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ON THE BORDERLINE?
PEOPLE WITH LEARNING DISABILITIES AND/OR AUTISTIC SPECTRUM DISORDERS IN SECURE, FORENSIC AND OTHER SPECIALIST SETTINGS
CHAPTER EIGHT MOVING ON: THROUGHCARE AND AFTER CARE
8.1 In chapter 7 it was suggested that the appropriateness of the different secure settings for people with learning disabilities and/or ASD hinged not just on the resources available 'in-house', but also on the availability of appropriate resources outwith these settings. The availability of appropriate community-based resources to meet both the risks posed and the vulnerabilities of individuals in this group also has implications for throughcare and after care planning and provision. This chapter explores these implications in more detail. 'Throughcare' relates to preparation for moving on and 'after care' to longer term support.
THROUGHCARE AND AFTER CARE PLANNING
Prison throughcare and after care planning
Throughcare and aftercare planning
8.2 Of the 16 prisons responding to the unit recording forms 12 felt that discharge/release planning worked well. This may, however, reflect discharge planning processes in general since a number of the prisons responding had no recent experience of release planning for anyone with a learning disability and/or ASD.
8.3 At the time of the study arrangements for throughcare and after care effectively divided prisoners into 2 groups. First, those subject to statutory supervision by criminal justice social work on release. This includes people serving sentences of over 4 years and those serving extended sentences or subject to Supervised Release Orders who serve less than 4 years but who are subject to statutory licence on release. The second group comprises people serving less than 4 years who are not subject to statutory post release supervision. This group is entitled to request advice, guidance and assistance from local authorities in the 12 months following release from prison.
8.4 The case recording form data for prisoners with a learning disability and/or ASD present a very mixed picture, reflecting not just the different arrangements for those subject to statutory licence and those entitled to voluntary aftercare, but also the difficulties of planning for someone on remand.
8.5 Of the 9 people in the prison sample a discharge plan was said to be in place for one person who was about one-third of the way through a 16 month sentence. In a further case the discharge plan was "in process of being developed". For a further 3, including one person on remand, there seemed to be a degree of planning, if not a plan, judging from the responses to a question concerning the professionals involved in discharge/release planning.
8.6 Of the remaining 4, one person was on remand and the remainder had recently commenced sentences spanning from 3 to 10 years.
8.7 The data from the case recording forms and site visits suggest there are broadly 2 approaches to discharge planning and implementation: informal and formal. These partly, but not entirely, reflect the division of prisoners into those receiving statutory after care and those eligible for voluntary after care. Neither are specific to people with learning disabilities and/or ASD.
Informal mechanisms for throughcare and after care planning
8.8 'Informal' mechanisms include the arrangements for individuals on remand and those eligible for voluntary after care. For people on remand the comment made on one case recording form was that it was not appropriate to prepare a discharge plan because of the potential for the person to be released at any time.
8.9 For people entitled to voluntary, but not statutory after care, 'planning' may be comparatively ad hoc. Health care or social work may seek out contacts in the area to which the person was returning. These contacts may be between prison social work and local social work and/or other local agencies or by prison health care staff with local agencies:
"Sometimes it's the health care nurses who are used to find outside support, sometimes its social workers, sometimes they work collaboratively."(Prison health care staff member)
8.10 The view from one medical respondent was that "a lot fell to nursing staff". One prison social work department, for example, commented that "for someone on voluntary after care the health centre might recommend contact with SACRO" (emphasis added). Nursing staff gave examples of cases where they had spent time trying to get someone supported accommodation, or arrange appointments.
8.11 Social workers would be involved with women prisoners where there were specific childcare issues.
8.12 For people with learning disabilities and/or ASD who are on remand, or who have committed less serious offences, the apparently unstructured nature of after care planning and limited move on resources can open up the possibility of people being discharged unsupported and at risk of re-offending. Drawing together issues of identification, throughcare and community resources, officers in one prison commented:
"There could be opportunities for staff to be more active in identifying people and trying to find housing etc for them when they leave…It's when people go out and there is nothing on the outside that the problems start…doesn't matter if someone is an adult or under 21, there is nothing out there to help them, so they come back in on a revolving door."
Formal mechanisms for throughcare and after care planning
8.13 While 'informal' planning approaches to throughcare and after care planning tend to be uni-disciplinary, the 'formal' and statutory are multi-disciplinary.
