Breaking the Cycle: Better Help for People with Learning Disabilities at Risk of Committing Offences

1
Breaking the Cycle Better Help for People with
Learning Disabilities at Risk of Committing
Offences

• Glynis Murphy
• Professor of Clinical Psychology
• Univ of Lancaster

2
NW strategy for people with LD at risk of offences

• Commissioned by Regional Task Force, about 18
  mths ago
• Core group of about 8 people (incl.
  commissioners, psychologists, community nurse,
  rep from secure service, social services rep
  (ex-PO), etc)
• Led by Martin Routledge, VP
• Document Breaking the Cycle went out to
  consultation (led by NWTDT) end of December 05
• Comments by end of Feb 06

3
Why is it important?

• People at risk of offending very often end up in
  restrictive provision, sometimes 100s of miles
  from home
• Secure hospital places increasing in number
  (private hospitals almost 1000 LD places now)
• Often people sent away because local services
  dont know how to meet their needs
• Often away for years
• Not always formally detained
• Not the least restrictive provision possible

4
Why are local services struggling?

• Insufficient knowledge and competence in CLDTs
  (health social care)
• Arguments over fair access to care whose
  responsibility it is for people at risk of
  offending
• Insufficient knowledge confidence in staff in
  residential, day employment services
• Poor inter-agency coordination
• Insufficient early intervention
• Insufficient training in this area
• Poor knowledge analysis at Commissioning levels

5
Who is it that needs better help?

• People with LD at risk of offending are
• Mostly male (maybe 20 female)
• Have relatively good self-care communication
  skills
• Often have additional health needs (mental
  health autism)
• Often had very disturbed, disrupted chaotic
  childhoods
• Usually have had little consistent emotional
  support
• Frequently bounce from service to service
  placement to placement
• 3 of those known to CLDTs have convictions
  (McBrien et al 03)

6
Breaking the CycleKey principles

• Legal civil rights to act as citizens to be
  held responsible for actions to understand
  exercise their rights in CJS
• Independence to learn new skills not to live
  in more restrictive environments than necessary
• Choice Choice thru Person-Centred Plans limits
  to choice
• Inclusion Need to be included in an ordinary
  life need good support, tailored to needs, plus
  good risk assessment risk management

7
Effective strategies

• Positive, person-centred emphasis, with good risk
  management
• Least restrictive
• Near to home (victim needs must be considered
  though)
• Multi-agency Positive partnerships between
  agencies (CJS probation, prison, police, youth
  justice teams, secure services, CAMHS, CLDTs,
  employment, residential)
• Sense of shared responsibility across services
• Good information where are people detained?, how
  much is it costing? what plans are there to
  bring them back nearer home?

8
Support services Community Teams

• Childrens and adolescent services problems
  often known about at this stage. Need good
  interventions coordination with adult services
• Youth Offending Teams also see lots of people
  with LD need to identify them coordinate with
  adult services
• Community support teams ALL CLDTs (health
  social services) should be able to provide for
  not so complex needs low risk (eg basic CBT
  risk assessment management care planning)

9
Intensive Support Teams (can be virtual)

• Intensive support teams for more complex needs
  higher risk people
• To liaise with police, probation, courts, prisons
  
• Provide rapid assessments for police, courts (eg
  on fitness to plead)
• Support people through the CJS (police station,
  courts, etc)
• Liaise with people in secure services
• Arrange care packages
• Provide assessment treatment
• Provide training for police, probation, courts,
  CLDTs, staff in res services

10
Day, college employment services

• Building based, large day services are not the
  answer
• Must be individualised day service- with
  supervision if necessary- could include college,
  employment, volunteering- has to be very
  carefully designed, well monitored, with good
  risk assessment management

11
Residential servicesWhere to live

• Range of provision needed
• Often struggle with families group homes not
  good option
• One and two person flats/houses better (
  support)
• Independent living can be possible, with
  carefully graded, flexible support on-call
  service
• Specialist intensive support services
• Emergency respite small number of places needed
  for assessmt/ttmt
• Secure service Need small local low/medium
  places if poss
• Need very small no. high secure (4 in NW)

12
Vaughans diagram

Hi secure
Medium low secure
Intermediate services
Ordinary community based services
13
Medium/low secure services what is needed?

