Characteristics of prisoners with intellectual disabilities

BACKGROUND

Previous studies have found high rates of intellectual disabilities (ID) in prison. However, little is understood about prisoners with ID. This study aimed to identify prisoners with ID and compare their characteristics with prisoners without neurodevelopmental disorders with regard to demographic profile, mental health, suicide risk and offences.

METHOD

This was a descriptive, cross-sectional study carried out using face-to-face interviews with 240 participants in a London Category C prison. Standardised tools were used to assess prisoners for ID and mental disorder.

RESULTS

The study identified 18 prisoners as having ID. Participants with ID were less likely to be from a black or minority ethnic background, be over 35 years of age or have any qualifications. They were more likely to have been single, homeless or unemployed before coming into prison. Prisoners with ID were significantly more likely to have mental health problems and 25% had thought about suicide in the last month and 63% had attempted suicide in the past. Prisoners with ID were also more likely to be housed in the vulnerable prisoners' wing and significantly more likely to have committed robbery than other prisoners.

CONCLUSIONS

The findings confirm the presence of significant numbers of people with ID with high levels of mental illness in a male prison. Services across the CJS are required for this group, specifically, there is a need for raised awareness among those working in prison about ID and improved skills to recognise offenders with ID and address major gaps in current healthcare provision in prison.

Offenders with intellectual disabilities in prison: what happens when they leave?

BACKGROUND

People with intellectual disabilities, if convicted of offences, may be sentenced to prison, but little is known about their life when they are released.

METHOD

This study followed up men with intellectual disabilities who were leaving prisons in England.

RESULTS

The men were hard to contact, but 38 men were interviewed, on average 10 weeks after leaving prison. The men were living in a variety of situations and often were very under-occupied, with limited social networks. A total of 70% were above the clinical cut-off for anxiety, and 59.5% were above the clinical cut-off for depression. The men were receiving little support in the community, and many had been reinterviewed by police.

CONCLUSIONS

Community teams need to provide better support to this very vulnerable group.

Prisoners with intellectual disabilities and detention status. Findings from a UK cross sectional study of prisons

The purpose of this study was to compare social and environmental historical and contextual risk factors between prisoners with intellectual disabilities and those without intellectual disabilities, and to investigate whether prisoners with intellectual disabilities were more likely to be placed on remand in prison (awaiting trial or sentencing) compared to those without intellectual disabilities, after controlling for socio-demographic factors such as age, gender, ethnicity, accommodation status and nature of offences. In this study, we carried out a secondary analysis of data from the 1997 Prison survey, which included 131 prisons in England and Wales. A fixed sampling fraction was used to obtain a representative sample of prisoners. A total of 3563 prisoners were approached and 3142 (88%) prisoners gave informed consent to be interviewed. Of these, 170 were identified as having intellectual disabilities using the Quick Test. Prisoners with intellectual disabilities were more likely to have lived in institutions or taken into local authority care and more likely to live in temporary accommodation. They were less likely to have had a paid job or any educational qualifications and more likely to perceive a lack of social support. Prisoners with intellectual disabilities were more likely to be placed on remand and were less likely to be sentenced, even after controlling for socio-demographic factors and nature of offence. This study suggests that prisons should be more pro-active at identifying people with intellectual disabilities and ensuring that their needs are met, including appropriate access to bail and court diversion schemes.

Intellectual Disabilities Among Prisoners: Prevalence and Mental and Physical Health Comorbidities

BACKGROUND

Limited evidence suggests that people with ID (ID) are overrepresented in prisons although prevalence rates of ID among prisoners vary significantly across studies, making it difficult to identify prevalence and assess existing need.

METHOD

A systematic review of relevant literature was conducted, and results were organized and compared in relation to study aims, design, measures used to screen for ID, sample, limitations and key findings.

RESULTS

Existing international data suggest a prevalence of prisoners with ID between 7 and 10%. Most frequent coexisting health issues among this population are hearing and vision impairments, obesity, diabetes and a range of mental health disorders, notably anxiety and personality and conduct disorders.

CONCLUSION

More research is required on prevalence rates and associated comorbidities of ID within prison settings, taking into account the heterogeneity of the population with ID.

