Health, Social Work and Related Services for Mentally Disordered Offenders in Scotland.

8: SERVICES FOR PEOPLE WITH A LEARNING DISABILITY

This section is about the services provided for people with a learning disability who offend. It illustrates the need for a variety of services to be provided by health, social services and the criminal justice system, after an individual assessment of the offender has been carried out. The majority of these services should be community-based, but there is a need for some semi-secure and secure facilities. Similar services may also be necessary for people who are at risk of losing their residential or daytime placement through behaviour which causes physical harm to others, and will be covered separately under the learning disability review (1998-99).

Introduction

8.1 For the purposes of this document people with learning disability are those who, by reason of their developmental intellectual impairment, need additional specialist services to lead a normal life or as normal a life as possible. The range of competence is very wide. Many have difficulties in addition to their learning disability that present them, their families and service providers with further challenges.

8.2 People with a learning disability may need assistance in coping with police interviews and court procedures. Following the Departmental Circular 2/1990, updated by the joint Police, SWSG and Health guidance (Interviewing People who are Mentally Disordered: "Appropriate Adult" Schemes) (3), "appropriate adult" schemes have been established in Scotland to facilitate police interviews with mentally disordered adults. People with a learning disability can be particularly vulnerable in prison. The criminal justice system should be aware of their special needs. Diversion schemes should be available for use when appropriate. It is, however, helpful for some people with a learning disability to see the consequences of their behaviour in a similar way to other citizens.

Current services for offenders with a learning disability

8.4 Some people with learning disability who offend are treated in hospital or in the community under the Mental Health (Scotland) Act 1984. A guardianship order may be used on the grounds of learning disability (mental handicap is the term used in the Act). Hospital treatment may be appropriate if the person suffers from mental impairment (or a severe impairment) of intelligence and social functioning associated with abnormally aggressive or seriously irresponsible conduct.

8.5 The health service provides facilities for specialised assessment and treatment of offenders. Assessment is carried out by appropriate professionals (eg nurses, psychiatrists, clinical psychologists and speech therapists) and may take place in the community, in hospital or in prison. Subsequent treatment may be provided in the community by multidisciplinary community teams, at a day hospital, in local in-patient facilities (many of which are in large learning disability hospitals) or within the secure facilities of the State Hospital.

8.6 Social work services have the lead responsibility for care in the community, both as providers of criminal justice services and as planners of social work services. The point at which social services may become involved with someone with a learning disability who may have offended will vary dependent on individual circumstances. Some will have been diverted whilst others may have been admonished. In other instances, people with learning disabilities may not always be recognised as needing additional assessment/support. When Social Enquiry Reports are requested prior to disposal, criminal justice services are involved. They may decide to consult with both social work colleagues in learning disability teams and with health professionals. (Paragraphs 3.2-3.17 and 5.9-5.25 also apply to people with learning disabilities.)

Future services

8.7 The Scottish Office view is that there should be a joint assessment of learning disability need by health boards and local authorities. Service providers should cater for the majority of offenders with a learning disability who require a comprehensive range of health, education and social work services to meet their needs. Serious offenders with learning disabilities should be separated from others where possible.

8.8 A range of services will be necessary including:

support from social work services, criminal justice social workers, primary health care teams, specialist learning disability teams and voluntary organisations; community accommodation with resident staff who may receive support from the agencies described above; potentially lockable well-staffed NHS accommodation for the purposes of assessment and treatment which should be in the form of small units; secure accommodation for the very small number of people who require such provision.

There should be linked access between the dedicated secure settings and less secure forms of accommodation in the community. There also should be adequate and properly planned aftercare including access to the necessary range of rehabilitation and training facilities and opportunities. Community care assessment as part of the discharge planning process should be included in the aftercare arrangements.

The respective roles of agencies

8.9 There should be liaison between all the relevant agencies: criminal justice services, National Health Service, police, prison and social work services and appropriate multi-agency agreements should be made.

8.10 Health boards and local authorities should ensure that an individual care plan is prepared for each person receiving a service, which takes a risk assessment into consideration. Services should be provided in the least restrictive environment consistent with public safety. An appropriate adult service should be established, with a register of identified individuals who should receive regular training. Independent advocates should be available for the service users.

8.11 Carers’ needs should also be taken into account. The Carers (Recognition and Services) Act 1995 is concerned with carers who are either providing or intending to provide substantial amounts of care on a regular basis. A carer meeting these requirements is entitled, on request, to an assessment of their own needs. Adequate day and respite care services should be provided.

8.12 There should be evidence of training strategies for all staff involved with the service. Monitoring systems should be in place to ensure that appropriate treatment/care plans are in place and are reviewed regularly.

The role of service providers

8.13 Appropriate services should be provided for offenders with a learning disability through multi-agency liaison and an assessment of the local need. There should be a range of treatment facilities (eg community, residential and specialised semi-secure or secure, which may be local or national). There should be a recognition that while the majority of offenders with a learning disability will need relatively short-term support, there is a small group who have severe enduring difficulties and will require long-term supervision.

Care for learning disabled offenders in the community

8.14 At a local level there should be comprehensive community plans and individual treatment packages, ensuring that care and supervision are provided in the least restrictive environment. A framework should be established to ensure multi-agency involvement and information sharing systems. Health service staff should be involved in all relevant points in assessment and treatment.

8.15 As indicated in paragraphs 8.10 and 8.11, appropriate adult schemes should be in place, advocacy services should be available and the needs of the carers should be considered. There should be a support service for victims with a learning disability. Procedures for dealing with abuse should be in place. Suitable accommodation should be available in the community, with opportunities for work, leisure and educational placements. Training should be available for staff of all agencies working within the offenders service. Monitoring systems should be established.

Semi-secure accommodation

8.16 This should be provided in small units dedicated to the needs of this client group. There should be facilities for comprehensive assessment and treatment, with close links to community resources. These units may also be used in the rehabilitation of people from secure units.

Secure accommodation

8.17 Although only a small number of learning disabled offenders will require such a facility, their stay may be prolonged and it is important that there is multi-professional input and treatment plans which are regularly reviewed. The environment should be congenial and adequate educational and recreational activities should be provided. It is likely that such units will be regional or national and it is important that links with the area of origin be maintained.

Aftercare

8.18 Services should be available for learning disabled offenders following discharge from prison or specialised semi-secure or secure facilities to offer support and reduce risk of re-offending.