• Currently have 218 places in NW for 4.4 million
  general pop but 50 ready to go so only need
  max. 9 places per 250,000 population)
• Secure services needs to work well
  rehabilitative active assessment treatment
  active discharge planning good cooperation with
  local services service users voice heard
• Not be too large and distant

14
Police what is needed

• Local police need to know about learning
  disabilities (not MI)
• They need to screen suspects at custody desk for
  LD
• They need to have helpful guides eg Youre
  Under Arrest, Youre On Trial
• They need to know local CLDT one key contact is
  preferable
• CLDT need to do training for them on LD, how to
  interview
• They need to have an AA list ( good AA training
  scheme)

15
Probation what is needed

• Local probation service needs to know about
  learning disabilities
• They need to screen people for learning
  disabilities
• They need helpful guides simplified info for
  people with LD
• They need to know their CLDT (one or two named
  contacts preferable)
• CLDT need to do training for them on how to work
  with pwld
• Probation could do some CLDT training
• Probation need to do joint working with CLDT -
  joint assessments joint treatment programmes

16
Prisons (16 in NW!) what is needed

• We need to know how many people with LD in
  prison? (probably lt1 of prison population)
• Prison should screen for LD
• Prison should have some services geared for
  people with LD
• Prison should know local CLDT (one or two named
  contacts are preferable)
• CLDTs should do training for prisons on LD

17
Consultation comments from..

• Phil Shackell, Specilaist Commissioner NW from
  Cumbria MDO group, NW catchment group
• Maria Johnson on behalf of Blackpool LD services
• Mark Horrocks on behalf of Salford LD services
• Don Rowbottom david Custance on behalf of
  Lancashire SSD
• Jean Doherty on behalf of Wirral LD services

18
Consultation comments from..

• Gill Brown, Paul Withers Mark Horrocks, on
  behalf of psychol-ogists in LD services
• Tracey Dean, SALT, on behalf of speech therapy
  services (Burnley, Pendle Rossendale PCT)
• Mari Saeki, on behalf of NAS, Manchester
• Wendy Silberman, National Development Team

19
Comments

• Welcomed as it focuses on needy group (Utopian?)
  excellent
• Well researched evidence based
• Partnerships need to be at 3 levels strategic,
  operational individual
• Needs high level commitment from other agencies
  (police, probation, etc) welding into their key
  strategies
• Needs to backed up by an Implementation Guidance
  document or it wont happen
• Need leadership from SHA

20
Comments

• How do we get Partnership Boards to take an
  interest?
• What do the Specialist Commissioners do?
• Need more emphasis on diversion schemes (eg the
  Bolton MDO diversion scheme)
• Need Link Worker for people in secure provision
• Need more on role of Assessment Treatment
  Centre
• Need checklists for YOTs, CAMHS, Transitions
  workers, Connexions
• Who would complete review the checklists?

21
Comments

• Document too big - needs to be split into
  sections for the different services
• Skills training is key multi-agency skills
  training is key to multi-agency coordination
  how will it be financed?
• How could we train police, probation etc to
  screen for LD?
• Need for training for CLDT members too
• Need for autism training for all groups too

22
Comments

• Specialist teams would be great BUT Is it
  realistic to think we could recruit to and/or
  fund new specialist teams?- others thought that
  this will create an elite team we need to
  spread knowledge
• Welcomed the alternatives to medium secure
  services felt the step up/step down community
  services would be preferable, less restrictive
  would help keep people out of Calderstones but
  need more on pros cons

23
Comments

• Can CLDTs take on lead role? Shouldnt mental
  health, prisons, probation, police do more?
• We need better info systems eg collated data on
  where people are across the Region
• Need more on communication
• Need more on role for advocates ( safety)
• Need more on adolescents
• Need more on women
• Need more on ethnicity
• HOW do we stop people being refused services?

24
Comments

• Need financial examination of costs, eg- current
  out-of-borough costs (need good info system!)-
  costs of intensive support residential services-
  costs of setting up small low/medium secure
  services- costs of setting up Intensive Support
  Teams- costs of training for LD staff others

25
What can be done.

• Some things we can easily do to the document-
  minor alterations- shortening dividing up
• Implementation- some things could be done with
  goodwill without extra cost- CLDT liaising
  with police, probation, prisons YOTs-
  providing some (eg a few days) joint/reciprocal
  training- setting up virtual specialist teams
  eg community nurse, psychologist, SW,
  psychiatrist to lead on pwld at risk of
  offending- joined up information on who is in
  secure provision/out-of-borough services

26
What can be done..

• What needs more work /or new funding- new
  specialist teams if we want them- local low
  secure provision- specialist residential
  services (step down from secure) - long term
  training (eg one year courses)
• Funding from where?- out of borough placements-
  economic analysis
• An implementation group with teeth eg to review
  checklists require action