Title: Forensic Learning Disability
1Forensic Learning Disability
- Dr Judith McBrien
- Consultant Clinical Psychologist
- Plymouth teaching Primary Care Trust
- Developmental Disability Research Education
Group
2What 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
3Prevalence 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.
4LD 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.
5Challenges 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
6LD 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).
7LD 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.
8LD 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.
9Offenders 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).
10Plymouth 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.
11Face 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
12Half or more of the settings cared for clients
who
- Assault others (64).
-
- Show sexually inappropriate behaviour towards
others (60). - Take or damage property (50).
13Settings 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.
14Risky/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
15Where are they living?
16Limitations 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.
17Characteristics 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
18Plymouth 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.
19Variables
- Family background
- Mental health
- Educational background
- Residential day occupation history
- Forensic history
- Services received
- Current care package
20Methods/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)
21Sample
22CJS 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
23Areas 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
24Reported 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
25Care Packages
26Sexual risk
- Study on characteristics found sexually
concerning behaviour occurring in - CJS groups 47
- Risky group 23
- Controls 0
27Sex 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.
28Current 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(No Transcript)
30Contact 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
31Case 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.
32Case 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.