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McKinnon I, Keown P. The potential unintended consequences of Mental Health Act reforms in England and Wales on people with intellectual disability and/or autism: commentary, McKinnon et al. Br J Psychiatry 2024; 224:180-181. [PMID: 38563223 DOI: 10.1192/bjp.2024.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Iain McKinnon
- Secure Services, Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK; and Population Health Sciences Institute, Newcastle University, UK
| | - Patrick Keown
- Psychiatric Rehabilitation, Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK; and Translational and Clinical Research Institute, Newcastle University, UK
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Lunsky Y, Matheson FI, Kouyoumdjian F, Whittingham L, Lin E, Durbin A, Calzavara A, Moser A, Dastoori P, Sirotich F, Volpe T. Intellectual and developmental disabilities in Ontario's criminal justice and forensic mental health systems: Using data to tell the story. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2024; 34:197-207. [PMID: 38264949 DOI: 10.1002/cbm.2331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND International studies show that adults with intellectual and developmental disabilities (IDD) are disproportionately represented in the criminal justice and forensic mental health systems; however, it is difficult to capture their involvement across systems in any one jurisdiction. AIMS The current study aimed to estimate the prevalence of IDD across different parts of the criminal justice and forensic mental health systems in Ontario and to describe the demographic and clinical profiles of these individuals relative to their counterparts without IDD. METHODS This project utilised administrative data to identify and describe the demographic and clinical characteristics of adults with IDD and criminal justice or forensic involvement across four sectors: federal correctional facilities, provincial correctional facilities, forensic inpatient mental health care and community mental health programmes. Questions were driven by and results were contextualised by a project advisory group and people with lived experience from the different sectors studied, resulting in a series of recommendations. RESULTS Adults with IDD were over-represented in each of the four settings, ranging from 2.1% in federal corrections to 16.7% in forensic inpatient care. Between 20% (forensic inpatient) and 38.4% (provincial corrections) were under the age of 25 and between 34.5% (forensic inpatient) and 41.8% (provincial corrections) resided in the lowest income neighbourhoods. Medical complexity and rates of co-occurring mental health conditions were higher for people with IDD than those without IDD in federal and provincial corrections. CONCLUSIONS Establishing a population-based understanding of people with IDD within these sectors is an essential first step towards understanding and addressing service and care needs. Building on the perspectives of people who work in and use these systems, this paper concludes with intervention recommendations before, during and after justice involvement.
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Affiliation(s)
- Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Flora I Matheson
- ICES, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Fiona Kouyoumdjian
- ICES, Toronto, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Whittingham
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Child and Youth Studies, Brock University, St. Catharines, Ontario, Canada
| | - Elizabeth Lin
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Anna Durbin
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | | | - Andrea Moser
- Research Branch, Correctional Service Canada, Ottawa, Ontario, Canada
| | - Parisa Dastoori
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | - Frank Sirotich
- Canadian Mental Health Association, Toronto Branch, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Tiziana Volpe
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Tromans S, Bhui K, Sawhney I, Odiyoor M, Courtenay K, Roy A, Boer H, Alexander R, Biswas A, McCarthy J, Gulati G, Laugharne R, Shankar R. The potential unintended consequences of Mental Health Act reforms in England and Wales on people with intellectual disability and/or autism. Br J Psychiatry 2023; 222:188-190. [PMID: 36746616 DOI: 10.1192/bjp.2023.10] [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: 02/08/2023]
Abstract
The draft Mental Health Bill, which amends the Mental Health Act 1983 for England and Wales, proposes protections for people with intellectual disability and/or autism (ID/A) to prevent detention in hospital in the absence of mental illness. This editorial critically appraises the positive impact and unintended consequences of the proposed reforms for people with ID/A.
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Affiliation(s)
- Samuel Tromans
- Department of Psychiatry, University of Leicester, Leicester, UK; and Leicestershire Partnership NHS Trust, Leicester, UK
| | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Indermeet Sawhney
- Faculty of the Psychiatry of Intellectual Disability, Royal College of Psychiatrists, London, UK; and Hertfordshire Partnership NHS Foundation Trust, Braintree, UK
| | - Mahesh Odiyoor
- Faculty of the Psychiatry of Intellectual Disability, Royal College of Psychiatrists, London, UK; Department of Psychiatry, University of Chester, Chester, UK; and Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Ken Courtenay
- Psychiatry of Intellectual Disability Services, Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK
| | - Ashok Roy
- Psychiatry of Intellectual Disability Services, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Harm Boer
- Learning Disabilities and Autism Services, West Midlands Partnership Alliance, Birmingham, UK
| | - Regi Alexander
- Intellectual Disability Forum, Royal Society of Medicine, London, UK
| | - Asit Biswas
- Leicestershire Partnership NHS Trust, Leicester, UK
| | - Jane McCarthy
- Learning/Intellectual Disability Service, Sussex Partnership NHS Foundation Trust, Worthing, UK; and Department of Psychiatry, King's College London, London, UK
| | - Gautam Gulati
- Department of Psychiatry, University of Limerick, Limerick, Ireland; and Faculty of Forensic Psychiatry, College of Psychiatrists of Ireland, Dublin, Ireland
| | - Richard Laugharne
- Cornwall Partnership NHS Foundation Trust, Truro, UK; Peninsula Clinical Research Network, Exeter, UK; and Cornwall Intellectual Disability Equitable Research, University of Plymouth, Plymouth, UK
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research, University of Plymouth, Plymouth, UK; Cornwall Partnership NHS Foundation Trust, Truro, UK
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Eber GB. I Refuse for the Devil to Take My Soul: Inside Cook County JailLiliKobielski by powerHouse Book, 2018. 152 pages, ISBN13: 9781576878880. WORLD MEDICAL & HEALTH POLICY 2022. [DOI: 10.1002/wmh3.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Gabriel B. Eber
- Senior Associate, Department of Epidemiologym, Affiliate Faculty, Center for Public Health and Human Rights Johns Hopkins Bloomberg School of Public Health Baltimore United States
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Askola R, Louheranta O, Seppänen A. Factors Affecting Treatment Regress and Progress in Forensic Psychiatry: A Thematic Analysis. Front Psychiatry 2022; 13:884410. [PMID: 35903640 PMCID: PMC9314742 DOI: 10.3389/fpsyt.2022.884410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 06/23/2022] [Indexed: 11/27/2022] Open
Abstract
International variability and shifting trends in forensic psychiatry lead to gaps in national service provision and needs for service development. This study explores these needs through the subjective narratives of those involved in Finnish forensic services, either as forensic psychiatric patients, their parents, or service providers. Data was gathered by means of thematic interview and subjected to thematic analysis. Three main themes emerged: (1) pre-treatment challenges, (2) institutional/treatment-related concerns about therapeutic security and (3) adapting and recovery. The research highlights the need to develop forensic psychiatric services at three levels. First, it calls for increased risk awareness and risk assessment skills at the general psychiatric level. Second, it emphasizes the need for increased therapeutic engagement throughout the rehabilitative process. Third, it calls for structured and meaningful post-discharge aftercare. At all three levels, gradated security-aware standardization and patient triage in forensic services would help to develop and maintain an intact care pathway. This would decrease offending, marginalization, and suffering. Only then can we begin to meet the requirements of the WHO European Mental Health Action Plan. These findings can contribute to the development of international, standardized treatment models for clinical forensic psychiatric practices.
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Affiliation(s)
- Riitta Askola
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | | | - Allan Seppänen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Vanha Vaasa Hospital, Vaasa, Finland
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