Guest editorial

Guest editorial

Article Type: Guest Editorial From: Journal of Intellectual Disabilities and Offending Behaviour, Volume 6, Issue 3/4.

Fergus Douds and Michael Brown

Dr Fergus Douds is Consultant Psychiatrist at The State Hospital, Carstairs, UK.

Professor Michael Brown is Nurse Consultant at the Health and Social Care Research, Edinburgh Napier University, Edinburgh, UK and NHS Lothian, Edinburgh, UK.

We are delighted to have the opportunity to bring together a series of papers that form a Special Scottish Edition of the Journal. In this Special Edition we present a series of papers that set out the legislative, policy and practice changes and developments that have taken place across Scotland over the past decade. These changes form part of wider developments in health and social care services which have impacted on people with intellectual disabilities, including those who offend, seeking to ensure that assessment, treatment, care and support are provided to those that need it.

By way of a brief overview, Scotland is a country in western Europe and is part of the UK, contributing 5.3 million to the total UK population of 64 million. Historically, Scotland was an independent Nation, but has been part of the Union which brought Scotland and England together to form a UK in 1707. Scotland retained an independent legal system with the 1707 Act of Union. This is an important point from the perspective of mental health legislation which has always been distinct from that of England, Wales and Northern Ireland. Legislative and policy divergence has continued apace since the establishment of the Scottish Parliament in 1999; health, social care, housing, education and law and order, and many other policy areas, are all devolved matters. The Scottish Parliament has devoted significant time to people with mental disorders and the resultant legislation and policy changes have had particular ramifications for people with intellectual disabilities.

The devolved powers of the Parliament have led to greater divergence between Scottish legislation and policy and that of the rest of the UK in the field of care and support for people with intellectual disabilities. Arguably, legislation is more informed by inclusive consultation processes and underpinned by guiding principles that saw, for example, new mental health legislation passed by the Scottish Parliament in 2003. The Mental Health (Care and Treatment) (Scotland) Act 2003 (2003) brought about important changes in mental health law in Scotland such as the establishment of the Mental Health Tribunal Service and community-based Compulsory Treatment Orders. The 2003 Act seeks to place people with mental disorders at the centre of the process by enabling involvement in decision making wherever possible.

From an intellectual disability policy perspective, Scotland, like the rest of the UK and most western countries, has moved away from long-stay institutional models of care for people with intellectual disabilities over the past 30 years. In 2000 The Same as You? A Review of Services for People with Learning Disabilities was published by the Scottish Executive, setting out the changes required to support community inclusion. This seminal policy guidance made a specific recommendation that all long stay intellectual disability hospital beds had to close by 2005. Care services for people with intellectual disabilities were shifted to community settings, with the policy aspiration being that in-patient intellectual disability health services should only be for specialist assessment and treatment, followed by discharge back to an appropriate community placement. It was explicit within the policy that hospitals should "not be home" and despite some problems with "delayed discharges" (Perera et al., 2009), Scotland has largely avoided the rebuilding of institutions run by the private sector, a development that has been an issue in England and Wales. The policy focus has continued in Scotland with the Scottish Government publishing The Keys to Life in 2013, setting out the priorities for the next ten years to improve the lives and health of people with intellectual disabilities.

In this Special Edition we bring together a series of papers that presents the distinct Scottish landscape of forensic intellectual disability practice, and the legislation and policy which informs it. In doing so we highlight some of the initiatives and developments that have taken place across Scotland to address the needs of people with intellectual disabilities who offend. We start with an overview of legislative reforms and their implications in a paper by Douds and Haut. In their paper, McKay and Welsh set out the important role played by the Mental Welfare Commission in Scotland in protecting the Human Rights of vulnerable groups, including those with intellectual disabilities.

In the first of the practice focused papers, Davis et al. describe the findings from a qualitative study which importantly looks at the experiences of a group of patients within a community forensic intellectual disability service, shining a light on issues which are salient to them. DeVilliers and Doyle then detail ten years of referral data from a forensic intellectual disability service, describe some of the outcomes achieved for patients and spotlight areas where further development and collaboration are required in the future. From a different perspective, the findings from a qualitative study about the views and experiences of professionals working in specialist forensic intellectual disability health services are presented by Mediseni and Brown.

Providing networking and practice development opportunities is an important focus across Scotland. Walker, Gration and Murphy highlight the work of the Scottish "Forensic Network" and School of Forensic Mental Health, and those organisations role in supporting service and practice development and in delivering education and training. Bowden and Wilson then describe the role and function of Appropriate Adults in Scotland, a service provided when people with intellectual disabilities are interviewed by the police. Finally, McMahon and McClements set out some of the issues relating to an "integrated" forensic intellectual disability service, the benefits derived from the model, and how limitations can be overcome.

In bringing together this Scottish Special Edition we hope that we have provided an overview of some of the relevant developments, challenges and opportunities that have impacted on the assessment and treatment, care and support of people with intellectual disabilities in Scotland. It is our intention to stimulate interest and debate from legislators, policy makers and practitioners about the models and systems within which they operate and the opportunities available to better meet the distinct needs of people with intellectual disabilities who offend.

References

Perera, C., Simpson, N., Douds, F. and Campbell, M. (2009), "A survey of learning disability inpatient services in Scotland", Journal of Intellectual Disabilities, Vol. 13 No. 2, pp. 161-171

The Mental Health (Care and Treatment) (Scotland) Act 2003 (2003),The Mental Health (Care and Treatment) (Scotland) Act 2003, The Stationery Office, Edinburgh

Further reading

Scottish Executive (2000), The Same as You? A Review of Services for People with Learning Disabilities, The Stationery Office, Edinburgh

Scottish Government (2013), The Keys to Life: Improving the Quality of Life for People with Learning Disabilities, The Stationery Office, Edinburgh