Discharging inpatients with intellectual disability from secure to community services: risk assessment and management considerations
| Pages | 98-109 |
| DOI | https://doi.org/10.1108/AMHID-01-2017-0003 |
| Published date | 02 May 2017 |
| Date | 02 May 2017 |
| Author | Verity Chester,Anthony Scott Brown,John Devapriam,Sharon Axby,Claire Hargreaves,Rohit Shankar |
| Subject Matter | Health & social care,Learning & intellectual disabilities |
Discharging inpatients with intellectual
disability from secure to community
services: risk assessment and
management considerations
Verity Chester, Anthony Scott Brown, John Devapriam, Sharon Axby, Claire Hargreaves and
Rohit Shankar
Abstract
Purpose –There is increasing emphasis on caring for people with intellectual disabilities in the least
restrictive, ideally community settings. Therefore, the purpose of this paper is to explore the risk factors
considered by clinicians involved in discharging people from secure services.
Design/methodology/approach –The views of five senior clinicians were sought in semi structured
interviews. Data were analysed thematically.
Findings –Themes related to risk assessment, risk management, and multidisciplinary and multiagency
working. Illustrative quotes are used to evidence themes.
Practical implications –This study described the risk assessment and management factors considered
during the discharge of patients from secure to community services, which are of direct relevance to multiple
stakeholders post-Winterbourne.
Originality/value –Challenges when facilitating discharge were highlighted, such as ongoing risk
management issues, or unexpected discharge from tribunals, and how these were addressed, via the
development of extensive risk assessment and management processes, and interdisciplinary and
interagency working.
Keywords Forensic, Learning disability, Forensic mental health, Forensic psychiatry,
Developmental disability, Secure
Paper type Research paper
Introduction
Accurately predicting and managing risk is a central aim of forensic (and broader community,
inpatient behavioural or mental health) services for people with intellectual disa bilities.A dmissionto
such services is usually following a historyof serious, or high frequencyviolent or other dangerous
behaviour(Jobbins et al., 2007), in addition to intellectual disability and other comorbid diagnoses of
mental disorder (Alexanderet al., 2011). However, not all patients take this route, most often due to
the police, the crown prosecution service or other criminal justice agencies not taking the c ase
through the courts, or dropping proceedings because the person is already in hospital, even if under
Part II of the Department of Health (1983, amended 2007) (“civil”sections)(Alexander et al., 2015).
Furthermore, carers ofthose with intellectualdisabilities canbe less likely to involvethe police when
an offence is committed (Lyall et al., 1995; Clare and Murphy, 1998). These situations usually result
in an “upwards referral”where patients are referred to services of increasing security, without
criminal justice system involvement (Alexander et al., 2015).
Forensic services manage patients with the potential to exhibit wide ranging risk behaviours,
such as; serious assault, escape, abscond, homicide and suicide (Allen, 2010). Services and
Received 16 January 2017
Revised 25 April 2017
27 April 2017
Accepted 28 April 2017
The authors affiliations can be
found at the end of this article.
PAGE98
j
ADVANCESIN MENTAL HEALTH AND INTELLECTUALDISABILITIES
j
VOL. 11 NO. 3 2017, pp.98-109, © Emerald Publishing Limited, ISSN 2044-1282 DOI 10.1108/AMHID-01-2017-0003
To continue reading
Request your trial