8.14 These 'formal' mechanisms are of 2 kinds: the criminal justice social work led process for people being released on statutory licence or supervision orders; and the health care led Care Programme Approach (CPA). Two prisons referred to the use of CPA. In one case it was in relation to someone with mental health problems, but in a second case a prison based RMHN was involved in implementing CPA for someone with learning disabilities. Although perhaps limited as evidence, these examples do illustrate the potential use of CPA as a mechanism for ensuring continuity of care for people with learning disabilities across and within institutions and agencies.
8.15 More frequently reference was made to the formal process of release planning for people leaving under licence. This involves multi-disciplinary case conferences, led by criminal justice social work, and involving different disciplines from within the prison and external agencies with responsibility for providing support on liberation. These may include specialists in learning disabilities. For one person in the sample, a Schedule 1 sex offender, this process was in the early stages at the time of the site visit, but was set in the context of what were described as "grave concerns":
"Social work now in charge. Going to convene a case conference. Talking about an intensive care package because of the risks he poses both to himself and to others."
8.16 Criminal justice social workers in 3 teams included in the study made the point that in developing release plans for individuals with learning disabilities an added concern was the degree to which people retained or understood information about their responsibilities and the requirements being placed upon them. One team for example commented:
"How can one say what the individual understands or retains - but this is important in terms of safety in the community."
8.17 Two of these criminal justice teams, one prison based and one community based, made the point that without being able to understand what information the individual could retain and comprehend the risk for someone with learning disabilities was that they were effectively being "set up to fail". One prison social work department described how, in relation to an individual who had committed a serious offence, the fact that they had a learning disability was highlighted in the course of release planning specifically because of the implications for how the person would respond to information. Efforts were made to ensure that the individual understood what was required of them. This included identifying a local agency to provide a 'befriending' service to work through with the individual and spell out what was expected of them under certain circumstances and the consequences if they failed to do this.
8.18 On the basis of the responses from the prisons current after care arrangements may mean that people committing less serious offences or on short sentences are at risk of returning due to lack of support outwith the prison. On the other hand, those going out on licence or under supervision may be at risk of returning to prison because they breach an order they do not fully comprehend.
8.19 In order to strengthen and extend current arrangements the report of the Tripartite Group (Scottish Executive, 2003) made a number of recommendations including: extending present arrangements for prisoners on Extended Sentences to all prisoners subject to statutory throughcare; prioritising voluntary after care for 3 groups including Schedule 1 offenders and sex offenders, young offenders and prisoners who have shown a commitment to addressing their offending; and formalising liaison arrangements between the Scottish Prison Service and local authority criminal justice social work services. When implemented these arrangements may indirectly benefit people identified as having learning disabilities and /or ASD: both as people subject to statutory licence, or because they come within one of the proposed priority groups for voluntary aftercare.
Forward planning in secure accommodation for children
Forward planning
8.20 Under Section 17 of the Children (Scotland) Act 1995 local authorities have a duty to provide advice and assistance to help prepare a child when he or she is no longer looked after by a local authority. Section 29 sets out the responsibilities of local authorities toward young people who leave care after school leaving age.
8.21 Of the 3 young people in secure accommodation for whom case recording forms were completed 2 had a discharge plan. A third young person had been assessed for transfer to another type of unit.
Joint working in forward planning
8.22 The data from the study suggest that the secure accommodation units are forward focused and proactive in terms of throughcare and after care planning. Further, that these processes are multi-disciplinary and multi-agency, including both unit and community-based professionals and providers. One unit, for example, described the regular review meetings, involving outside agencies and professionals, as a forum for putting together a throughcare plan.
8.23 The proactive role of the secure accommodation units in throughcare and after care planning, together with the emphasis on multi-disciplinary working emerges from the example given of one young person with learning disabilities on a probation order. An initial plan for 24-hour monitoring until the end of the probation period was felt to be inappropriate by the unit which drew attention to the young person's therapeutic and long term needs. Working with the individual's criminal justice social worker and adult social work department, staff were successful in getting the person placed in supported accommodation. One practitioner involved in planning described how:
"Initially the only option proposed was a package focused on the sexual risk he posed….But the school and the criminal justice social worker argued up through social work management that he should go to [Supported Housing project] on the basis that his needs related to his severe learning disability - not the risk of offending. [Supported Housing project] would not only be able to manage the risk, but would also be able to support the development of his independent living skills. The school and criminal justice social worker were successful in getting the person placed in [Supported Housing project]."
