1
|
Trofimovs J, Dowse L, Srasuebkul P, Trollor JN. Impact of post-release community mental health and disability support on reincarceration for prisoners with intellectual disability and serious mental illness in NSW, Australia. BJPsych Open 2023; 9:e44. [PMID: 36847167 PMCID: PMC10044015 DOI: 10.1192/bjo.2023.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Prisoners with an intellectual disability are overrepresented in custody and more likely to reoffend and be reincarcerated compared with the general prison population. Although prisoners with intellectual disability have many of the same risk factors for recidivism as the general prison population, the high rates of mental illness experienced by this group are key drivers of recidivism. AIMS We aimed to assess the impact of provision of post-release disability and community mental health support on rates of reincarceration in a cohort with identified intellectual disability and serious mental illness diagnosis. METHOD We conducted a historical cohort study using linked administrative data-sets, including data on hospital admissions, community mental health, disability support and corrections custody in New South Wales, Australia (n = 484). To assess the time to return to adult custody, we used survival analysis on multiple failure-time data. RESULTS Over the median follow-up period of 7.4 years, 73.7% (357) received community mental health support, 19.8% (96) received disability support and 18.6% (85) received a combination of supports during a post-release period from prison. Lower hazards of reincarceration in a post-release period were associated with receipt of community mental health support (hazard ratio [HR] = 0.58, CI 0.49-0.69, P < 0.001), or a combination of community mental health and disability support (HR = 0.46, CI 0.34-0.61, P < 0.001). CONCLUSIONS High rates of reincarceration for prisoners with intellectual disability and history of serious mental illness may be modifiable by provision of appropriate mental health and disability supports.
Collapse
Affiliation(s)
- Julian Trofimovs
- Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Leanne Dowse
- University of New South Wales School of Social Sciences, Sydney, Australia
| | - Preeyaporn Srasuebkul
- Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Julian N Trollor
- Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia; and Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| |
Collapse
|
2
|
Quinn S, Rhynas S, Gowland S, Cameron L, Braid N, O Connor S. Risk for intellectual disability populations in inpatient forensic settings in the United Kingdom: A literature review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1267-1280. [PMID: 35995572 PMCID: PMC10087896 DOI: 10.1111/jar.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND People with an intellectual disability who commit a criminal offence can be detained, by a court, in a forensic inpatient facility. There is limited understanding of how inpatients with an intellectual disability and their nurses navigate risk in U.K. forensic services. METHODS A traditional literature review design was followed to map evidence (2000-2021) around the forensic and health and wellbeing risks faced by inpatients with an intellectual disability, nurses' perceptions of managing risk, and patient experiences of informing risk assessment and management. Papers were analysed thematically. RESULTS Findings suggest that restrictive measures to mitigate forensic risks (e.g., violence) can exacerbate the risk of poor health and wellbeing outcomes. There was some limited evidence of direct patient involvement in risk assessment and management. CONCLUSION Further research is required to explore how forensic inpatients with an intellectual disability can have input in care planning, risk assessment and management.
Collapse
Affiliation(s)
- Sam Quinn
- The University of Edinburgh, Edinburgh, Scotland
| | - Sarah Rhynas
- The University of Edinburgh, Edinburgh, Scotland
| | | | | | | | | |
Collapse
|
3
|
