Editorial

Citation

Dale, C. (2014), "Editorial", Journal of Intellectual Disabilities and Offending Behaviour, Vol. 5 No. 1. https://doi.org/10.1108/JIDOB-01-2014-0001

Editorial

Article Type: Editorial From: Journal of Intellectual Disabilities and Offending Behaviour, Volume 5, Issue 1.

December 2013 saw the publication of the “Learning Disability Census Report – England, 30th of September 2013”. The principal aim of the Census is to deliver action 17 in “‘Transforming Care: A national response to Winterbourne View Hospital’ – an audit of current services for people with challenging behaviour to take a snapshot of provision, numbers of out of area placements and lengths of stay”.

The Learning Disability Census provides a snapshot of inpatients with learning disabilities, autistic spectrum disorder and/or behaviour that challenges, and the services they receive, for service users who were inpatients in NHS and independent services at midnight on 30 September 2013. The census will be re-run on 30 September 2014.

The range of inpatient environments within the scope of the census included:

• high-, medium- and low-secure forensic wards;

• acute admission beds within specialised learning disability units;

• acute admission beds within generic mental health settings;

• forensic rehabilitation beds;

• complex continuing care and rehabilitation beds; and

• other beds including those for specialist neuropsychiatric conditions.

Overall, more than four in ten service users (45.2 per cent or 1,470 people) were inpatients in general (non-secure) wards and more than one in three (36.8 per cent or 1,195 people) were staying in low-secure wards. Around one in seven service users (15.8 per cent or 512 people) were in medium-secure wards; few (2.2 per cent or 73 people) were inpatients in high-secure wards.

The number of people with a learning disability in hospital inpatient units since 2010 has hardly changed. In the 2010 Census for England there were found to be 3,376 people and in 2013 the number is 3,250.

Sixty per cent (1,949) of these people have been in units for one year or more and nearly a quarter have been in the units for five years or more.

In the southwest, over half of people are in units 100 km or more from home (80 people). In the northeast just under 8.8 per cent of people are in units 100 km or more from home (29 people). The southwest, the southeast and Yorkshire and The Humber were the highest “net exporters” of service users; the East Midlands and the east of England were the highest “net importers” of service users.

One in five (20.1 per cent or 653) were inpatients in mental health wards. The remainder (3.6 per cent or 116) were inpatients on wards predominantly providing some other service. Ward stays in wards designed primarily for people with learning disabilities were substantially below the national proportion in Yorkshire and The Humber (62.2 per cent), London (59.7 per cent) and the southwest (40.5 per cent). As a region, the southwest had the highest proportion of inpatients staying in mental health wards (45.6 per cent) and in other wards (13.9 per cent).

Sixty-one out of 104 providers could not provide a residential postcode for at least one of the 3,250 service users. However, most (71.6 per cent) of this problem was focused on nine providers. This covered seven independent providers with and two NHS Trusts where they were unable to provide postcodes for hundreds of their patients. This must therefore beg the question “If you do not know where these people originate from how are you liaising with local services?”

Of the 104 providers submitting data on behalf of the 3,250 service users 58 were NHS providers on behalf of 1,804 service users; and 46 were independent provider's submitted data on behalf of 1,446 service users. Provision of inpatient services for people with learning disabilities was concentrated in a small number of providers. Overall, 17 providers with 50 or more service users together accounted for 65.1 per cent of all service users in the Learning Disability Census. Given the size of these establishments they have the characteristics of long-stay institutions (miles away from home and large) which community care was planned to replace decades ago.

It is now two and half years since the Winterbourne View scandal and the census and progress report show nothing has changed. Many people with a learning disability are still in in-patient units hundreds of miles away from their homes and many have been there for over a year or more.

The government released its report “Winterbourne View: Transforming Care – One Year On” on the same day as the “Learning Disability Census”. Care and Support Minister, Norman Lamb, said it is “not acceptable” for people with learning disabilities to live in institutions if with support they can live in their own community.

My experience of this situation makes me question who is advocating on behalf of the people placed in these services? If these large (mainly independent hospitals) are unable to provide details of where people are from it indicates little is being done with local services in any future repatriation. There is also a financial issue here where independent hospitals are being paid large sums of money to care for people where there may be a disincentive to encourage early discharge. Questions need to be asked of the commissioners who are securing and financing these placements about what mechanism are in place to ensure that the care people are in receipt of is appropriate and that there are clear plans for ensuring that the goal of returning people to their local communities into the least restrictive environments is underway. I see nothing in this report which shines a light on the commissioners repeated failings in this area; basically you cannot put all of the blame on commercial providers of care for this situation.

