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Forensic Learning Disability

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LD is Mental Impairment' within Mental Health Act. ... There is a worryingly low level of Consultant Psychiatry provision for LD. ... – PowerPoint PPT presentation

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Title: Forensic Learning Disability


1
Forensic Learning Disability
  • Dr Judith McBrien
  • Consultant Clinical Psychologist
  • Plymouth teaching Primary Care Trust
  • Developmental Disability Research Education
    Group

2
What is Learning Disability?
  • LD is Mental Impairment within Mental Health
    Act.
  • Significantly sub-average intellectual
    functioning (IQ under 70) AND
  • Significant impairments in adaptive behaviour AND
  • Onset prior to age 18 years

3
Prevalence of LD
  • Administrative prevalence is considered to be
    0.45 of general population.
  • In Plymouth City prevalence of LD amongst adults
    in general population is 0.68.
  • Equates to 1,326 adults known to health social
    services LD teams in the City.

4
LD and the CJS
  • Some people with learning disabilities commit
    offences.
  • Low IQ is one of many risk factors for crime.
  • People with LD are over-represented at various
    stages of the CJS compared to the general
    population, although in the UK not in prisons.
  • Such people pose enormous challenges to local
    services - human financial.
  • Most are not prosecuted.

5
Challenges to CJS
  • Witnesses/complainants may have LD
  • Suspect may not be fit to plead
  • Vulnerable to false confessions
  • Cope poorly in prison
  • CJS often fails to identify LD in a suspect
  • Often no community disposal available to the
    Court

6
LD Offenders the NHS
  • Of 77 high cost LD placements, 43 are forensic
  • Of these 43
  • Only 17 are known to CJS.
  • 13 are in a secure unit out of the area (3,000
    per week in some cases).
  • Only 8 of the13 are receiving tailored treatment.
  • 35 are in local homes, highly staffed for public
    protection, but not treated (similar costs to
    SS).

7
LD Offenders and NHS/SSKeeping Track
  • Some national local providers import adults
    with LD from elsewhere in the country.
  • They claim to specialise in high risk behaviour.
  • There is no contact with the local LD service
    prior to placement.
  • Local Social Services do not monitor them.
  • The Health team does not know of them until a
    crisis referral is made.

8
LD Offenders the NHS Current services
  • There are no Forensic LD teams in community
    services in Devon (1 million pop) or Cornwall
    (1/2 million pop).
  • There is a worryingly low level of Consultant
    Psychiatry provision for LD.
  • There are no Medium Secure LD beds in the SW
    Region.

9
Offenders with LDLimited evidence base
  • Even UK prevalence studies are hard to interpret
    (McBrien, 2003) - most studies examine prevalence
    of LD amongst CJS populations.
  • Predisposing factors poorly researched.
  • No offence-specific data for LD groups.
  • Limited evidence on treatment effectiveness and
    outcomes (Barron et al 2002).
  • No reliable system for assessing risk or
    dangerousness (Fraser, 2004).

10
Plymouth study 1 McBrien, Hodgetts Gregory
2003
  • Survey of all 1,326 adults with LD in Plymouth
    City in 2001.
  • 348 or 26 were reported as either high risk or
    known offenders.
  • Similar findings in replication in Teignbridge
    Torbay 2002.

11
Face to face interviews with
  • 69 Residential home managers
  • 13 Day centre managers
  • 2 Respite Units
  • 21 Care Managers
  • 9 Community Nurses
  • 5 Psychologists/Psychiatrists
  • Health Authority Representative

12
Half or more of the settings cared for clients
who
  • Assault others (64).
  • Show sexually inappropriate behaviour towards
    others (60).
  • Take or damage property (50).

13
Settings continued...
  • 48 of settings 93 of Care Managers cared for
    clients with a CJS history.
  • Carers of 11 people with convictions did not know
    nature of the offence.
  • Carers of 5 people with current sentences for
    criminal offences did not know nature of the
    offence.

14
Risky/Offending Individuals (n 348)Type of CJS
contact
  • CJS Contact N of 1,326
  • Contact with CJS as suspect 128 9.7
  • Questioned by police 84 6.3
  • Police called to disturbance 68 5.1
  • Arrested in past 62 4.7
  • Convicted in the past 31 2.3
  • Currently serving a sentence 11 0.8

15
Where are they living?
16
Limitations to the study
  • Data reliant on informants knowledge.
  • Some informants unfamiliar with the past
    histories of their clients.
  • Some offenders might have been missed.
  • Only captured those known to services.