Edberg H, Chen Q, Andiné P, Larsson H, Hirvikoski T. Criminal recidivism in offenders with and without intellectual disability sentenced to forensic psychiatric care in Sweden-A 17-year follow-up study. Front Psychiatry 2022; 13:1011984. [PMID: 36213925 PMCID: PMC9533124 DOI: 10.3389/fpsyt.2022.1011984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Offenders with intellectual disability (ID) constitute a distinct subgroup of offenders with mental disorders. Regarding criminal recidivism, it is unclear whether or not offenders with ID in forensic psychiatric settings differ from offenders without ID. Factors associated with criminal recidivism among offenders with ID have been scarcely investigated. AIM To investigate the association between ID and criminal recidivism among offenders sentenced to forensic psychiatric care and to explore the impact of clinical, sociodemographic and offense variables. MATERIALS AND METHODS We conducted a retrospective cohort study based on Swedish nationwide registers. A total of 3,365 individuals being sentenced to forensic psychiatric care in Sweden in 1997-2013 were followed from the forensic psychiatric assessment until first reconviction, death, emigration, or 31 December 2013, whichever occurred first. Cox regression models compared rates of recidivism in individuals with and without ID. Impact of clinical, sociodemographic, and offense variables on risk of criminal recidivism was presented as hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS Out of 3,365 offenders sentenced to forensic psychiatric care, 259 (7.7%) were diagnosed with ID. During follow-up (0-17 years, median 6 years), one third (n = 1,099) of the study population relapsed into criminality, giving a recidivism rate of 50.5 per 1,000 person-years. We observed an association between ID and a decreased risk of recidivism (HR 0.8, 95% CI 0.6-1.0, p = 0.063), although this reached statistical significance only for the subgroup of male offenders (HR 0.8, 95% CI 0.6-1.0, p = 0.040) and not females (HR 1.0, 95% CI 0.6-1.8). ID offenders with concurrent ADHD tended to have a higher rate of recidivism (73.9 per 1,000 person-years, HR 1.2, 95% CI 0.6-2.4) than ID offenders without ADHD (42.5 per 1,000 person-years, HR 0.8, 95% CI 0.6-1.1). Amongst ID offenders, concurrent autism spectrum disorder, young age or male sex were not associated with recidivism, while previous criminal convictions were strongly associated with recidivism. CONCLUSION A diagnosis of ID was associated with a lower risk of criminal recidivism among male offenders sentenced to forensic psychiatric care. The association between ADHD and recidivism among ID offenders highlights eligible focus areas in the management of offenders with ID.
Collapse
Affiliation(s)
- Hanna Edberg
- Paediatric Neuropsychiatry Unit, Department of Women's and Children's Health, Centre for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm, Sweden.,Swedish Prison and Probation Services, Norrköping, Sweden.,Northern Stockholm Psychiatric Clinic, Region Stockholm, Stockholm, Sweden.,Centre for Psychiatry Research, Region Stockholm, Stockholm, Sweden
| | - Qi Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Andiné
- Centre for Ethics, Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Tatja Hirvikoski
- Paediatric Neuropsychiatry Unit, Department of Women's and Children's Health, Centre for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm, Sweden.,Centre for Psychiatry Research, Region Stockholm, Stockholm, Sweden.,Habilitation & Health, Region Stockholm, Stockholm, Sweden
| |
Collapse
|
4
|
Whittingham L, Durbin A, Lin E, Matheson FI, Volpe T, Dastoori P, Calzavara A, Lunsky Y, Kouyoumdjian F. The prevalence and health status of people with developmental disabilities in provincial prisons in Ontario, Canada: A retrospective cohort study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1368-1379. [PMID: 32529696 DOI: 10.1111/jar.12757] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 04/15/2020] [Accepted: 05/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data on the prevalence of developmental disabilities in people who experience imprisonment and on their characteristics are lacking. METHODS The present authors identified adults with developmental disabilities who were released from Ontario provincial prisons in 2010 and a general population comparator group using administrative data. The present authors examined demographic characteristics, morbidity and healthcare use. RESULTS The prevalence of developmental disabilities was 2.2% in the prison group (N = 52,302) and 0.7% in the general population (N = 10,466,847). The prevalence of psychotic illness, substance-related disorder and self-harm was higher among people in the prison group with developmental disabilities. People with developmental disabilities were more likely to have emergency department visits and hospitalizations in prison and in the year after release. CONCLUSIONS People with developmental disabilities are overrepresented in provincial prisons and have a high burden of disease. Strategies are indicated to prevent incarceration and to improve health.
