Outcomes of an inner city forensic intellectual disability service
| DOI | https://doi.org/10.1108/JIDOB-08-2017-0016 |
| Date | 12 March 2018 |
| Published date | 12 March 2018 |
| Pages | 1-8 |
| Author | Leah Wooster,Jane McCarthy,Eddie Chaplin |
| Subject Matter | Health & social care,Learning & intellectual disabilities,Offending behaviour,Sociology,Sociology of crime & law,Deviant behaviour,Education,Special education/gifted education,Emotional/behavioural disorders |
Outcomes of an inner city forensic
intellectual disability service
Leah Wooster, Jane McCarthy and Eddie Chaplin
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.
Keywords Intellectual disability, Reoffending, Forensic services, Community intellectual disability teams,
Reconvictions, Transforming care
Paper type Research paper
Introduction
The availability of forensic services for people with intellectual disabilities (ID) varies across the
UK in terms of patient group and levels of security (Chaplin and McCarthy, 2015).
Although there is c lear policy and guid ance to what servi ces should look like for the most
complex cases (Ministry of Justice, 2009; Mansell et al., 2010), the provision of appropriate
community-base d services for this gr oup being discharg ed from secure hospit al care is still
aspirational in ma ny areas of the UK. The t ransforming care age nda has put a focus on the
reduction of inpat ient services, including secure se rvices for people with ID following ab use of
patients at Winte rbourne View (Devapriam et al., 201 5). Due to the lack of local communi ty and
specialist servic e provision for those most vulner able including offenders with ID , many people
with ID are placed out of area so away from their local supportnetworks (Chaplin et al., 2010).
Many of the arguments put forward for not dev eloping services lo cally such as communi ty
forensic service s where there is clinical need is financ ial; given secure services operat e as high
cost, low volume services, which consume around a fifth of the NHS mental health budget
(Fazel et al., 2016).
Received 7 August 2017
Revised 25 October 2017
Accepted 26 October 2017
The authors would like to
acknowledge the support of Paul
Gilluley at East London Foundation
Trust for his help and support.
Leah Wooster is a Consultant
Forensic Psychiatrist at the
Nottinghamshire Healthcare
NHS Trust, Nottingham, UK.
Jane McCarthy is based at East
London NHS FT, London, UK.
Eddie Chaplin is a Senior
Lecturer at the London South
Bank University, London, UK.
DOI 10.1108/JIDOB-08-2017-0016 VOL. 9 NO.1 2018, pp. 1-8, © Emerald Publishing Limited, ISSN 2050-8824
j
JOURNAL OF INTELLECTUAL DISABILITIES AND OFFENDING BEHAVIOUR
j
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