Enhancing intellectual disabilities awareness in Irish law enforcement interactions

Emerging research has highlighted higher rates of people with intellectual disabilities in police custody and prisons as compared to general population prevalence across multiple jurisdictions. This is a constituency that are vulnerable in criminal justice settings. Against a background of Ireland’s ratification of the United Nations’ Convention on the Rights of People with Disabilities (UNCRPD), this thesis examines the variety of ways in which accused persons with intellectual disabilities face barriers in accessing justice equally at the policing interface: including non-recognition of disability, psychological vulnerabilities, a lack of accessible information and deficiencies in service provision. It further identifies ways to address lacunae, generating recommendations for policymakers in strengthening safeguards and allowing progress in respect of Ireland’s human rights obligations. In addition to international literature reviews and analysis of Irish data setting out the societal context, this thesis contributes new knowledge and progresses existing knowledge in four areas. First, the elicitation and thematic analysis of stakeholder viewpoints in respect of barriers to equal access to justice for people with intellectual disabilities in Ireland – this is the largest such study of its kind in Ireland and will usefully inform governmental policy and law reform in this area post UNCRPD ratification. Second, the systematic development of a UNCRPD-informed model of intellectual disability awareness training for law enforcement officers with pilot empirical evaluation. This can potentially be generalised to the other State Parties that have ratified the Convention. Third, the systematic development of an Easy-to-Read Notice of Rights developed through focus group methodology with multidisciplinary and advocate consensus including people with a disability. Whilst this output is arguably jurisdiction-specific, a methodology template is provided for other countries to develop this important document. Fourth, the thesis provides a critical appraisal of current legal and clinical scenario in respect of the policing interface for people with intellectual disabilities in Ireland. In that context, this thesis both reviews and recommends, based on existing laws, policies, and practices, approaches to advancing specific safeguards. </p

Prisons and the COVID-19 pandemic

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The experience of law enforcement officers interfacing with suspects who have an intellectual disability – A systematic review

There is a high prevalence of people with intellectual disability (ID) among those in police custody. Consequently, law enforcement officers (LEOs) at the frontline of the criminal justice system are commonly required to interact with people who have ID. Notwithstanding the frequency of these interactions, research indicates that police exchanges with persons with ID frequently take place against a backdrop of tenuouslyresourced disability awareness training. At the time of writing, a paucity of research data exists with respect to the experiences of LEOs operating within this training vacuum at an international level. A better understanding of their experiences could meaningfully inform research, training and improve support programmes for LEO's. We systematically reviewed six databases to identify studies published up to 1st December 2019 reporting the experience of LEOs interfacing with suspects who have an ID. Following a review of 670 abstracts, 16 studies were identified from five countries involving 983 LEOs. LEOs identified 1) a need for specialised training; 2) challenges in identifying people with ID; 3) a need to improve safeguards and 4) challenges in supporting/ communicating with individuals who have ID through the investigation process

Experiences of people with intellectual disabilities encountering law enforcement officials as the suspects of crime – A narrative systematic review

It is well established internationally that there is a high prevalence of intellectual disability (ID) among people in police custody. Some people with ID may face particular challenges in negotiating the forensic formalities adopted by police at the pre-trial stage of the criminal process. These challenges need to be acknowledged and mitigated through appropriate procedural safeguards in order to, at once, preserve the fact-finding accuracy of criminal investigations and minimise the risk of securing a wrongful conviction. And yet, despite the formative role which pre-trial procedures exert over the trajectory of proceedings, little is known about the experiences of people with ID during their initial interaction with law enforcement officers. In an attempt to address this research lacuna, we reviewed six databases systematically to identify studies that explore such experiences. Seven studies with a total of 1199 participants were identified. Frequently, participants with ID describe challenges in police custody, experiencing particular difficulties in understanding and communicating information. They report a paucity of appropriate supports generally in this setting and an unmet need for the provision of procedural and emotional supports. Consistent implementation of legal safeguards is necessary, along with consistent availability of accessible practical measures to support people with ID within the criminal justice system

People with Intellectual Disabilities and the COVID-19 pandemic

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Editorial: Evidence-based frameworks of assessment and treatment in forensic psychiatry practice

Forensic psychiatry thrives within the complex overlap of two seemingly distinct realms: the legal arena and the field of psychiatry. It focuses on evaluating and treating mental disorders when they appear linked to criminal behavior. Forensic psychiatry has evolved into a recognized discipline with a robust background of scientific inquiry, primarily because mental health care has always had a significant interface with the law. While it is fundamentally a clinical discipline, it also demands a comprehensive understanding of the law for effective clinical practice.</p

Hunger strikes in prisons: a narrative systematic review of ethical considerations from a physician's perspective.