Differences between juvenile offenders with and without intellectual disabilities in the importance of static and dynamic risk factors for recidivism

BACKGROUND

Juvenile offenders with intellectual disability (ID) have been largely ignored in the literature of risk assessment, while they are overrepresented in the criminal justice system, and ID is a risk factor for juvenile delinquency and recidivism. The aim of this study was to examine whether there are differences between juvenile offenders with and without ID in the impact of risk factors for recidivism. Both the impact of static and dynamic risk factors were examined. Static risk factors were examined in the criminal history domain and dynamic risk factors were examined in the domains of family, school, use of free time, friends, alcohol/drugs, attitude, aggression and skills. This knowledge is important for both assessment and treatment of juvenile offenders with ID.

METHOD

The sample consisted of adolescents who appeared before the courts for a criminal act and for whom the Washington State Juvenile Court Assessment (WSJCA) was completed. The group of ID juvenile offenders (n = 102) consisted of juvenile offenders with a formal diagnosis of ID, which means a full scale IQ of less than 70, coupled with significant deficits in adaptive behaviour, with childhood onset. The juveniles of this group are special education students or they have a formal diagnosis of a special education need. The group without ID (n = 526), was a random sample of all juvenile offenders without a formal diagnosis of ID.

RESULTS

No differences were found between juvenile offenders with and without ID in the impact of risk factors on recidivism in most domains. However, in the skills domain, the relations between all risk factors and recidivism were significantly stronger in adolescents without ID than in adolescents with ID. Although not or only borderline statistically significant, these risk factors were all negatively related to recidivism in adolescents with ID, whereas these risk factors were significantly and positively related to recidivism in adolescents without ID.

CONCLUSIONS

There are few differences between juvenile offenders with and without ID in the impact of risk factors for recidivism, suggesting that the same assessment methods can be used for juvenile offenders with and without ID. There were, however, differences between juvenile offenders with and without ID in the skills domain. What these differences mean for the treatment of juvenile offenders is yet to be determined. For now it is important to be aware of potential negative (side) effects on recidivism when skills training is offered to juvenile offenders with ID.

Assessing the prevalence of intellectual disability among young male prisoners

BACKGROUND

In recent years, academic debate has (re)focused on the extent of the co-occurrence of intellectual disability (ID) and criminality, although findings from prevalence studies examining this link have been inconsistent. In April 2004, a process for transferring responsibility for commissioning healthcare services in UK prisons to Primary Care Trusts (PCTs) commenced. This development meant that it was important for PCTs to ascertain the need for specialist ID services in prisons in their areas. Because there were no reliable prevalence data, this research was commissioned by one such PCT.

METHOD

Using a stratified random sampling frame, data were collected from 185 young adult male prisoners aged 18 and 21 years old. Participants completed a semi-structured research questionnaire, the Kaufman Brief Intelligence Test (Second Edition) (KBIT2) and the Vineland Adaptive Behavior Scales (Second Edition) (VABS2).

RESULTS

Ten per cent had an IQ composite of 69 or below, indicating a significant impairment in cognitive functioning. A further 10% had IQ composite scores between 70 and 74, and 14% between 75 and 79. None of the sample had an Adaptive Behavior Composite (ABC) score of 69 or less, although 15% scored between 70 and 79 on this measure. While none of the sample could be classified as having an ID in strict diagnostic terms, 4% scored 69 or below on the KBIT2 and in the borderline (71-79) range on the VABS2, 4% had borderline ABCs and IQs between 70 and 74; and 3% had borderline ABCs and IQs less than 79. This equates to a point prevalence of borderline ID of 11%.

CONCLUSIONS

Eleven per cent of the sample had borderline ID, supporting suggestions that this group are prevalent--and easily hidden--in mainstream criminal justice settings. Differences between borderline ID inmates and non-ID counterparts are discussed, and implications for service delivery are considered.

