Trauma and adversity in forensic patients with an intellectual disability: a review of risk assessment reports
| Date | 06 September 2024 |
| Pages | 17-30 |
| DOI | https://doi.org/10.1108/JIDOB-08-2023-0007 |
| Published date | 06 September 2024 |
| Author | Adrian Ierna,Heather Tolland,Abi McGinley,Laura Mathieson |
Trauma and adversity in forensic patients
with an intellectual disability: a reviewof
risk assessment reports
Adrian Ierna, Heather Tolland, Abi McGinley and Laura Mathieson
Abstract
Purpose –People withintellectual disabilities are at a significantlyhigher risk than the generalpopulation
for experiencinga wide range of adverse and potentially traumaticevents. This paper aims to explore the
incidence of experiences of lifetime trauma across this populationin one Forensic Intellectual Disability
Service. Risk management recommendations and psychological risk formulations were also examined
for their considerationof traumatic experiences.
Design/methodology/approach –Risk assessment reports (n¼39) were reviewed for evidence of
traumatic experiencesand the consideration of trauma in patient risk formulationsand risk management
treatmentrecommendations.
Findings –Trauma was ratedas present or partially present in 84.6% (n¼33) of risk assessmentreports
reviewed. None of the patients had received a post-traumatic stress disorder (PTSD) diagnosis.
Recommendations regarding trauma were identified in 39.4% (n¼13) of the risk assessment reports
where traumawas rated either ‘‘present’’ or ‘‘partially present’’.
Practical implications –Findings suggest a need for diagnostic tools to be used to measure trauma
symptoms and potentialcases of PTSD to best support needs of patients. Trauma-focusedinterventions
should also be considered. Further investigation is needed to clarify the disparity between the
considerationof trauma in formulations and treatmentrecommendations.
Originality/value –This studyhighlights the different traumaticexperiences that forensic patientsacross
three settingshave been exposed to during their lifetimes.
Keywords Trauma, Risk formulation, Forensic, Adverse childhood experiences, Intellectual disability,
Risk assessment
Paper type Research paper
Lay summary
䊏The majority of patients in one Forensic Intellectual Disability service have been
exposed to traumatic experiences.
䊏The majority of these patients did not have treatment recommendations (within their risk
assessment report) that were related to trauma.
䊏This highlights the high levels of trauma experienced by this population and the need
for the development of trauma-informed care and treatment approaches in forensic
intellectual disabilities populations.
Introduction
The experience of lifetime trauma and adversity is common and can have a significant
impact upon individual health,social and economic outcomes (Kessler et al.,2017;
Adrian Ierna and Heather
Tolland are both based at
the Directorate of Forensic
Mental Health and Learning
Disabilities, NHS Greater
Glasgow and Clyde,
Glasgow, UK.
Abi McGinley is based at
the Psychological
Therapies Service, HMP
Shotts, NHS Lanarkshire,
Shotts, UK.
Laura Mathieson is based
at the Directorate of
Forensic Mental Health and
Learning Disabilities, NHS
Greater Glasgow and
Clyde, Glasgow, UK.
Received 22 August 2023
Revised 9 May 2024
Accepted 22 May 2024
The authors would also like to
thank Dr Hannah Lyall for her
assistance with data analysis.
Funding statement: This
research received no specific
grant from any funding agency,
commercial or not-for-profit
sectors.
Declaration of interest: None.
DOI 10.1108/JIDOB-08-2023-0007 VOL. 15NO. 3/4 2024, pp . 17-30, ©Emerald Publishing Limited, ISSN 2050-8824 jJOURNAL OF INTELLECTUAL DISABILITIES AND OFFENDING BEHAVIOUR jPAGE 17
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