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Article
Publication date: 14 December 2015

Kenneth MacMahon and Ricky McClements

There is a general consensus that healthcare for people with intellectual disabilities should be provided by multi-disciplinary teams. Within a forensic setting…

Abstract

Purpose

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.

Design/methodology/approach

Literature review, description of service outline with case example.

Findings

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.

Originality/value

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.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 6 no. 3/4
Type: Research Article
ISSN: 2050-8824

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Article
Publication date: 16 August 2011

Simon Gibbon and Colin Doyle

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

Abstract

Purpose

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

Design/methodology/approach

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.

Findings

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.

Originality/value

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

Details

The British Journal of Forensic Practice, vol. 13 no. 3
Type: Research Article
ISSN: 1463-6646

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Article
Publication date: 4 October 2019

Anna Leonie Wark

Legislative guidance stipulates that people with a learning disability have the right to receive local provision of personalised support within the least restrictive…

Abstract

Purpose

Legislative guidance stipulates that people with a learning disability have the right to receive local provision of personalised support within the least restrictive environment. On these bases there is a growing emphasis on the requirement for local authorities to develop appropriate services for people who are currently in a hospital setting. The purpose of this paper is to examine the literature addressing factors influencing the provision of effective community-based forensic services.

Design/methodology/approach

The six articles were analysed separately using the evaluation tool – Currency, Relevance, Authority, Accuracy, Purpose. The six articles used divergent sample groups and employed both qualitative and quantitative methods to collate data. The articles shared a purpose of examining forensic community service provision with an aim to improve services.

Findings

There were three themes that emerged consistently across the literature these included: balancing risk management vs individual autonomy; multi-disciplinary and multi-agency working; service improvement. There is a growing emphasis on the need to replace long-term hospital placements with specialist, community provision, employing least restrictive methods and positive responses to crisis situations. In this climate, it is crucial that multi-disciplinary agencies from local authority, health and the charitable and private sector continue to work collaboratively on the integration of service provision in order to bring about the development of effective and responsive community services.

Research limitations/implications

Research limited to peer reviewed and published research papers focusing on the subject of community forensic services with publications specifically made within the time frame of the Transforming Care Agenda.

Practical implications

This paper looks to examine the practical solutions to providing effective community forensic services for a person with an intellectual disability and makes recommendations for research into improving service specific training for support staff.

Social implications

Following the Winterbourne View Hospital scandal (BBC One, 2011) instigations were made to make legislative change under the Transforming Care Agenda. Despite a renewed conviction in the rights of people to be a part of their local community without segregation or discrimination, professionals in the field continue to report a failure to reduce numbers of people in long stay hospitals and secure settings. With commissioning under pressure to make these intentions a reality it is a really good time to reflect on practice and evaluate service models to establish the factors that bring about positive outcomes for individuals enabling inclusion within community settings.

Originality/value

This review will focus on the literature evidencing positive intervention and outcome focussed methods of supporting people with a forensic history in the community. This is an entirely original piece of work analysing peer reviewed and published research.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 10 no. 3
Type: Research Article
ISSN: 2050-8824

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Article
Publication date: 22 March 2010

Shamim Dinani, Wendy Goodman, Charlotte Swift and Teresa Treasure

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…

Abstract

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.

Details

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

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Article
Publication date: 23 March 2012

David Palmer, John Nixon, Simone Reynolds, Anastasia Panayiotou, Antje Palmer and Ruth Meyerowitz

This paper aims to discuss an audit evaluation of a specialist independent mental health advocacy service based in the London Borough of Bexley.

Abstract

Purpose

This paper aims to discuss an audit evaluation of a specialist independent mental health advocacy service based in the London Borough of Bexley.

Design/methodology/approach

The audit included qualitative interviews with ten service users, resident in two specialist forensic mental health and challenging behaviour units. All participants were long‐term in‐patient residents. A number of ethical issues required consideration, in particular respondent confidentiality and informed consent.

Findings

Findings indicate that the service's approach, which combines formal advocacy methods with a proactive ethos, had a positive impact on engagement. The importance of trust in the relationships between advocates and service users was also highlighted by the study and is discussed here. The audit also indicates a significant increase in self‐reported wellbeing, self‐efficacy and empowerment for participants. Given that enhancing personal empowerment is one of the primary objectives of the advocacy service, the positive wellbeing outcomes reported are encouraging.

Research limitations/implications

The paper relies on a small number of individuals. There is no attempt to claim representativeness or endeavour to generalise from the findings.

Originality/value

It is recommended that, in the absence of a comprehensive national evidence base, the advocacy needs of patients in forensic and specialist settings be constantly reviewed. Additionally, further action research, to inform educational material and guides for advocacy in specialist settings, may be beneficial and timely.