Collapse
Affiliation(s)
- Lisa Whittingham
- Department of Child and Youth Studies, Brock University, Saint Catharines, ON, Canada
| | - Anna Durbin
- ICES, Toronto, ON, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Lin
- ICES, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Flora I Matheson
- ICES, Toronto, ON, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Tiziana Volpe
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Parisa Dastoori
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | | | - Yona Lunsky
- ICES, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Fiona Kouyoumdjian
- ICES, Toronto, ON, Canada.,Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
5
|
Rowe S, Dowse L, Newton D, McGillivray J, Baldry E. Addressing Education, Training, and Employment Supports for Prisoners With Cognitive Disability: Insights from an Australian Programme. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2019. [DOI: 10.1111/jppi.12321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Simone Rowe
- School of Social SciencesUniversity of New South Wales Sydney NSW Australia
| | - Leanne Dowse
- School of Social SciencesUniversity of New South Wales Sydney NSW Australia
| | | | | | - Eileen Baldry
- School of Social SciencesUniversity of New South Wales Sydney NSW Australia
| |
Collapse
|
6
|
Melvin CL, Langdon PE, Murphy GH. "I feel that if I didn't come to it anymore, maybe I would go back to my old ways and I don't want that to happen": Adapted sex offender treatment programmes: Views of service users with autism spectrum disorders. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 33:739-756. [PMID: 31304657 DOI: 10.1111/jar.12641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 05/18/2019] [Accepted: 06/04/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND The cognitive and behavioural profile associated with autism spectrum disorders (ASD) includes difficulties with social interaction, communication and empathy. Each of these may present barriers to effective participation in sexual offending treatment, leading to poorer outcomes. METHOD Semi-structured interviews were conducted with 13 men with autism and an intellectual disability (including the borderline range) who had completed an adapted sex offender treatment programme. Grounded Theory was used to explore the men's experiences of treatment and perceptions of risk. RESULTS The men's perceptions of sexual risk were inextricably linked to constructs of identity and shaped their opinions of treatment effectiveness. Risk of reoffending was conveyed through narratives of changes in self and circumstances and included notions of blame and culpability. CONCLUSIONS The findings illustrated some clear benefits for men with ASD associated with attending adapted sex offender treatment programmes, including delivery of treatment within groups and opportunities for social development. The study supports the view that difficulties with empathy and cognitive flexibility complicates treatment for sexual offending.
Collapse
Affiliation(s)
- Clare L Melvin
- The Tizard Centre, University of Kent, Canterbury, UK.,Hertfordshire Partnership University NHS Foundation Trust, The Broadland Clinic, Norfolk, UK
| | - Peter E Langdon
- The Tizard Centre, University of Kent, Canterbury, UK.,Hertfordshire Partnership University NHS Foundation Trust, The Broadland Clinic, Norfolk, UK
| | | |
Collapse
|
7
|
Ray I, Simpson AIF, Jones RM, Shatokhina K, Thakur A, Mulsant BH. Clinical, Demographic, and Criminal Behavior Characteristics of Patients With Intellectual Disabilities in a Canadian Forensic Program. Front Psychiatry 2019; 10:760. [PMID: 31681051 PMCID: PMC6803491 DOI: 10.3389/fpsyt.2019.00760] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 09/20/2019] [Indexed: 11/30/2022] Open
Abstract
Background: People with intellectual disability (ID) and forensic issues constitute a challenging clinical group that has been understudied in forensic settings. Methods: We assessed the characteristics of patients with ID under the authority of the Ontario Review Board (ORB) in a large forensic program of a tertiary psychiatric hospital (excluding those with a cognitive disorder) and compared their characteristics with those of a non-ID control group. Results: Among 510 adult ORB patients, 47 had an ID diagnosis. ID patients were of younger age at index offense, with a lower level of education, and were less likely to have been married or employed, more likely to have committed a sexual offense, more likely to have a diagnosis of paraphilia, less likely to be "not criminally responsible," and more likely to be "unfit to stand trial." They were also more likely to have committed their index offenses against care professionals and be treated in a secure unit. Conclusion: Our findings have major implications for clinicians, clinical leaders, and policymakers about the specific needs of patients with ID presenting with forensic issues and differing needs in terms of treatment and risk management.
