Written by Clare Melvin.
Following on from last week’s mental health review, this week the blog is focusing on Forensic learning disability services.
Why do we need Forensic LD services?
As we discussed in the Complex Needs I blog, sometimes people with learning disabilities and/or autism commit crimes or get into trouble with the police. Prison isn’t always the right place for these individuals as they are likely to be vulnerable among other offenders (without LD) because of their learning disability, autism or a mental health problem. Forensic LD services are there to support and manage risks for people with LD or autism who have broken the law, or are at risk of breaking the law.
Depending on what someone has done they may be supported or have their risk (likelihood of breaking the law) managed in the community. However sometimes, particularly if the person has additional mental health needs and are a risk to themselves or others, they will be detained under the Mental Health Act and admitted to an inpatient service e.g. a secure hospital.
Following Winterbourne View, the newspapers and TV programmes have written many stories on hospitals and care services, highlighting bad practices and unethical care. This has been vital to draw attention to the risk of abuse people face when locked away and are unseen. One area that has been focused on is the use of restrictive practices and physical intervention. This is when a person is held or prevented from moving, sometimes necessary if a person is being violent or trying to self-harm.
The use of physical intervention and restrictive practices needs to be closely monitored and regulated and Verity Chester, has published a report, commissioned by the Royal College of Psychiatrists, providing guidance on how to record, monitor and regulate the use of Restrictive Intervention in LD inpatient services. Verity is a Research Associate and PhD Candidate in the field of learning disabilities. Verity is also a member of the NHS England National Reducing Restrictive Practices Expert Reference Group. Her report (available here) is very much concerned with not simply focusing on the numbers (which you will often only be given in the newspapers) but looking at where the numbers come from and what they are actually showing:
“Current efforts to monitor them [incidents of RI] rely almost exclusively on the numbers of such incidents. This approach is fundamentally flawed because numbers alone do not assess the quality of a service’s overall restrictive interventions practice and cannot be used to infer good or poor standards of practice and abuse“.
In conjunction with @WeLDNurses, Verity hosted a twitter chat last night discussing the report and talking with those who implement the physical interventions, how they are recorded and monitored and how that information is then used to help the individual and improve the service overall.
The Twitter chat was an interesting hour, hearing from many frontline staff as well as parents, carers, service managers and clinical staff. You can read the comments from the chat here and follow @VerityChester and @WeLDNurses and #letsmonitorRIbetter for more information.
Second Tizard Forensic Conference.
Just before Christmas The 2nd Tizard Forensic IDD Conference was held in London. The day explored current research and practice in this area, with speakers from the Probation Service, Circles of Support, The Tizard Centre, National Health England and the Challenging Behaviour Foundation. The day provided a mix of research, policy and practice for those working with offenders with learning disabilities and autism, including service provision
and specific interventions e.g. EQUIP programme, screening for ID in the Criminal Justice System, Autism in the Criminal Justice System, support for offender with IDD in the community and . Feedback from the event was overwhelmingly positive with the consensus being that. Presentations from the event are available here along with speaker details and how to find out about similar events in the future.
LD in the News
- 5 ways that the NHS ten-year plan will improve the care of people with learning disabilities and autism.
- Crucial vote about the Autism Bill at National Assembly for Wales this month.
- How embedding understanding of autism across the NHS can benefit everyone
- How to Keep Brothers and Sisters Safe and Happy with Yvonne Newbold, January 12th 2019, London. When your own child is violent, aggressive and destructive at home, how do our other children cope? What can we, as parents, do to make it easier and more bearable for them? This workshop works to create a safe, welcoming and emotionally supportive environment where parents can look at the issues and at their own, very real, concerns about the damaging effects that living with a sibling’s violence may be having on our other children. Find out more and book your place here.