In this issue

Christy Patterson and colleagues describe a Life Skills Group which aims to increase knowledge and motivation in offenders with a learning disability. The paper explains that offenders with a learning disability present with greater clinical need than those without a learning disability. The authors argue that for this client group, access to, and engagement with, psychological and criminogenic interventions are often limited. This paper discusses a potentially useful approach to this issue.

A single case study design was used to evaluate an introductory group programme, delivered over 12 weekly sessions, in a forensic learning disability service. Semi-structured interviews were used alongside psychometric measures, which were completed prior to, and following completion of, the group, in order to assess the individual's experience of the group, their emotional understanding and difficulties, and readiness to change.

There findings were that readiness to change and emotional understanding improved following completion of the programme. Self-reported emotional difficulties showed improvement, although not all staff reports corroborated this. Notably, the service user reported a positive experience, with increased confidence and motivation to attend further groups.

The authors suggest that offering an introductory programme prior to further, more criminogenically focused intervention may be more effective than offering these interventions as the first stage of treatment.

William Jackson's article on “Developing a values evidence based clinical supervision model within a forensic intellectual disability service” discusses the development of such a model of clinical supervision for implementation by registered and non-registered clinical staff.

The paper demonstrates a novel and innovative approach to the conceptualisation and implementation of clinical supervision by exploring the dominant concepts that shape existing thinking around this topic and suggests a new interpretation that involves greater pragmatism through a values evidence-based approach.

Laura Willets and colleagues article explores the “Social climate in learning disability services”. The authors outline how the social climate of psychiatric institutions correlates with multiple outcomes related to staff and patients.

Staff and patients in learning disability services have documented both positive and negative experiences and this study therefore aims to understand how these compare and the impact of security on social climate.

The findings of this study suggest that patients in learning disability and non-learning disability services did not differ in their perceptions of social climate. Staff in non-learning disability services had a more positive perception of social climate than staff in learning disability services. However, patients and staff did not differ in their views on climate; security was negatively related to patients’ experienced safety.

Ian Hall and colleagues from East London NHS Foundation Trust describe a needs assessment of their secure inpatient services.

This study was completed with the aim of enabling the development of a robust pathway of care for adults with a learning disability requiring secure care, and to assist commissioners to make informed planning decisions.

The authors identified people with a learning disability originating from London who were in secure care (249), and collected data about them.

On average, patients were cared for 61.5 miles away from their homes, with NHS patients far closer to home; 69.1 per cent had a mild learning disability; 82.3 per cent had a history of violence. Approximately one in six patients could not progress due to a lack of an appropriate ward, facility, resource and/or intervention.

The authors observe that secure care for this population is a major public health issue; many being placed a long way from home. The paper concludes that local services should be developed, and there should be sufficiently robust “step down” places for patients to be discharged to.

Fergus Douds and colleagues describe their “Staying Well” project which is a psycho-educational group for people with an intellectual disability, co-morbid mental illness and offending behaviour.

The “Staying Well” programme was adapted and developed to be suitable for people with intellectual disability. The authors observe that input from a very experienced speech and language therapist was of great importance. Five groups with a total of 20 participants were run over a two-year period. At the end of each group, an individualised “Staying Well Plan” was devised, to reduce the risk of future relapses.

The group was very positively welcomed in the two pilot hospitals, by participants and members of the clinical teams. The key measure of the success of the programme is that the “Staying Well Plans” developed for the individuals are still in place two years after the completion of the first groups.

The authors believe that this approach is of benefit to both the participants and their carers, stimulating positive engagement, open discussion about mental illness and reinforcing strategies for “Staying Well”.

Colin Dale

Further reading

Department of Health (2013), “Winterbourne view: transforming care – one year on”, available at: www.gov.uk/%E2%80%A6/Winterbourne_View_One_Year_On_Report.pdf (accessed 15 January 2014)
Health and Social Care Information Centre (HSCIC) (2013), “Learning Disability Census report – England, 30th of September 2013”, available at: www.hscic.gov.uk/catalogue/PUB13149/ld-census-initial-eng-sep13-rep.pdf (accessed 15 January 2014)