Details

Mental Health Review Journal, vol. 17 no. 1
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 12 March 2018

Leah Wooster, Jane McCarthy and Eddie Chaplin

National policy in England is now directed towards keeping patients with intellectual disability (ID) presenting with forensic problems for time-limited treatment. The…

Abstract

Purpose

National policy in England is now directed towards keeping patients with intellectual disability (ID) presenting with forensic problems for time-limited treatment. The result is that secure hospital services are expected to work much more proactively to discharge patients to community-based services. However, there is little evidence in recent years on the outcome of discharged patients with ID from secure hospitals. The purpose of this paper is to describe the outcomes of a patient group discharged from a specialist forensic ID service in London, England.

Design/methodology/approach

This is a descriptive retrospective case note study of patients with ID admitted to and discharged from a secure service with both low and medium secure wards, over a six-year period from 2009 to 2016. The study examined patient demographic, clinical and outcome variables, including length of stay, pharmacological treatment on admission and discharge, offending history and readmissions to hospital and reoffending following discharge.

Findings

The study identified 40 male patients, 29 of which were admitted to the medium secure ward. In all, 27 patients (67.5 per cent) were discharged into the community with 14 patients having sole support from the community ID services and 4 from the community forensic services. In total, 20 per cent of patients were readmitted within the study period and 22.2 per cent of patients received further convictions via the Criminal Justice System following discharge.

Originality/value

This was a complex group of patients with ID discharged into the community with a number at risk of requiring readmission and of reoffending. Community-based services providing for offenders with ID must have sufficient expertise and resourcing to manage the needs of such a patient group including the ongoing management of risks. The national drive is significantly to reduce the availability of specialist inpatient services for this group of patients but this must occur alongside an increase in both resources and expertise within community services.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 9 no. 1
Type: Research Article
ISSN: 2050-8824

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Article
Publication date: 8 December 2010

Ian Hall, Evan Yacoub and Babur Yusufi

Secure inpatient services for people with intellectual disability are provided in a piecemeal way, often without strategic commissioning. We describe how we conducted a…

Abstract

Secure inpatient services for people with intellectual disability are provided in a piecemeal way, often without strategic commissioning. We describe how we conducted a needs assessment that enabled us to develop a new service for men with intellectual disability who often had substantial additional mental health needs. Consulting with all stakeholders was essential, and we found the service user and family perspectives particularly helpful. We had to make special arguments for some aspects of the treatment programme. We found that foundation trusts that are able to develop services at financial risk, before contracts are signed, enabled development to take place at a faster pace. Good relationships with community teams have been essential, as has true integration with mainstream forensic services. Maintaining a relationship with commissioners was a particularly challenging aspect, perhaps because the development was provider‐led. Despite these challenges, many people with intellectual disability with very high needs are being supported much nearer to home.

Details

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

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Article
Publication date: 1 March 2008

Clare McLeod, Graeme Yorston and Robert Gibb

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…

Abstract

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.

Details

The British Journal of Forensic Practice, vol. 10 no. 1
Type: Research Article
ISSN: 1463-6646

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Article
Publication date: 14 December 2015

Jana de Villiers and Michael Doyle

Nationally community services for patients with intellectual disability and forensic needs are limited, and research to guide service development for this patient group…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Originality/value

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.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 6 no. 3/4
Type: Research Article
ISSN: 2050-8824

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Article
Publication date: 8 January 2021

Deborah J. Morris, Elanor L. Webb, Inga Stewart, Jordan Galsworthy and Paul Wallang

A co-produced clinical practice that aims to improve outcomes through a partnership with service users is becoming increasingly important in intellectual disability (ID…

Abstract

Purpose

A co-produced clinical practice that aims to improve outcomes through a partnership with service users is becoming increasingly important in intellectual disability (ID) services, yet these approaches are under-evaluated in forensic settings. This study aims to explore and compare the feasibility of two approaches to co-production in the completion of dynamic risk assessments and management plans in a secure setting.

Design/methodology/approach

A convenience sample of adults admitted to a secure specialist forensic ID service (N = 54) completed the short dynamic risk scale (SDRS) and drafted risk management plans under one of two conditions. In the first condition, participants rated the SDRS and risk management plan first, separately from the multidisciplinary team (MDT). In the second condition, participants and MDTs rated the SDRS and risk management plan together.

Findings

In total, 35 (65%) participants rated their risk assessments and 25 (47%) completed their risk management plans. Participants who rated their risk assessments separately from the MDT were significantly more likely to complete the SDRS (p = 0.025) and draft their risk management plans (p = 0.003). When rated separately, MDT scorers recorded significantly higher total SDRS scores compared to participants (p = 0.009). A series of Mann-Whitney U tests revealed significant differences between MDT and participant ratings on questions that required greater skills in abstraction and social reasoning, as well as sexual behaviour and self-harm.

Originality/value

Detained participants with an ID will engage in their dynamic risk assessment and management plan processes. The study demonstrates the impact of different co-production methodologies on engagement and highlights areas for future research pertaining to co-production.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 12 no. 1
Type: Research Article
ISSN: 2050-8824

Keywords

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