Objectives. We sought to identify and review published studies that discuss the ethical considerations, from a physician’s perspective, of managing a hunger strike in a prison setting. Methods. A database search was conducted to identify relevant publications. We included case studies, case series, guidelines and review articles published over a 20-year period. Non-English language publications were translated. Results. The review found 23 papers from 12 jurisdictions published in five languages suitable for inclusion. Conclusions. Key themes from included publications are identified and summarised in the context of accepted guidelines from the World Medical Association. Whilst there seems to be an overall consensus favouring autonomy over beneficence, tensions along this fine balance are magnified in jurisdictionswhere legislation leads to a dual loyalty conflict for the physician

The prevalence of major mental illness, substance misuse and homelessness in Irish prisoners; systematic review and meta-analyses.

Aims. To systematically review studies from Irish prisons that estimate the prevalence of major mental illness, alcohol and substance misuse, and homelessness at the time of committal. Methods. Healthcare databases were searched for studies quantifying the point prevalence for each outcome of interest. Searches were augmented by scanning of bibliographies and searches of governmental and non-governmental websites. Proportional meta-analyses were completed for each outcome. Results. We found eight, six and five studies quantifying the point prevalence of major mental illness, substance misuse, and homelessness respectively. Considerable heterogeneity was found for each subgroup (except psychosis where substantial heterogeneity was observed) and random effects models were used to calculate pooled percentages. The pooled percentage for psychotic disorder was 3.6% [95% confidence interval (CI) 3.0–4.2%], for affective disorder 4.3% (95% CI 2.1–7.1%), for alcohol use disorder 28.3% (95% CI 19.9–37.4%), for substance use disorder 50.9% (95% CI 37.6–64.2%) and for those who were homeless on committal 17.4% (95% CI 8.7–28.4%). Conclusions. Estimates for the prevalence of psychotic illness and substance abuse amongst Irish prisoners are in keeping with international estimates of morbidity in prisons, whilst those for affective disorders are lower. The prevalence of homelessness in committal to Irish prisons is higher than some international estimates. Rates for psychoses, alcohol and substance misuse as well as homelessness in Irish prisons are significantly higher than the general population prevalence of these vulnerabilities. A need for service development is discussed

The evaluation of a training course to enhance intellectual disability awareness amongst law enforcement officers: a pilot study.

Disability awareness training is mandated by the United Nations Convention on People with Disabilities (UNCRPD), but there is a paucity of evidence regarding the systematic evaluation of the effectiveness of such training. This study describes the evaluation of a pilot intellectual disability awareness programme for law enforcement officers (LEOs) in Ireland. Pre-and post-training Likert scales and a semi-structured survey were used to evaluate the effectiveness of an intellectual disabilities awareness programme delivered to LEOs. Quantitative differences in Likert scores and thematic analyses of practice-based responses were used in evaluation. Twenty-two LEOs participated in the training and 11 completed the evaluation cycle. Statistically significant improvements were found in participants' self-rated knowledge of intellectual disability, their understanding of the challenges faced by people with intellectual disabilities in law enforcement interactions, their communication skills and their knowledge of how to approach a person with a disability in crisis. Thematic analysis excavated potential practical application of learning around pre-arrest considerations, recognition of disability, communication skills and need for procedural safeguards. An approach grounded in the views of people with intellectual disabilities and with emphasis on recognition of disability, communication, accessibility of information and providing appropriate support in custody, appears to promote improvement in self-reported knowledge and prospective application in LEOs. The findings of this study are potentially applicable to countries that have ratified the UNCRPD

Homelessness amongst psychiatric Inpatients: a cross-sectional study in the Mid-West of Ireland.

This cross-sectional study sought to establish the prevalence of homelessness amongst inpatients in two psychiatric units in Ireland and explore the perceived relationship between psychiatric illness and homelessness. The study employed a semi-structured interview format utilising a specifically designed questionnaire which received ethical approval from the Limerick University Hospitals Group ethics committee. Fifty psychiatric inpatients were interviewed. Fifteen were either "currently" homeless (n = 8) or had experienced "past" homelessness (n = 7). Those who had experienced homelessness were more likely to have a psychotic illness. A majority of those who had experienced homelessness believed that psychiatric illness contributed to their homelessness. Involuntary admission rates were more than double for patients in the homeless group. A number of participants also reported that a lack of accommodation was preventing their discharge. Homelessness affects a significant number of psychiatric patients and can be both a contributory factor to, and consequence of, mental illness. With homelessness at unprecedented levels, there is a need for the development of tailored programmes aimed at supporting these vulnerable groups