Abstract
PurposeNational policy in England is now directed towards keeping patients with intellectual disability (ID) presenting with forensic problems for time-limited treatment. The result is that secure hospital services are expected to work much more proactively to discharge patients to community-based services. However, there is little evidence in recent years on the outcome of discharged patients with ID from secure hospitals. The purpose of this paper is to describe the outcomes of a patient group discharged from a specialist forensic ID service in London, England.Design/methodology/approachThis is a descriptive retrospective case note study of patients with ID admitted to and discharged from a secure service with both low and medium secure wards, over a six-year period from 2009 to 2016. The study examined patient demographic, clinical and outcome variables, including length of stay, pharmacological treatment on admission and discharge, offending history and readmissions to hospital and reoffending following discharge.FindingsThe study identified 40 male patients, 29 of which were admitted to the medium secure ward. In all, 27 patients (67.5 per cent) were discharged into the community with 14 patients having sole support from the community ID services and 4 from the community forensic services. In total, 20 per cent of patients were readmitted within the study period and 22.2 per cent of patients received further convictions via the Criminal Justice System following discharge.Originality/valueThis was a complex group of patients with ID discharged into the community with a number at risk of requiring readmission and of reoffending. Community-based services providing for offenders with ID must have sufficient expertise and resourcing to manage the needs of such a patient group including the ongoing management of risks. The national drive is significantly to reduce the availability of specialist inpatient services for this group of patients but this must occur alongside an increase in both resources and expertise within community services.
Highlights
National policy in England is directed towards keeping patients with intellectual disability (ID) presenting with forensic problems for time limited treatment
The patients’ offending history was looked at. 15 (37.5%) of the patients had an offending history of a similar nature to the index offence associated with this admission, 24 (60%) of fe the patients had a history of offending which was of a different nature to the index offence, with 9 (22.5%) patients having no previous offending history
In terms of comorbid neurodevelopmental disorders 4 (10%) of the patients had a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) (3 of which were placed in medium security) and 7 (17.5%) had received a diagnosis of Autistic Spectrum Disorder (ASD), (6 of which were placed in medium security)
Summary
National policy in England is directed towards keeping patients with intellectual disability (ID) presenting with forensic problems for time limited treatment. The availability of forensic services for people with intellectual disabilities (ID) varies across the UK in terms of patient group and levels of security (Chaplin and McCarthy, 2015). There is clear policy and guidance to what services should look like for the most complex cases ((Ministry of Justice 2009, Mansell et al 2010), the provision of appropriate community based services for this group being discharged from secure hospital care is still aspirational in many areas of the UK. Within forensic services for people with ID there are three levels of security; low, medium ili and high in UK ((Royal College of Psychiatrists 2003)& 04). ID services did apd pear in the selected papers, the authors did not present data specific to ID populations
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