8.24 What this example also illustrates is how the tension between the risk/offending behaviour and the vulnerabilities which stem from having a learning disability and/or ASD, identified in chapter 5 surface and continue into throughcare and after care planning.
Discharge planning in the State Hospital and other health care settings
Discharge planning
8.25 Of the State Hospital sample 9 out of 11 for whom case recording forms were completed had a discharge plan. Discussions had also taken place in respect of the remaining 2 people.
8.26 On units outwith the State Hospital discharge plans were "being developed" for 2 out of the 20 people in learning disability units, although some discussion seems to have taken place in relation to a further 5 people. The small numbers of people for whom some discharge planning had taken place may reflect the inclusion of assessment and continuing care wards: for the former it may be too early to consider plans for discharge; the latter, by their nature, may not anticipate people moving on, especially those who have already recently moved from another hospital.
8.27 Discharge plans were in place for 2 out of 6 people in psychiatric units.
Joint working in discharge planning
8.28 Within the State Hospital the decision to discharge is made by the State Hospital team, following which Consultant Psychiatrist to Consultant Psychiatrist negotiations begin with the relevant local area. Although multi-disciplinary, the majority of those involved in discharge planning for patients on the State Hospital site were professionals based within the hospital, although Community Learning Disability Teams were involved in 2 cases. The Scottish Executive also requires to be involved in relation to people on restriction orders
8.29 A 'Managed Forensic Mental Health/Learning Disabilities and Social Care Network' was being piloted between the State Hospital and 3 health boards. This sets out the roles and responsibilities of different agencies at each stage of the patient's journey, pre, during and on transfer from the State Hospital. This may open up the possibility of greater involvement of external agencies in the process of discharge decision-making and planning.
8.30 In learning disability and psychiatric units outwith the State Hospital there appears to be a greater involvement by community based health, social work and housing agencies in the discharge planning process.
Mechanisms for discharge planning
8.31 For the majority of people in the State Hospital sample the discharge plan involved moving to another in-patient unit of lesser security, rather than direct to the community. One respondent remarked that "Moving straight from maximum security to community is a major challenge [it] requires a lot of work and huge packages of care".
8.32 A number of mechanisms were in place or being developed to ensure continuity and joint working for people moving on from the State Hospital. CPA was increasingly being used, including for people with learning disabilities. In one case a local secure unit operated CPA as part of a process of admitting someone with Asperger's syndrome from the State Hospital. To ensure that services would also be available once the person was ready to move on from the local unit the receiving Consultant Psychiatrist also involved the joint commissioners for the local service.
RESOURCES FOR AFTER CARE
Gaps in resources
8.33 As already outlined in chapter 7, across settings the key issue for respondents was the perceived availability of appropriate resources to support people once they were ready to move on from the secure environment.
8.34 The perceived 'gaps' include the lack of different types of resources, for example 24-hour supported accommodation, places in healthcare units with lower levels of security and adolescent psychiatry units.
8.35 What was also felt to be lacking was sufficient support to continue therapeutic work already started with an individual in the secure setting, and/or a structure of support to prevent people returning to the secure setting. As described in chapter 7 people in the State Hospital, in the secure accommodation units and even the prisons were felt to be able to access a level of therapeutic and other supports that would not be available to them outwith the secure setting.
8.36 For example, in relation to one person with learning disabilities coming up for parole, prison health care staff expressed concerns about how the person would be maintained safely in the community:
"[He] is known to the A & E department of his local hospital because of the number of threats of overdosing. But he is also dangerous. Almost needs 24-hour care to protect himself. [Prison] performs a role, but he won't get that level of supervision when he is out..Whatever it is it won't be adequate - he won't cope with someone with him 24/7 and he could become aggressive and cause injury. There will be conflicts and the package will fall apart unless he is in a secure setting."
8.37 For people leaving prison who are not under licence or a statutory supervision order, prison health centre or social work staff can make contacts with relevant agencies outwith the prison but it may be some time before a community-based service makes contact with the person. Although not specific to people with learning disabilities and/or ASD the comment was made by one prison health care team that:
"The prison contacts people to say person is being released, but it's not picked up because of the waiting lists across the board. A few weeks later the person is back in prison not having been picked up."
8.38 One prison social work department also referred to the variability between local authorities in the extent to which they would provide voluntary after care.