17
Characteristics of LD offenders
  • Most studies have looked at people in custody or
    prison and tried to study those with LD.
  • Most of of those found do not have LD.
  • E.g. Winter et al 1997
  • one of the best studies,
  • but, only 2 of sample of 21 had IQ lt70

18
Plymouth study 2 characteristicsMcBrien,
Masters Morris 2004
  • Four groups
  • Convicted
  • CJS contact but no convictions
  • Risky behaviour but no CJS contact
  • Controls no risky behaviour, no CJS contact.

19
Variables
  • Family background
  • Mental health
  • Educational background
  • Residential day occupation history
  • Forensic history
  • Services received
  • Current care package

20
Methods/Measures
  • File reviews
  • Client assessment
  • Carer and Care Manager interviews
  • IQ (WASI)
  • Adaptive Behaviour (ABS I)
  • Challenging behaviour (ABS II)
  • Mental health life events (PASS-ADD)

21
Sample
22
CJS group show differences from Non CJS in these
areas
  • Individual differences
  • Male and younger
  • Higher Full Scale IQ (61 vs 54)
  • History of psychiatric disorder
  • More life events in last two years
  • Family differences
  • In care as children
  • Physically sexually abused as child
  • Parents separated/divorced
  • Family history of offending
  • Service differences
  • Exclusions from residential placements
  • No day care placement
  • Known to Social Services LD team

23
Areas of no difference between CJS Non CJS
  • Individual similarities
  • Adaptive behaviour (daily living skills)
  • Level of risky/challenging behaviour
  • Current substance misuse
  • Epilepsy or Autistic Spectrum Disorder
  • Family similarities
  • Family histories of domestic violence or
    substance misuse
  • Service similarities
  • Living locally or away. Or in secure setting
  • Whether placement meets needs or contains risk
  • Type of special school attended (MLD or SLD)
  • Current contact with LD health team

24
Reported risk
  • In terms of perceptions of current risk
    presented,
  • there are no differences between the CJS groups
  • and the Risky Only group.
  • High/Medium current risk was reported for
  • CJS groups 44
  • Risky group 55

25
Care Packages
26
Sexual risk
  • Study on characteristics found sexually
    concerning behaviour occurring in
  • CJS groups 47
  • Risky group 23
  • Controls 0

27
Sex Offending in LD(Thompson Brown 1997 Brown
Stein, 1997)
  • High incidence of sexual abuse of people with LD,
    including by men with LD. Peer abuse is
    widespread.
  • Men with LD are capable of any type of sexual
    offence, but generally at less serious end.
  • Not explained by lack of knowledge or awareness
    of rules.
  • Repeat offences and lack of appropriate
    intervention are the norm.
  • Sexual offences account for up to half index
    offences of men with LD admitted to specialist
    units/hospitals.

28
Current research linked to service development
  • Evidence on efficacy of Cognitive-Behaviour
    Therapy group treatment is amassing.
  • We have joined a multi-centre outcome trial of
    treatment for sex offenders with LD, providing
    control group data (Murphy Sinclair et al).
  • Therefore we are assessing men for risk and
    treatment suitability.
  • A Home Office Adapted Sex Offender Treatment
    Programme is planned for the local area.

29
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30
Contact details
  • Dr Judith McBrien
  • Consultant Clinical Psychologist
  • LDS, Westbourne Unit
  • Scott Business Park
  • Plymouth PL2 2PQ
  • email judith.mcbrien_at_pcs-tr.swest.nhs.uk
  • tel 01752 314333

31
Case study
  • 26 yr old male with LD. Brought up by
    grandparents from 11ms. Entered residential care
    when gran entered nursing home.
  • Blossomed in residential home, popular, charming,
    helpful.
  • Concerns referred for Personal Relationships
    course.
  • 2 female residents complained he had touched
    them. When asked he admitted to rape.
  • Moved to respite unit. Adult Protection. Police
    interviewed and Cautioned. Risk assessment. FSIQ
    56.
  • Moved to male only residential home. Found
    coming out of a residents bedroom. Buzzer put on
    his door to alert staff.
  • Found out of room about to enter anothers had
    disarmed buzzer.
  • Told staff he had raped 2 LD men.

32
Case study contd
  • Adult Protection. Police no action no
    complaint, no witnesses.
  • Assessment by NSPCC sex offender expert high
    risk.
  • Moved to respite unit, then to singleton
    placement. Staffing costs 2,400 per week. High
    anxiety amongst staff.
  • Female with LD complained he touched her. Police
    interviewed her.
  • Tried for MHA assessment ASW disagreed
  • Referred to 2 Medium Secure Units for Sex
    Offender Treatment Programme one said not able
    enough for treatment other says yes.
  • Police interviewed and plan to charge, eventually
    dropped.
  • Has now been in MSU for 1 yr receiving treatment
    but will return to Plymouth.
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