Collapse
Affiliation(s)
- Ipsita Ray
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Alexander I F Simpson
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roland M Jones
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Anupam Thakur
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Benoit H Mulsant
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
8
|
Jones E, Chaplin E. A systematic review of the effectiveness of psychological approaches in the treatment of sex offenders with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 33:79-100. [DOI: 10.1111/jar.12345] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Emma Jones
- Department of Forensic and Neurodevelopmental Sciences Institute of Psychiatry, Psychology and Neurosciences Kings College London London UK
| | - Eddie Chaplin
- Department of Forensic and Neurodevelopmental Sciences Institute of Psychiatry, Psychology and Neurosciences Kings College London London UK
| |
Collapse
|
9
|
Marotta PL. A Systematic Review of Behavioral Health Interventions for Sex Offenders With Intellectual Disabilities. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2017; 29:148-185. [PMID: 25667227 PMCID: PMC4530095 DOI: 10.1177/1079063215569546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article reviews evaluation studies of programs designed to treat sex offenders with intellectual and developmental disabilities (IDD) published in peer-reviewed journals between 1994 and 2014. The design of this study is mirrored after PRISMA (Preferred Reporting of Items for Systematic Reviews and Meta-Analyses) recommendations for conducting a systematic literature review. The study design, study setting, characteristics of participants, type of treatment, and intervention procedures comprise areas of focus for evaluating the implementation of treatment programs. Therapeutic outcomes include changes in attitudes consistent with sex offending, victim empathy, sexual knowledge, cognitive distortions, and problem sexual behaviors. Eighteen treatment evaluation studies were identified from the United States, the United Kingdom, Australia, and New Zealand. Cognitive-behavioral treatments were the most commonly delivered treatment modality to sex offenders with IDD. Other less common treatments were dialectical behavioral therapy, problem solving therapy, mindfulness, and relapse prevention. No randomized controlled trials were identified. The most common designs were multiple case studies and pre- and post-treatment assessments with no control and repeated measures follow-up. Small sample sizes, no control groups, and wide variation in treatment length and follow-up time complicate the qualitative synthesis of study findings. Short follow-up times introduce the potential for bias in conclusions surrounding treatment efficacy for many of the studies reviewed in this analysis. The overall quality of studies examining treatments for sex offenders with IDD is poor and requires further development before rendering firm conclusions about the effectiveness of interventions for this population.
Collapse
|
10
|
Morrissey C, Geach N, Alexander R, Chester V, Devapriam J, Duggan C, Langdon PE, Lindsay B, McCarthy J, Walker DM. Researching outcomes from forensic services for people with intellectual or developmental disabilities: a systematic review, evidence synthesis and expert and patient/carer consultation. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundInpatient services for people with intellectual and other types of developmental disabilities (IDD) who also have forensic or risk issues are largely provided in secure hospitals. Although this is a health service sector with high levels of expenditure, there is limited empirical information on patient outcomes from such services. In order for a future substantive longitudinal outcomes study in forensic IDD services to be informed and feasible, more needs to be understood about the outcome domains that are of relevance and importance and how they should be measured. A preliminary series of studies was therefore undertaken.ObjectivesTo synthesise evidence in relation to the outcome domains that have been researched in the existing literature from hospital and community forensic services for people with IDD, within the broad domains of service effectiveness, patient safety and patient experience. To identify a definitive framework of outcome domains (and associated measures and indicators) based both on this research evidence and on the views of patients, carers and clinicians. To synthesise the information gathered in order to inform design of future multisite longitudinal research in the sector.DesignThree linked studies were conducted. Stage 1 was a systematic review and evidence synthesis of outcome domains and measures as found within the forensic IDD literature. Stage 2 was a consultation exercise with 15 patients with IDD and six carers. Stage 3 was a modified Delphi consensus exercise with 15 clinicians and experts using the information gathered at stages 1 and 2.ResultsAt stage 1, 60 studies that researched a range of outcomes in forensic IDD services were identified from the literature. This resulted in the construction of an initial framework of outcome domains. The consultation with patients and carers at stage 2 added to these framework domains that related particularly to carer experience and the level of support post discharge in the community. The Delphi process at stage 3 confirmed the validity of the resulting framework for clinician. This survey also identified the outcome measures preferred by clinicians and those that are currently utilised in services. Thus, indicators of appropriate measures in some important domains were identified, although there was a paucity of measures in other domains.ConclusionsTogether, these three linked studies led to the development of an evidence-based framework of key outcome domains and subdomains. A provisional list of associated measures and indicators was developed, although with the paucity of measures in some domains development of specific indicators may be required. With further refinement this could eventually be utilised by services and commissioners for comparative purposes, and in future empirical research on outcomes in forensic IDD services. An outline research proposal closely linked to recent policy initiatives was proposed. Limitations of the study include the relatively small number of carers and patients and range of experts consulted.Future workThis would comprise a national longitudinal study tracking IDD in patients through hospitalisation and discharge.Study registrationThis study is registered as PROSPERO CRD42015016941.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Catrin Morrissey