8.39 One of the greatest obstacles is the perceived reluctance of other services to take referrals from people in secure settings. This includes both social care and health care services. For example, one prison healthcare centre, trying to find supported accommodation for a young offender described how "no-one would have him because his behaviour is so appalling".
8.40 Health care settings may reject someone on the grounds that they are too capable:
"With somewhere like [local unit] the concern is that the people from the State Hospital are more able than other patients and this raises the risk of predation on the more disabled patients."(Ward Manager)
8.41 There may also be debates with local health services over the primary diagnosis and whether the person has a learning disability or a personality disorder. If interpreted as a personality disorder they will not be accepted by some units.
8.42 The person may be viewed as engaging in the 'wrong' sort of offending: some health care units, for example, will not take sex offenders.
8.43 'Local' secure units may not take people from prison because they come from the 'wrong' catchment area.
8.44 In one case someone in prison was assessed for transfer to the State Hospital, but turned down. Within the prison one interpretation was that the Hospital felt there was nothing they could do for the person: "the State Hospital felt that [his] problems were contained at [prison], in a context in which the State Hospital is trying to get people out". The prison had also contacted an in-patient unit with a secure facility "but they felt he was too high risk for them".
8.45 It is the capacity for local units to cope with the risks posed which is perhaps the crux of the problem. One State Hospital respondent summarised what they perceived to be the difficulties for local units:
"Have had statements that someone was 'too tall' for the service i.e. for the ceiling tiles. But the problem behind this is that they don't have sufficient experience or knowledge to take people on. They don't have the skills for this unique, special group. They don't have the confidence in their ability to do the job."
8.46 For one person in the sample funding for additional staff had been agreed to enable them to move from the State Hospital to a local secure unit. The move though was being delayed because of the receiving unit's concerns about being able to manage the person. As a result of the delay staff felt the person was "stagnating".
8.47 For people in the State Hospital the stigma that attaches to the place and the "myths" which develop around individuals' past histories may also make local areas resistant to taking people back. As such these people are truly 'entrapped'.
8.48 The only option in relation to some people may be to seek funding for placements in privately run units, usually located in England. The need to negotiate funding can further delay an individual's discharge from the State Hospital.
8.49 The lack of integrated care networks, clarity of agency responsibilities, and a lack of appropriate resources, including expertise and experience, has major implications for people in secure settings. Not only may their discharge be delayed, literally by years in some cases, but, when they do move it may be to units in England. This may compound their social exclusion, moving them away from any remaining family or social contacts. For people moving out of prison the lack of timely and appropriate support may increase the risk of recidivism. For people in the community with inadequate support or staff with sufficient experience and confidence it may mean a break down in community placements and admission or re-admission to the State Hospital.
Care packages
8.50 Despite all the difficulties, examples were described of care packages that had enabled people to move on. For example the package of support for one young person leaving secure accommodation described above. One psychiatric in-patient unit also described putting together a joint care package, co-ordinated by a care manager and involving health input, including specialists in learning disabilities, social work, social care, housing and voluntary agency contributions. The value of joint working was underlined in each of these cases. The comment was, however, made in one case, that this was almost in spite, rather than because, of the available structures to support partnership working:
"No system in place to co-ordinate multi-agency approach. Dependent on enthusiasm of care manager and Team's personal knowledge of local resources. " (Comment on case recording form)
8.51 People with learning disabilities have also been transferred from the State Hospital to a local secure unit. The process was felt to have been facilitated not just by the dual role of the Consultant Psychiatrist as RMO for both the State Hospital specialist unit and the local unit, but also the close working between the different professions on the 2 sites.
MANAGING TRANSITIONS
8.52 Although in each of the secure settings discharge planning involves linking in with other agencies, whether through 'informal' contacts, or formal mechanisms such as pre-release meetings or CPA, the process of transition may take different forms.
8.53 One of the secure accommodation units described a number of ways in which they sought to smooth transitions. Where, for example, a young person was moving from the unit to less secure care, the unit staff would be involved in preparation for the move including taking the young person on escorted visits. The view was that these visits also helped to allay security concerns on the part of the receiving unit. Work would also be undertaken with families when planning for discharge with the aim of giving them "an individual strategy for managing the young person's risk".
8.54 For people moving from the State Hospital to a local secure unit, respondents described how they were able to implement a 'model process':
"Got the staff from outside to work with the key worker and the patients so they got the real picture, both positive and negative. The OT and psychologist from the receiving unit worked with the Ward OT and psychologist and looked at ways of replicating the groups the patients were attending in the State Hospital. So that when people moved the change wouldn't be so extreme."
