“Why can’t they be in the community?” A policy and practice analysis of transforming care for offenders with intellectual disability
| DOI | https://doi.org/10.1108/AMHID-02-2015-0011 |
| Pages | 139-148 |
| Date | 05 May 2015 |
| Published date | 05 May 2015 |
| Author | Regi Alexander,John Devapriam,Dasari Michael,Jane McCarthy,Verity Chester,Rahul Rai,Aezad Naseem,Ashok Roy |
| Subject Matter | Health & social care,Learning & intellectual disabilities |
“Why can’t they be in the community?”
A policy and practice analysis of
transforming care for offenders
with intellectual disability
Regi Alexander, John Devapriam, Dasari Michael, Jane McCarthy, Verity Chester, Rahul Rai,
Aezad Naseem and Ashok Roy
The authors affiliations can be
found at the end of this article.
Abstract
Purpose –The purpose of this paper is to describe key policy and practice issues regarding a significant
subgroup of people with intellectual disability –those with offending behaviour being treated in forensic hospitals.
Design/methodology/approach –The reasons why psychiatrists continue to be involved in the treatment
of people with intellectual disability and mental health or behavioural problems and the factors that may
lead to patients needing hospital admission are examined. Using two illustrative examples, three key
questions –containment vs treatment, hospital care vs conditional discharge and hospital treatment vs using
deprivation of liberty safeguards usage in the community are explored.
Findings –Patients with intellectual disability, mental health problems and offending behaviours who are
treated within forensic inpatient units tend to have long lengths of stay. The key variable that mediates this
length of stay is the risk that they pose to themselves or others. Clinicians work within the framework of mental
health law and have to be mindful that pragmatic solutions to hasten discharge into the community may not
fall within the law.
Originality/value –This paper makes practical suggestions for the future on how to best integrate hospital
and community care for people with intellectual disability, mental health and offending behaviours.
Keywords Secure, Learning disability, Intellectual disability, Forensic, Inpatient, Psychiatric
Paper type Viewpoint
Introduction
Following the broadcast of BBC’s Panorama programme “Undercover care: the abuse exposed”
in May 2011 (BBC One, 2011), specialist intellectual disability hospitals came under scrutiny.
Describing such treatment as an outdated model of institutional care, the government published
The Concordat to work with other stakeholders and meet 63 transforming care commitments,
with one central commitment of moving into the community, anyone with an intellectual disability
and challenging behaviour that does not need to be in a hospital setting (Department of Health,
2012a, b). The dramatic reduction in hospital placements that was expected did not happen
(Health and Social Care Information Centre, 2013). It is now acknowledged that the complexity
and scale of the challenge was underestimated and the scope and quality of data on inpatients
with intellectual disability was poor (National Audit Office, 2015).
This paper focuses on the policy and practice issues regarding a significant subgroup of people
with intellectual disability –those with offending behaviour being treated in forensic hospitals.
Received 26 February 2015
Revised 17 March 2015
Accepted 24 March 2015
DOI 10.1108/AMHID-02-2015-0011 VOL. 9 NO. 3 2015, pp.139-148, © Emerald Group Publishing Limited, ISSN 2044-1282
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ADVANCESIN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
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PAGE139
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