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

Background: In 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. Aims: To compare the characteristics, needs, and care pathways of long-stay patients with and without intellectual disability within forensic psychiatric hospital settings in England. Method: File 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. Results: Of 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. Conclusions: In 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

Challenges and pitfalls of antipsychotic prescribing in people with learning disability

No abstract available

Heterogeneity within Autism Spectrum Disorder in Forensic Mental Health: The Introduction of Typologies

Purpose: Individuals with diagnoses of Autism Spectrum Disorder (ASD) within criminal justice settings are a highly heterogeneous group. Although studies have examined differences between those with and without ASD in such settings, there has been no examination of differences within the ASD group. Design/methodology/approach: Drawing on the findings of a service evaluation project, this paper introduces a typology of ASD within forensic mental health and learning disability settings. Findings: The eight sub-types that are described draw on clinical variables including psychopathy, psychosis and intensity/ frequency of problem behaviours that co-occur with the ASD. The initial assessment of inter rater reliability on the current version of the typology revealed excellent agreement, multirater Kfree = .90. Practical implications: The proposed typology could improve understanding of the relationship between ASD and forensic risk, identify the most appropriate interventions and provide prognostic information about length of stay. Further research to refine and validate the typology is ongoing. Originality/value: This paper introduces a novel, typology based approach which aims to better serve people with ASD within criminal justice settings

Restrictive Interventions in Inpatient Intellectual Disability Services: How to Record, Monitor and Regulate

This report is concerned with the standards of recording, monitoring, and regulation of restrictive interventions involving people with intellectual disabilities with mental health and/or behaviour that challenges within inpatient services. Restrictive interventions, a central concern for all stakeholders of intellectual disability services, has come under increased scrutiny following the abuse scandal at Winterbourne View. Current efforts to monitor them rely almost exclusively on the numbers of such incidents. This approach is fundamentally flawed because numbers alone do not assess the quality of a services’ overall restrictive interventions practice and cannot be used to infer good or poor standards of practice and abuse. Further, there are problems with the variable use of definitions, the failure to distinguish between various degrees of physical restraint, the impact of outliers, the failure to capture individual patient progress and the absence of meaningful benchmarking. Service providers and regulators must therefore rely on other methods to evaluate the use of restrictive interventions and move from basing their conclusions on just the total number of restrictive interventions to one of examining a wider range of quality parameters. With representative examples, this document makes recommendations on how restrictive interventions should be recorded, monitored, regulated and published

Low Prevalence of Chlamydia trachomatis Infection in Non-Urban Pregnant Women in Vellore, S. India

Objective: To determine the prevalence and risk factors for Chlamydia trachomatis (CT) infection in pregnant women and the rate of transmission of CT to infants. Methods: Pregnant women ($28 weeks gestation) in Vellore, South India were approached for enrollment from April 2009 to January 2010. After informed consent was obtained, women completed a socio-demographic, prenatal, and sexual history questionnaire. Endocervical samples collected at delivery were examined for CT by a rapid enzyme test and nucleic acid amplification test (NAAT). Neonatal nasopharyngeal and conjunctival swabs were collected for NAAT testing. Results: Overall, 1198 women were enrolled and 799 (67%) endocervical samples were collected at birth. Analyses were completed on 784 participants with available rapid and NAAT results. The mean age of women was 25.8 years (range 18– 39 yrs) and 22 % (95 % CI: 19.7–24.4%) were primigravida. All women enrolled were married; one reported.one sexual partner; and six reported prior STI. We found 71 positive rapid CT tests and 1/784 (0.1%; 95 % CI: 0–0.38%) true positive CT infection using NAAT. Conclusions: To our knowledge, this is the largest study on CT prevalence amongst healthy pregnant mothers in southern India, and it documents a very low prevalence with NAAT. Many false positive results were noted using the rapid test. Thes

A systematic review and synthesis of outcome domains for use within forensic services for people with intellectual disabilities

Aims In response to the Winterbourne scandal, and the large number of people with intellectual disabilities (IDs) and offending behavior being treated in psychiatric hospitals, this study identified the domains that should be used to measure treatment outcomes of this group. Methods A systematic search of relevant databases was undertaken to identify domains. Sixty studies met the eligibility criteria, and findings were synthesized using content analysis. The findings were refined within a consultation and consensus exercises with carers, service users, and experts. Results The final framework encompassed three a priori super-ordinate domains (a) effectiveness, (b) patient safety, and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviors, reactive and restrictive interventions, quality of life and patient satisfaction. Conclusions To index recovery, services need to measure outcome using this framework