The prevalence of intellectual disabilities among 12,000 prisoners - a systematic review

There are 9 million prisoners worldwide, but it is uncertain what proportion have intellectual disabilities. Such prisoners have been identified as a vulnerable group at risk of victimization and mental illness. Psychiatric surveys based on interviews of unselected prison populations were sought, involving diagnoses of intellectual disabilities. The search was performed by computer-assisted searches, scanning of relevant reference lists, hand-searching of journals, and correspondence with authors of relevant reports. Prevalence rates of intellectual disabilities by gender and other potentially relevant study characteristics were abstracted from publications, supplemented by information from authors of reports. Ten relevant surveys from four different countries were identified that included a total of 11,969 prisoners (mean age: 29 years; 92% male; 23% violent offenders). No formal calculation of a summary estimate of prevalence was undertaken due to substantial heterogeneity. The results suggest that typically 0.5-1.5% of prisoners were diagnosed with intellectual disabilities (range 0% to 2.8% across studies). We conclude that the number of prisoners with intellectual disabilities is considerable and discuss implications for policy and practice.

Persons with intellectual disabilities in the criminal justice system: review of issues

Although the vast majority of individuals with intellectual disabilities (ID) are law-abiding citizens, there is a small percentage with offending behaviour that is considered antisocial, socially inappropriate, or defined as illegal. It has long been recognised that individuals with ID or mental-health needs who break the law should be dealt with differently from the general population. There have been an increasing number of empirical studies in this area; however, these have been plagued by various definitional and methodological issues. Prevalence estimates of offenders with ID are complicated by diagnostic variations and inconsistencies in the criminal justice process. International studies have shown a large range, from 2% to 40%, depending on methodological approaches. The following review will highlight the salient issues including prevalence of offending, characteristics of offenders, vulnerabilities within the legal system, assessment, and a brief overview of intervention and treatment approaches.

Offending Behaviour in Adults with Asperger Syndrome

Considerable speculation is evident both within the scientific literature and popular media regarding possible links between Asperger syndrome and offending. A survey methodology that utilised quantitative data collection was employed to investigate the prevalence of offending behaviour amongst adults with Asperger Syndrome in a large geographical area of South Wales, UK; qualitative interviews were then conducted with a sub-sample of those identified. A small number of participants meeting the study criteria were identified. For those who had offended, their experience of the criminal justice system was essentially negative. Possible implications of the results were discussed.

Rate and characteristics of men with an intellectual disability in pre-trial detention

BACKGROUND

Various lines of research point to the overrepresentation of individuals with intellectual disability (ID) in the criminal justice system. Studies have also shown that individuals with ID are vulnerable to mental health problems. To date there have been no Canadian studies of individuals with an ID in the criminal justice system.

METHOD

The present study reports on the sociodemographic, mental health and criminological characteristics of 281 individuals with an ID from a Canadian study of men in a pre-trial holding centre.

RESULTS

Almost 19% of the men had a probable ID, and nearly one-third (29.9%) were in the borderline IQ range. As was the case for their non-ID counterparts, the mean age of the probable ID group was in the early 30s, few were employed, and most had low incomes. Individuals in the probable and borderline ID groups had lower rates of high school completion than those in the average intellectual ability range. Over 60% of individuals with an ID had a substance use disorder, and 1 in 5 was intoxicated at the time of assessment. These rates were similar across groups, and to those found in the literature. A large majority of individuals with ID had a previous conviction, and most had previously committed a violent offence.

CONCLUSIONS

Among other limitations, the sample may not have been entirely representative of the total population of men in the pre-trial detention centre, given the relatively high refusal rate (39.5%). Results are discussed in terms of orienting criminological and mental health services as a function of the level of intellectual and adaptive functioning of individuals with ID.

Offenders with intellectual disability: a prospective comparative study

BACKGROUND

Intellectually disabled offenders (IDO) are a poorly served and under-recognized group, who are likely to require long-term specialist treatments and interventions.

METHOD

This prospective study investigated the characteristics and factors that influence outcome in this group, with particular reference to therapeutic interventions. Sixty-one individuals were identified from contact with either (1) specialist health and social services for people with intellectual disability (ID) or (2) nonspecialist services in the criminal justice or (forensic) mental health/social service systems. The participants were assessed at baseline and after a mean of 10 months in order to compare recidivism rates and the impact of therapeutic interventions.

RESULTS

The findings suggest that IDO start offending at an early age, that they frequently have a history of multiple offences, and that sex offending and arson are over-represented offence types. Those participants recruited from nonspecialist ID services had significantly higher IQs and were less likely to have had contact with community social and health support agencies. Despite the high rates of psychopathology, there was little evidence for efficacy of therapeutic interventions, which, where offered, appeared to be of a nonspecific nature. At second interview, approximately half of the sample had re-offended.