8.55 Patients were also able to spend time in the new unit prior to leaving.
8.56 The resource implications in terms of ensuring staff cover in both units meant, however, that the 'model' could not always be implemented. For people moving out to units in England, for example, the number of pre-transfer visits may be circumscribed by the need for the person to be accompanied by 3 staff who have to stay overnight.
8.57 For people in prison not going out on licence transitions can be comparatively abrupt. There is no further input from prison health care or social work staff. People going out on licence will have had contact with their criminal justice social work supervisor prior to discharge.
HIGH HOPES AND LET DOWNS: USERS VIEWS ON MOVING ON
8.58 In interviews people with learning disabilities and/or ASD in the prisons, the State Hospital and secure accommodation expressed their hopes and aspirations for the future: to get a job or go to college and get a place of their own. People were also aware of the obstacles in their way. One of the barriers was the feeling that they lacked the skills to realise their hopes. One person described their ambitions:
"I'd like to get a job that people with learning disabilities do. Working in Tesco's stacking baskets or shelves, but I maybe couldn't stack shelves as it would need to be in alphabetical order and I don't know how to do that."
8.59 But a major barrier, particularly for people in hospital was not being able to move on because places were not available for them in other units. There is an almost overwhelming sense of hope that the new placements will be the stepping stone to achieving the things they want from life. One person for example, felt that by moving to a local unit they would "feel a bit more stability" and the unit would give him advice on the best routes for getting a house and a job.
8.60 At the same time there is a mixture of resignation and frustration as people wait for the promised placements to materialise. For one person interviewed in hospital the opportunity to move on was also a chance to "make up for lost time":
"I want to move on and make up for lost time….I'll go to the local hospital..I've talked to the staff and the doctor. I'm waiting on feedback from [local hospital]. It could happen within the next 2 or 3 months. I just have to wait."
8.61 For this person the worst thing about being on the unit was "wanting to move on". Unfortunately the anticipated place was no longer available.
8.62 Another person was prepared to be transferred to a unit some distance away from his family in order to move on, but was aware that although funds had been made available, there was no place for him yet. The waiting, he said, was making him nervous and edgy.
8.63 People were also sensitive to having been rejected. One person had hoped to go to a local unit near his family, but was told there were no beds available, but believed that "15-16 beds are empty". Another describing the reasons for the delays commented that "It seems only [local unit] will accept me. Other hospitals have turned me down".
8.64 Echoing the views of service providers, a number of people felt there should be more places available so that when they were "clear for discharge" they could move.
"I am leaving here but there's not enough hospitals provided for people with learning disabilities. Lennox Castle has shut down. It was for people like me…There needs to be more facilities for people with learning disabilities."(Hospital in-patient)
EXAMPLES OF PRACTICE
8.65 Despite the obstacles and frustrations described by staff and experienced by people with learning disabilities and/or ASD, examples of ways in which these barriers were surmounted were also described in each of the different settings.
- The use of CPA to ensure continuity of care for one person with ASD moving from the State Hospital to a local unit. In this case local service joint commissioners were also involved to ensure a further smooth transition from the local unit to appropriate community services
- The graduated transitions for people moving from the State Hospital to a local secure unit
- The joint work between one secure accommodation unit, a young person's criminal justice social worker and the local social work department to provide a care package that met the needs arising not just from the young person's offending behaviour but from their learning disability
- The joint work between a psychiatric in-patient unit and social work to provide a package of care involving statutory and voluntary agencies able to meet the needs of an individual with ASD
- The provision of a 'befriender' for one person with a learning disability leaving prison under licence to help them to understand, in their own terms, what was required of them and the consequences if they breached the order
DISCUSSION
8.66 Accounts of throughcare and after care underline the need for mechanisms to be flexible enough to meet the specific needs arising from the offence related risks individuals may pose and the vulnerabilities that may arise from the learning disability and/or ASD.
8.67 At present, outwith specialist health care settings, arrangements are not specific to people with learning disabilities and/or ASD. For people in prison, or admitted to secure accommodation via the criminal justice system the mechanisms are informed by criminal justice requirements and are largely aimed at preventing re-offending. For people being liberated under licence the formal process provides a forum for multi-agency and multi-disciplinary planning and for continuity beyond secure care. But there is the risk that, unless the impact of the learning disability and/or ASD is recognised, in terms of capacity to retain information, comprehension or other behaviours, the person is being "set up to fail".
