Long-stay patients with and without intellectual disability in forensic psychiatric settings: comparison of characteristics and needs

Abstract

BackgroundIn recent years, concerns have been raised that too many patients stay for too long in forensic psychiatric services and that this is a particular problem in those with an intellectual disability.AimsTo compare the characteristics, needs, and care pathways of long-stay patients with and without intellectual disability within forensic psychiatric hospital settings in England.MethodFile reviews and questionnaires were completed for all long-stay patients in high secure and a representative sample of those in medium secure settings in England. Between-group analyses comparing patients with and without intellectual disability are reported.ResultsOf the 401 long-stay patients, the intellectual disability and non-intellectual disability groups were strikingly similar on many sociodemographic, clinical and forensic variables. The intellectual disability group had significantly lower lengths of stay, fewer criminal sections, restriction orders and prison transfers, and higher levels of behavioural incidents and risk assessment scores.ConclusionsIn spite of similar offence histories and higher risk levels, those with intellectual disability appear to be diverted away from the criminal justice system and have shorter lengths of stay. This has implications about the applicability of the Transforming Care programme to this group.

Factors Influencing Length of Stay of Forensic Patients: Impact of Clinical and Psychosocial Variables in Medium Secure Setting

“…The findings deriving from our sample failed to confirm the observations of Chester et al. ( 30 ) that patients diagnosed with an intellectual disability had significantly shorter stays in forensic institutions, however, conclusions pertaining to this group are limited by a small number of these patients in our sample. There is good evidence to support an association between violence and schizophrenia ( 31 , 32 ), and a systematic review and meta-analysis of 128 studies ( 33 ) found higher rates of inpatient violence in forensic settings compared to acute psychiatric wards in each of 10 countries surveyed.…”

“…In the one-way analysis of variance from among eight categorical diagnoses based on the ICD-10, schizophrenia and schizoaffective disorder were found to significantly prolong LoS [Kruskal-Wallis Test: H (8, N = 150) = 24.66962 p = .0018], which is consistent with earlier studies (10)(11)(12)(13). The findings deriving from our sample failed to confirm the observations of Chester et al (30) that patients diagnosed with an intellectual disability had significantly shorter stays in forensic institutions, however, conclusions pertaining to this group are limited by a small number of these patients in our sample. There is good evidence to support an association between violence and schizophrenia (31,32), and a systematic review and meta-analysis of 128 studies (33) found higher rates of inpatient violence in forensic settings compared to acute psychiatric wards in each of 10 countries surveyed.…”

People with Intellectual and Developmental Disorders in the United Kingdom Criminal Justice System

“…However, inpatient services for people with IDD and mental health or behavioural problems in the UK have come under scrutiny as a result of an abuse scandal which was exposed by an investigative report broadcast on the UK BBC television programme 'Panorama' in 2011, 61 and the model has recently begun to fall out of favour in the UK. 62 The resulting "Transforming Care" programme committed the Department of Health to a rapid reduction in the number of people with IDD within inpatient care, particularly those who were perceived to have been detained for reasons of challenging behaviour. 57 Concerns have been raised about the application of the principles of the Transforming Care programme to those in inpatient secure IDD services.…”

“…6 The population in inpatient secure IDD services therefore represent a number of challenges to current UK government policy, and clarifications regarding their status is required. 62…”

“…71 Further work on the long-stay cohort has identified that, despite significant time spent in secure services, institutional aggression and risk levels remain high. 62 These patients represent a cohort of individuals who may present ongoing risks, who are progressing through their care pathway. Approximately onethird were discharged directly to community placements, under various legal conditions, such as guardianship or supervised discharge, or as an informal patient.…”