Editorial

Editorial

Article Type: Editorial From: Journal of Intellectual Disabilities and Offending Behaviour, Volume 7, Issue 1.

Colin Dale

Two documents were published in the middle of December 2015 which may prove to be important milestones for the care and treatment of people with a Learning Disability in the UK. International colleagues may also consider how these issues may be reflected in their own jurisdictions.

The first document was the publication of the “Department of Health’s response to the Law Commission’s consultation on mental capacity and deprivation of liberty”. The background to this was that Committees of both Houses of Parliament had criticised the current Deprivation of Liberty Safeguards (DoLS) and called for the system to be reviewed. In addition, the Supreme Court’s judgment (in the case of Cheshire West) has led to a tenfold increase in DoLS applications and has in effect brought the system to its knees in backlogs of applications.

In light of this, the Department of Health (DOH) decided to fund the Law Commission to undertake a fundamental review of the DoLS legislation. This began in autumn 2014.

The DOH have now accelerated this project so that it completes (in the form of a draft bill and detailed policy proposals) by the end of December 2016; with a provisional report due in spring 2016. The Law Commission is currently of the firm opinion that legislative change is required.

The stated top priority for the DOH is that any scheme delivers real, tangible benefits for individuals who are eligible and for their families. They state that the scheme should be as accessible and user-friendly/family-friendly as possible. Of clear importance also to the DOH are issues of cost-effectiveness and value for money. Another key priority is ensuring that any scheme fits well within the current health and care system and can be implemented by professionals.

It has been previously argued that the problem with the current legislation is that it was designed by lawyers and it is therefore welcome that the DOH stresses the “great importance” that any revisions to the Law Commission’s proposals are developed in active discussion with the professionals that will be charged with implementing such a scheme, service users and their families. It is also welcome that the DOH are suggesting that any revised proposals will likely benefit from simulation testing with these groups.

The truth of the matter is that over ten years after this legislation was introduced it remains poorly understood by professionals and has failed to deliver the beneficial protection to individuals that it promised as a result. Let us hope that the opportunity to learn the lessons from this are not lost and the opportunity is grasped to deliver a more workable system for all involved.

The second document which was released in December 2015 was the “Independent review of deaths of people with a Learning Disability or Mental Health problem in contact with Southern Health NHS Foundation Trust April 2011 to March 2015”. This was a review of all deaths of people in receipt of care from Mental Health and Learning Disability services in the Southern Health NHS Foundation Trust between April 2011 and March 2015. This review discovered that whilst within Adult Mental Health services, 60 per cent (237 out of 394) of all unexpected deaths were investigated in Learning Disability only 4 per cent (4 out of 93) were subjected to an investigation.

The document rightly points out that there is only national non-statutory guidance in place for serious incident reporting which allows Trusts to exercise considerable discretion over what they choose to investigate. In the case of Southern Health NHS Foundation Trust the review found that “there was no effective systematic management and oversight in reporting deaths and the investigations that follow”.

Also there was a limited amount of corporate oversight at all stages of reporting and investigating deaths. My personal experience of this is that Southern Health are not alone in these failings. There is sometimes a lack of objectivity in considering which incidents should be subject to investigation and a clear lack of independence in the process. The other problem is what is reported at a Board level; the drive for higher level reporting and aggregated information makes it difficult from Board papers to determine what is problematic (e.g. of the figures for this Trust how would the circa 60 cases per month of unexpected deaths have been reported in such a way that Board members felt able to challenge whether an investigation was required remembering that this is one item on a Board agenda and probably allocated no more than 30 minutes for consideration? The implication of this report is that manger’s were hiding bad news, saving resources on investigation, and therefore failing to learn valuable lessons to reduce the likelihood of repeating errors. However, it must also be remembered that this was not a clinical review of the cases but a statistical analysis but the figures remain as very stark. Where Southern Trust had their difficulties was their inability to demonstrate robust systems and processes to demonstrate how they arrived at their decisions; perhaps a salutary lesson for all.

In this issue

In this issue we have an innovative article from the USA describing a “Geographic Information System analysis of developmentally disabled adult offenders”. George Tsagaris, and Mamadou Seck from Cleveland State University together with Janet Keeler and Robert Rowe from the County Board of Developmental Disabilities examined the distribution of referrals for services to a Northeast Ohio county agency to three areas of the county as determined by zip (post) codes, their involvement with the criminal justice system, types of offences they committed, their indictment, and the court outcomes.

