abstract

This article describes a process undertaken to develop a set of commissioning principles to support the commissioning of secure learning disability services across England. The principles, shaped around the 11 competencies laid down in the World Class Commissioning competencies framework (Department of Health, 2008a), were produced following a scoping exercise that looked at provision and commissioning of secure learning disability services within each strategic health authority (SHA) area in England. Specific details were collected about types of services provided, including detailed service specification, quality indicators, how these (specialist) services link with local services (secure and non secure) and cost of services. Information collected about commissioning concentrated on strategic vision, practical commissioning arrangements, how the quality of services was monitored, how access to services was controlled and how ‘secureservice users are reintegrated back into local (non secure) services and communities. This scoping exercise was augmented by qualitative data obtained from interview with a group of former service users. Themes generated through the interviews were integrated within the general guidance. A quality assurance framework based on the World Class Commissioning Competencies is proposed, against which specialist and local commissioners can benchmark their current commissioning arrangements.

Details

Journal of Learning Disabilities and Offending Behaviour, vol. 1 no. 1
Type: Research Article
ISSN: 2042-0927

Keywords

Article
Publication date: 4 March 2014

Laura Willets, Paul Mooney and Nicholas Blagden

The social climate of psychiatric institutions correlates with multiple outcomes related to staff and patients. Research into social climate in Learning Disability services

Abstract

Purpose

The social climate of psychiatric institutions correlates with multiple outcomes related to staff and patients. Research into social climate in Learning Disability services is limited. Staff and patients in Learning Disability services have documented both positive and negative experiences. No research has directly compared the social climate of Learning Disability and non-Learning Disability psychiatric services. The purpose of this paper is to understand how these compare. The study will also compare staff and patient views of social climate and the impact of security on social climate in Learning Disability services.

Design/methodology/approach

A total of 64 patients and 73 staff, from Learning Disability and non-Learning Disability psychiatric hospitals completed the Essen Climate Evaluation Schema (EssenCES) measure of social climate.

Findings

Patients in Learning Disability and non-Learning Disability services did not differ in their perceptions of social climate. Staff in non-Learning Disability services had a more positive perception of social climate than staff in Learning Disability services. Patients and staff did not differ in their views on climate. Security was negatively related to patients’ Experienced Safety.

Originality/value

The findings suggest that staff perceive that the deficits associated with Learning Disabilities may limit patients’ therapeutic experience and relationships with their peers. Despite this, patients with Learning Disabilities feel supported by their peers, have positive views of the treatment process and feel as safe as non-Learning Disabled psychiatric patients.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 5 no. 1
Type: Research Article
ISSN: 2050-8824

Keywords

Article
Publication date: 2 August 2013

Rebecca Fish

This paper aims to review research of relevance to women with learning disabilities, focusing in particular on literature which is applicable to women with learning

Abstract

Purpose

This paper aims to review research of relevance to women with learning disabilities, focusing in particular on literature which is applicable to women with learning disabilities who use forensic services.

Design/methodology/approach

Research involving women with learning disabilities over the past 30 years was sought out and reviewed, and literature relating to women living in locked wards (including those without learning disabilities) was focused upon. Related themes such as the BPD diagnosis, self injury, and aggression are explored.

Findings

The author found very little research relating to women with learning disabilities who use secure services, particularly which included quotes from the women themselves.

Research limitations/implications

The author recommends that more research in this area is needed, primarily research which includes the voices of women service users themselves.

Originality/value

This paper will be relevant to all staff who work with women in secure services.

Details

The Journal of Forensic Practice, vol. 15 no. 3
Type: Research Article
ISSN: 2050-8794

Keywords

Article
Publication date: 1 December 2004

Elizabeth Berber and Harm Boer

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…

Abstract

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

Details

The British Journal of Forensic Practice, vol. 6 no. 4
Type: Research Article
ISSN: 1463-6646

Article
Publication date: 24 January 2011

Catrin Morrissey and Bridget Ingamells

Dialectical behaviour therapy (DBT) (Linehan, 1993) is a comprehensive psychological treatment that was first developed for suicidal individuals with a diagnosis of…

Abstract

Dialectical behaviour therapy (DBT) (Linehan, 1993) is a comprehensive psychological treatment that was first developed for suicidal individuals with a diagnosis of borderline personality disorder. The model has successfully been used to address violence and aggression in a forensic setting (Evershed et al, 2003). The National High Secure Learning Disability Service (NHSLDS) piloted an adapted DBT programme suitable for men with mild learning/intellectual disabilities in 2004, and the programme has been developed over a period of six years. This paper describes the rationale for development of the programme, how the programme has evolved, the major modifications to mainstream DBT that it incorporates, and the challenges that remain.

Details

Journal of Learning Disabilities and Offending Behaviour, vol. 2 no. 1
Type: Research Article
ISSN: 2042-0927

Keywords

Article
Publication date: 5 May 2015

Catrin Morrissey, Ben Hobson, Emma Faulkner and Tamsin James

The “outcomes revolution” in healthcare has yet to impact strongly on secure intellectual disability (ID) services in the UK. The purpose of this paper is to review the…

Abstract

Purpose

The “outcomes revolution” in healthcare has yet to impact strongly on secure intellectual disability (ID) services in the UK. The purpose of this paper is to review the service-level outcome studies that exist for this population, and to explore some of the challenges of conducting such research. It further describes some illustrative routine outcome data from the National High Secure Learning Disability Service.