Offenders with intellectual disability: the size of the problem and therapeutic outcomes

BACKGROUND

People with intellectual disability (ID) who offend may be subject to a variety of dispositions within the criminal justice system, or via diversion to health and social services in inpatient units or in community ID teams. Offenders with ID are a group with complex needs who may pose a recurrent risk to the public. Despite the significant number of offenders with ID, there is limited evidence on treatment effectiveness and outcomes.

METHODS

A literature search of all electronic databases was undertaken, and journals were hand-searched for clinical trials or case studies of interventions for offenders with ID. The main outcome was recidivism rates.

RESULTS

There were no published clinical trials of offenders with ID. A series of small-scale group cognitive-behavioural treatments for sex offenders offers the most persuasive evidence of success in reducing recidivism.

CONCLUSION

Offenders with ID often receive inadequate services as a result of poor identification through the criminal justice system and research into effective treatments is rudimentary. Further studies are necessary in order to improve treatment efficacy and service provision for a complex group of individuals.

Prevalence of criminal offending by men and women with intellectual disability and the characteristics of offenders: implications for research and service development

The investigation of the relationship between criminal offending and the presence of an intellectual disability (ID) is problematic for two main reasons. First, because of problems associated with the definition of 'ID' and secondly, because much criminal offending goes undetected or unreported, and studies can only investigate those already involved with the criminal justice process. Studies using IQ as a continuous variable indicate that significantly below-average intellectual ability is an independent predictor of future offending. Whilst people with ID may be over-represented in parts of the criminal justice system, given the intellectual and other psychosocial disadvantages which they experience, the level of offending behaviour in this particularly vulnerable group is strikingly low. The present authors propose that two broad groups of people can be identified. The first, broader, group is one of people for whom social disadvantage and mental ill health (particularly substance abuse), coupled with a significant intellectual impairment, are the main characteristics. Secondly, there is a smaller group of people, usually already known to ID services as service users, but for whom the process whereby what might have been conceptualized as 'challenging behaviour' becomes 'offending' is far from clear. The distinction the present authors make between challenging behaviour and offending is important for understanding how 'difficult' behaviour becomes identified as 'antisocial/criminal behaviour'. They argue that research needs to move from prevalence and descriptive studies to investigating the processes which determine movement in and out the criminal justice system. The present political emphasis on public protection and proposals for significantly broader mental health legislation raise the danger of a re-expansion of institutional models of care, rather than the development of multi-agency support networks. The present paper underscores a note of caution, particularly where choices have to be made between expanding institutional models on the one hand and providing more integrated services on the other. Over and above policy decisions, these are social and political choices.

Health risk escalators and the rehabilitation of offenders with learning disabilities

This paper presents a study of risk management in a hospital within the UK. National Health Service which attempts to rehabilitate offenders with learning disabilities. Analysis is based on the metaphor of a 'risk escalator'. Health and social care systems can be characterised as risk escalators if they possess three attributes. Firstly, risk managers should agree the rough ordering of the severity of a set of related risks. Secondly, a repertoire of responses which provide different trade-offs between autonomy and safety, and which can be calibrated against risk severity, should be available. Thirdly, the potential for positive and/or negative feedback, which give risk escalators their dynamic character, should be identified. Risk escalators may be deliberately designed, or may, like the hospital regime discussed in this paper, coalesce from pre-existing sub-systems offering different autonomy/safety balances. They may carry service users upwards towards greater safety if needed, as in health screening systems, or downward towards greater autonomy if justified, for instance in rehabilitation systems. Their therapeutic status is contestable. Upward risk escalators can be accused of generating positive feedback, with iatrogenic effect. Downward risk escalators may be criticised for pushing service users too strongly towards less intense interventions, causing neglect. The present case study brings out emergent properties of a downward risk escalator, including: organisational disruption to system functioning; preferencing of safety over autonomy; active and reflexive system management by clients; multiple, organisational risk rationalities; and the reification of riskiness as a generic attribute of individuals.