- Division of Psychiatry and Applied Psychology, School of Medicine University of Nottingham, Nottingham, UK
- Community Forensic Service, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Nicole Geach
- Division of Psychiatry and Applied Psychology, School of Medicine University of Nottingham, Nottingham, UK
| | | | | | - John Devapriam
- Community Learning Disability Service, Leicester Partnership NHS Trust, Leicester, UK
| | | | - Peter E Langdon
- Tizard Centre, University of Kent, Canterbury, UK
- Hertfordshire Partnership University NHS Foundation Trust, Norfolk, UK
| | - Bill Lindsay
- Danshell Ltd, London, UK
- University of the West of Scotland, Paisley, UK
| | - Jane McCarthy
- John Howard Centre, East London NHS Foundation Trust, London, UK
| | - Dawn-Marie Walker
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
11
|
Morrissey C, Langdon PE, Geach N, Chester V, Ferriter M, Lindsay WR, McCarthy J, Devapriam J, Walker DM, Duggan C, Alexander R. A systematic review and synthesis of outcome domains for use within forensic services for people with intellectual disabilities. BJPsych Open 2017; 3:41-56. [PMID: 28243465 PMCID: PMC5303894 DOI: 10.1192/bjpo.bp.116.003616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/23/2016] [Accepted: 01/09/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is limited empirical information on service-level outcome domains and indicators for the large number of people with intellectual disabilities being treated in forensic psychiatric hospitals. AIMS This study identified and developed the domains that should be used to measure treatment outcomes for this population. METHOD A systematic review of the literature highlighted 60 studies which met eligibility criteria; they were synthesised using content analysis. The findings were refined within a consultation and consensus exercises with carers, patients and experts. RESULTS The final framework encompassed three a priori superordinate 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 behaviours, reactive and restrictive interventions, quality of life and patient satisfaction. CONCLUSIONS To index recovery, services need to measure treatment outcomes using this framework. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.
Collapse
Affiliation(s)
- Catrin Morrissey
- , PhD, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, and Complex and Forensic Service, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Peter E Langdon
- , PhD, Tizard Centre, University of Kent, Canterbury, and Broadland Clinic, Hertfordshire Partnership University NHS Foundation Trust in Norfolk, Norwich, UK
| | - Nicole Geach
- , MRes, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Verity Chester
- , MSc, Department of Psychiatry, Partnerships in Care, Norfolk, and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Michael Ferriter
- , PhD, [Retired from] Forensic Division, Nottinghamshire Healthcare NHS Trust, Nottingham, UK
| | - William R Lindsay
- , PhD, Department of Psychology, University of the West of Scotland, UK, and Department of Psychology, The Danshell Group, UK
| | - Jane McCarthy
- , FRCPsych, Department of Forensic and Neurodevelopmental Sciences (FANS), Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - John Devapriam
- , FRCPsych, Department of Psychiatry, Leicestershire Partnership NHS Trust, Leicester, and Care Quality Commission, London, UK
| | | | - Conor Duggan
- , OBE, FRCPsych, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Regi Alexander
- , FRCPsych, Department of Psychiatry, Partnerships in Care, Department of Psychiatry, Leicestershire Partnership NHS Trust, and Department of Psychiatry, University of Leicester, Leicester, UK
| |
Collapse
|
12
|
Lindsay WR, Carson D, Holland AJ, Taylor JL, O'Brien G, Wheeler JR, Steptoe L. Alcohol and its relationship to offence variables in a cohort of offenders with intellectual disability. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2013; 38:325-331. [PMID: 24279785 DOI: 10.3109/13668250.2013.837154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Alcohol use and misuse may be lower in people with intellectual disability (ID) than in the general population but may be related to offending. METHOD Alcohol-related crime and history of alcohol use was recorded in 477 participants with ID referred to forensic ID services and related to offending. RESULTS Level of alcohol-related crime and history of alcohol misuse was lower than in some previous studies at 5.9% and 20.8%, respectively. History of alcohol abuse was associated with alcohol-related offences and theft. Higher rates of alcohol problem history were associated with histories of a number of offences, psychiatric disturbance in adulthood, psychiatric disturbance in childhood, and experiences of childhood adversity. Most effect sizes were weak or moderate. CONCLUSIONS The convergence of childhood adversity, psychiatric problems in childhood and adulthood, and alcohol abuse is consistent with studies that have found these as risk markers for offending.
Collapse
|