The study found that the concentrations of offenders in the core city, inner, and outer suburbs of the county were, respectively 71.7, 19.6, and 8.7 per cent. The largest racial groups included African Americans (112; 70 per cent) and Whites (33; 20.6 per cent). Male offenders (155; 96.9 per cent) outnumbered female offenders. Of the offences committed, 42.9 per cent were crimes against persons including kidnapping, abduction, and assault, followed by crimes against property (22.2 per cent), and crimes against society (26.4 per cent). As they appeared before Mental Health Court or Non Mental Health Court judges, the court outcome ranged from community control for six months to prison sentence of 120 months.

The authors suggest that the findings of this study will help enable agency professionals to look for protective as well as risk factors that are prevalent in each area of this County and make plans for more effective, preventative, and clinical service provision.

Peter Oakes from the University of Hull, Glynis Murphy University of Kent and Alison Giraud-Saunders and Nzinga Akinshegun, of the Foundation for People with Learning Disabilities describe “The Realistic Evaluation of an Adapted Thinking Skills Programme”. They explain that the outcome of a series of events including the publication of the Bradley Report (Bradley, 2009) and an individual case known as the Gill case (Rayner, 2010) identified the need to develop rehabilitation programmes that are accessible to people with intellectual disabilities.

Their article reports the evaluation of an adapted form of the Thinking Skills Programme with prisoners with intellectual disabilities. In particular, the utility of realistic evaluation is explored as a response to the difficulties in applying research-based interventions in practice and rolling out pilot projects that have been evaluated under specific conditions.

Findings are reported in respect of the three aspects of context, mechanism and outcome to demonstrate the utility of realistic evaluation. Contextual findings suggested that ATSP is effective with male prisoners representing a range of intellectual disabilities, who would otherwise be excluded from mainstream programmes. The evaluation approach proved to be helpful in identifying relevant factors to be considered in the wider implementation of ATSP.

This is a novel approach to programme evaluation in psychological therapies that was shown to be of value in identifying conditions under which pilot schemes can be extended to other parts of a service, and research on interventions for offenders with intellectual disabilities applied in practice.

Christine Day (University of Liverpool) together with Alexandra Lampraki, Dean Ridings, and Karen Currell from Calderstones NHS Foundation Trust present their article on “Intellectual Disability and Substance Use/Misuse: A Narrative Review”.

The paper provides a narrative review of the literature on substance use/misuse within an intellectual disability (ID) population. The paper is focused on the prevalence, motivation, and implications of substance use as well as interventions for misuse.

Their findings indicate a disparity between research findings regarding the prevalence of substance use/misuse within ID populations. Previous research indicates that individuals with ID may use/misuse substances as a form of relief or respite from negative experiences. Although there is a clear need for intervention, many of the ID population do not engage with generic interventions for substance misuse. Additionally, professionals responsible for the provision of interventions identify a lack of training and support to meet the needs of ID populations.

Clare Allely (University of Salford) and Ann Creaby-Attwood (Northumbria University) review “Sexual Offending and Autism Spectrum Disorders”.

They explain that studies have found innate vulnerabilities which potentially may increase the risk of an individual with autism spectrum disorders (ASD) finding themselves involved with the criminal justice system as a result of being charged with a sexual offence. The purpose of their review is to evaluate the literature which has explored sexual offending in individuals with ASD.

The review found that only a small number of case reports on sexual offending in individuals with ASD and a small number of prevalence studies were identified and that consequently research is urgently required to identify the specific requirements and needs of sexual offenders with ASD in order to inform an appropriate treatment strategy for successful outcomes.

References

Bradley, K. (2009), The Bradley Report, HMSO, London

Rayner, J. (2010), available at: www.lawgazette.co.uk/blogs/news-blog/the-four-year-prison-term-became-a-life-sentence (accessed 15 January 2016)

Further reading

Department of Health (2015), “Department of Health’s response to the Law Commission’s consultation on mental capacity and deprivation of liberty”, available at: www.gov.uk/government/publications/deprivation-of-liberty-standards-dols-consultation-response/department-of-health-response-to-the-law-commissions-consultation-on-mental-capacity-and-deprivation-of-liberty (accessed 15 January 2016)

Mazars (2015), “Independent review of deaths of people with a Learning Disability or Mental Health problem in contact with Southern Health NHS Foundation Trust April 2011 to March 2015”, available at: www.england.nhs.uk/south/wp-content/uploads/sites/6/2015/12/mazars-rep.pdf (accessed 15 January 2016)