Research and literature on sex offenders with intellectual and developmental disabilities

The present paper sets out to review the literature on several aspects of sex offenders with intellectual and developmental disabilities, including the relationship between sex offending and developmental disabilities, the prevalence and characteristics of sex offenders in this client group, assessment, treatment, and outcome of intervention. Several important variables were identified as influencing the disparate results found in different prevalence studies. These include variations in inclusion criteria, differences in the source of the sample, differences in determination of IQ, the impact of deinstitutionalization, and the effect of changing social and penal policies in the area where studies have been conducted. Although some studies have suggested an increasing incidence, there is no clear evidence for the over- or under-representation of people with developmental disabilities amongst sex offenders. One of the main methodological flaws in several reports listing the characteristics of sex offenders is that considerations are based on clinical samples. Therefore, there is no control group to show that these characteristics do not exist in other samples of individuals with intellectual disability (ID). It does appear that sex offenders with ID are more likely to commit offences across categories and to be less discriminating in their victims. There may also be an association with sexual abuse in childhood. The primary issue considered has been assessment of competency, in that people with ID are considered to be disadvantaged by the criminal justice process. While several authors have delineated the important areas for assessment, there are few assessment measures with robust psychometric properties. Pharmacological, behavioural, educational and cognitive treatments are reviewed. Several comprehensive treatments which include all of the aforementioned methods are also considered. Although most studies do not report particularly positive outcomes, several authors have found better outcomes with treatment lasting at least 2 years.

Intellectual disability amongst people on probation: prevalence and outcome

BACKGROUND

Previous research has suggested that people with intellectual disability (ID) can be found in the criminal justice system. However, little is currently known about those supervised in the community on probation orders.

METHODS

Ninety people on probation in south-east England were screened using the Learning Disabilities in the Probation Service (LIPS) screening tool, which was designed to be used by probation officers to identify those with possible ID. The LIPS incorporates two measures of cognitive functioning: (1) the Quick Test (QT); and (2) the Clock Drawing Test (CDT).

RESULTS

Seven per cent of participants were found to have QT IQs and CDT scores 1.6 SD below the mean. When compared to those who appeared to be functioning within the normal range, those with possible ID were found to be significantly younger. However, no differences were found between the two groups in terms of the final outcome of the probation order.

CONCLUSIONS

It seems likely that the probation service contains a significant minority of people with ID. Despite the fact that no difference was found to exist in terms of outcome, people with ID or borderline ID are likely to have a number of support needs which could affect the success of their time on probation.

Patterns of offending among people with intellectual disability: a systematic review. Part II: predisposing factors

In the present study, the second part of a review of offending by adults with intellectual disability (ID), data on predisposing factors are presented and there is a discussion of the overall conclusions. The available data are shown to be problematic in a number of respects: there is no offence-specific data; and a number of dimensions are under-explored, specifically race, class and subjective accounts of offenders. Age and gender were the most highly correlated factors, as they are with offenders generally; however, there does appear to be evidence that the average age of offenders with ID is higher than for other offenders. The present authors note with concern the inattention to mainstream criminological research, and a tendency to downplay the extent to which an 'offender' is the outcome of complex and multifarious social processes. The authors also argue that the literature is dominated by unsubstantiated assumptions regarding the direction which policy and practice should take.

Patterns of offending among people with intellectual disability: a systematic review. Part I: methodology and prevalence data

A systematic review of research on offenders with intellectual disability (ID) was conducted. In the present study, the first of a two-part presentation of the findings, the authors outline the methodology of the review and present data on the prevalence of offending by adults with ID. The review highlights the methodological problems of the research and the low level of rigour in many of the studies. The organization of the penal and 'care' systems are seen to have a huge impact on research findings. In addition, studies which adopt an IQ-based concept of ID show low rates of offending, whilst those which use wider definitions (e.g. attendance at special school) show higher ones. There is also preliminary evidence for believing that the prevalence of arson and sexual offences may be higher relative to other kinds of crimes for people with ID than for other offenders.

Offenders who have a learning disability

This article examines aspects of the criminal justice system in relation to offenders with learning disabilities. Questions relating to the vulnerability and responsibility of suspects are explored in the light of recent literature. The legal rights of detainees are considered with reference to the Police and Criminal Evidence Act 1984. The role of the 'appropriate adult' is reviewed and implications for service workers are explored. Future directions are considered with reference to innovative developments in services. Victims and witnesses will be considered in a subsequent article.