A national review of learning disability services in Scotland, The Same As You? recommended that Health Boards should close all long stay beds by 2005 and reduce assessment and treatment places to specified levels. A psychiatry-led service planning study was carried out in 2007 to find out whether these recommendations had been met. The extent of delayed discharges was also investigated. All 15 Health Boards in Scotland responded and supplied the requested information. There were 388 adults with learning disabilities within inpatient services, 91 of whom were within forensic learning disability services. The age, gender, reasons for admission and length of stay are reported for this inpatient population. Recommendations are made for future recording of delayed discharges and the adequacy of the number of assessment and treatment inpatient places in Scotland is discussed.
Purpose -In Scotland, following the closure of long stay learning disability hospitals in 2005, focus has shifted on to developing robust community services/resources to cater for the healthcare needs of people with learning disabilities. In the absence of robust in-patient services, a small number of individuals with learning disabilities and associated severe challenging behaviours, despite not being regarded as ''forensic'' cases, do inappropriately get referred and sometimes admitted to forensic learning disability services. This study aims to explore this area of clinical practice in the context of referrals to the high secure forensic setting of The State Hospital, Carstairs, Scotland and in light of key UK and Scottish Government policies. Design/methodology/approach -All referrals made to the State Hospital's forensic learning disability service between August 2005 and July 2010, which met the criteria, were reviewed (n ¼ 5) and common determinants leading to these referrals identified and thematically analysed.Findings -The identified determinants leading to the making of these referrals were broadly classifiable into psychiatric, environmental and staffing themes.Practical implications -In Scotland, there does appear to be a requirement for a specialist in-patient service to meet the needs of this complex and challenging group of patients. There is a need for effective supra-regional planning to meet the needs of similar ''high cost, low volume'' patient groups.Originality/value -This study highlights the wider issue of ''gaps'' within services in Scotland for individuals with severe challenging behaviours and autism and the requirement for a national specialist service.
Purpose – UK best practice guidelines for the treatment for people with schizophrenia recommend the use of psychoeducational approaches. The purpose of this paper is to describe the introduction of psychoeducational groups for people with an intellectual disability and co-morbid mental illness within forensic settings. Design/methodology/approach – “Staying Well”, a psychoeducational programme for people with an intellectual disability and co-morbid mental illness was based in part on a group programme from Ashworth Hospital, but adapted and developed to be suitable for people with intellectual disability. Input from a very experienced speech and language therapist was of great importance. Five groups with a total of 20 participants (15 different individuals) with mild to moderate intellectual disability and co-morbid mental illness were run over a two-year period. At the end of each group, an individualised “Staying Well Plan” was devised, to reduce the risk of future relapses. Findings – The group was very positively welcomed in the two pilot hospitals, by participants and members of the clinical teams. The key measure of the success of the programme is that the “Staying Well Plans” developed for the individuals are still in place two years after the completion of the first groups. Practical implications – The authors believe that this approach is of benefit to both the participants and their carers, stimulating positive engagement, open discussion about mental illness and reinforcing strategies for “Staying Well”. Originality/value – This paper shows how a psychoeducational approach to severe mental illness in individuals with an intellectual disability is both possible and well received.
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