Design/methodology/approach

Routinely collected outcome measures (length of stay; violent incidents; Emotional Problem Scale (EPS) Behaviour Rating Scale and EPS Self-Report Inventory) were analysed for two overlapping cohorts of patients resident in the high-secure service between 2008 and 2013.

Findings

The median length of stay of those discharged during the study period (n=27) was around 9.9 years (range one to 40 years). A significant proportion (25 per cent) of discharges resulted in an eventual return to high security. There did not appear to be a treatment effect over two to three years using staff-rated global clinical measures, but patient-rated clinical measures did reduce. Violent incidents also reduced significantly over a longer period of four years in treatment.

Research limitations/implications

There are identified challenges to research design and outcome measurement which need to be addressed in any future cross-service studies.

Originality/value

There are relatively few published outcome studies from forensic ID services. None of the studies have used clinical measures of changes or patient-rated outcome measures.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 9 no. 3
Type: Research Article
ISSN: 2044-1282

Keywords

Article
Publication date: 8 June 2012

Fola Esan, Melanie Pittaway, Beatrice Nyamande and Alex Graham

This paper aims to describe the experience of a secure learning disability service in participating in the national Shared Pathway pilot project in secure services.

Abstract

Purpose

This paper aims to describe the experience of a secure learning disability service in participating in the national Shared Pathway pilot project in secure services.

Design/methodology/approach

Some background drivers to the project are explored as well as the experience of service users and staff who were involved in the pilot project. Recommendations on service‐wide implementation of the Shared Pathway are made.

Findings

The Shared Pathway will lead to considerable changes in practice. This will also have resource implications.

Originality/value

The paper shows that the Shared Pathway may be useful in ensuring evidence based outcomes are routinely used by clinicians in secure services in collaboration with patients. It may also clarify to patients what their role is in engaging in treatment that helps them in moving through secure services.

Details

Journal of Learning Disabilities and Offending Behaviour, vol. 3 no. 2
Type: Research Article
ISSN: 2042-0927

Keywords

Article
Publication date: 27 September 2010

Irene Brackenridge and Catrin Morrissey

Literature on trauma and post‐traumatic stress disorder (PTSD) has neglected the needs of people with intellectual disability, particularly those in forensic settings. The…

Abstract

Literature on trauma and post‐traumatic stress disorder (PTSD) has neglected the needs of people with intellectual disability, particularly those in forensic settings. The National Centre for High Secure Learning Disability Services at Rampton Hospital conducted a service evaluation on aspects of trauma experience and post‐trauma symptoms in the current population. File information and self‐reports indicated that most individuals had experienced a great deal of lifetime trauma, typically multiple types of abuse. A high rate of potentially trauma‐related symptoms was noted in files. However, file records of potentially traumatic events, including abuse, were often lacking in detail. There was limited information about the events themselves, and there was no information to suggest that any trauma‐specific assessments had been used to measure trauma exposure or symptoms. PTSD as a diagnosis was rarely considered, and there was little consideration of trauma‐specific interventions. While some individuals said that their experiences had resulted in a lot of distress, others could not talk about the past at all. This paper discusses the problem of assessing past trauma and response in a forensic intellectual disability population, and future directions for practice in forensic services. The service under study plans to address the needs of patients who have experienced trauma and abuse by conducting routine structured assessments, offering adapted evidence‐based psychological interventions where appropriate, and providing trauma‐specific education for staff to promote a compassionate approach.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 4 no. 3
Type: Research Article
ISSN: 2044-1282

Keywords

Article
Publication date: 21 June 2010

Claire Lewis and Catrin Morrissey

The study explored the relationship between self and informant reports of emotional problems in a forensic intellectual disability sample. The Emotional Problems Scales…

Abstract

The study explored the relationship between self and informant reports of emotional problems in a forensic intellectual disability sample. The Emotional Problems Scales (EPS) (Prout & Strohmer, 1991), which comprises a Self Report Inventory (EPS‐SRI) and an informant Behaviour Rating Scale (EPS‐BRS), was routinely administered to 30 individuals with intellectual disability in a secure forensic setting, as part of a standard clinical assessment procedure. It was hypothesised that there would be a moderate relationship between corresponding scores on the EPS‐SRI and EPS‐BRS. However, there were no significant relationships between corresponding scales of the EPS‐SRI and EPS‐BRS, apart from the EPS‐SRI and EPS‐BRS scales measuring anxiety (r = .376, p<.05). The results continued to be non‐significant, even when positive impression management was controlled for. The findings suggest little relationship between self and informant ratings in a forensic intellectual disability sample, and therefore support the need to gather information from multiple sources when assessing such individuals.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 4 no. 2
Type: Research Article
ISSN: 2044-1282

Keywords

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