8.68 For people in prison who fall outwith this formal framework there is a reliance on 'informal' arrangements. Prison health care and social work staff will make links or liase with relevant agencies outside on behalf of the person with a learning disability and/or ASD. But there is a risk of arrangements failing if resources outside are unwilling, unable or do not exist to meet the person's specific needs. People may also not follow through the arrangements made on their behalf. As a result transition for some people can mean leaving the comparative stability of the prison environment to chaotic unsupported lives outside and a consequent risk of returning to prison. Although people cannot be required to take up services, there may be a value in greater involvement by community-based agencies to encourage continued contact post liberation.
8.69 In health care settings, transitions may be planned, but people may again face the obstacle of what is or is not available outside the secure setting.
8.70 There is no doubt that the examples cited where planning and transitions were felt to work well were those where there was collaborative working between and across units, agencies and professionals. Where barriers were encountered these were due not only to the lack of resources but also to a perceived reluctance on the part of agencies outwith the secure setting to take on responsibility for individuals. As a result people with learning disabilities and/or ASD can experience the rejection described by a number of those interviewed.
8.71 A number of policy developments not specific to people with learning disabilities and/or ASD have the potential to smooth the pathways for this group of people. Although the Joint Future policy, in general, and single shared assessment in particular do not appear yet to be a feature of the language of these secure environments ( see chapter 6), it may open up further opportunities for partnership working as it is rolled out across community care groups,
8.72 The progress being made to set up a national forensic managed care network may also enhance opportunities for greater continuity of care. Similarly, the implementation of the Tripartite Group's recommendations for throughcare and aftercare for people leaving prison may have a beneficial impact for people with learning disabilities and/or ASD.
8.73 The success of these different initiatives to enhance throughcare and aftercare will, though, hinge on the extent to which agencies and services accept responsibility for people with learning disability and/or ASD. They are also dependent upon the capacities and confidence of 'mainstream' services to respond to the combined risks and vulnerabilities of this "unique" group of people.
KEY POINTS
- For people in prison arrangements for throughcare and after care are contingent on whether they are on remand or sentenced, and, if sentenced, the length of sentence and/or whether they will be going out on licence or under a supervision order
- For people on remand and those eligible for voluntary after care, arranging support on release will be a largely informal process involving prison healthcare or social work staff making contact with outside agencies on behalf of the person
- 'Formal' mechanisms for throughcare and after care planning include the criminal justice social work led process for people going out on licence and the health care led Care Programme Approach
- The formality of the process for people going out on licence may ensure continuity of care, but may place requirements on an individual that they are unable to fulfil. The informal approach for people who are not under licence may mean they do not receive follow up or support in the community, potentially increasing the likelihood of re-offending
- The secure accommodation units for children appear to be forward focused and proactive in planning for throughcare and aftercare. There is also an emphasis on multi-disciplinary and multi-agency working involving unit based and external professions and agencies
- Discharge planning for people on the State Hospital site was multi-disciplinary but primarily involved professionals from within the hospital
- In the few cases where discharge planning was in progress for people on in-patient units outwith the State Hospital there appeared to be greater involvement by external agencies and services
- Respondents felt that one of the fundamental barriers faced by people ready to move on from healthcare settings was the lack of appropriate resources beyond the secure setting, including a range of types of accommodation and activities and interventions
- Community-based health and social care resources may also be reluctant to take on responsibility for people, particularly those moving from the State Hospital. State Hospital staff suggested that local units may feel they do not have the capacity to cope with the risks someone poses
- Interviews with people with learning disabilities and/or ASD revealed their hopes and aspirations but also their frustrations as they wait for appropriate places to become available so they can move on
- The lack of integrated care networks, clarity of agency responsibilities and a perceived lack of appropriate resources can have a number of implications for people with learning disabilities and/or ASD. Some people may have to wait a number of years before they are able to move; some may have to move to units even further away from their family and friends; the risk of recidivism may increase when people move out of prison without timely and appropriate support. For people in the community inadequate or inexperienced support may mean admission or re-admission to the State Hospital
- A number of recent policy initiatives may assist to break down some of the barriers encountered by people in secure settings. This however hinges on the preparedness of 'external' agencies to accept responsibility for these individuals, and the capacities and confidence of mainstream services to respond to their complex needs
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