Jane McCarthy

“Why can’t they be in the community?” A policy and practice analysis of transforming care for offenders with intellectual disability

Purpose – The purpose of this paper is to describe key policy and practice issues regarding a significant subgroup of people with intellectual disability – those with offending behaviour being treated in forensic hospitals. Design/methodology/approach – The reasons why psychiatrists continue to be involved in the treatment of people with intellectual disability and mental health or behavioural problems and the factors that may lead to patients needing hospital admission are examined. Using two illustrative examples, three key questions – containment vs treatment, hospital care vs conditional discharge and hospital treatment vs using deprivation of liberty safeguards usage in the community are explored. Findings – Patients with intellectual disability, mental health problems and offending behaviours who are treated within forensic inpatient units tend to have long lengths of stay. The key variable that mediates this length of stay is the risk that they pose to themselves or others. Clinicians work within t...

Assessment and diagnosis of psychiatric disorder in adults with autism spectrum disorder

Purpose – Adults with autism spectrum disorder (ASD) present with a range of psychiatric disorders. However, making an accurate diagnosis is challenging. It is important to follow a robust and informed process in the assessment of psychopathology that is centred on the individual and their neurodevelopmental difficulties. The purpose of this paper is to provide clinicians with an evidence-based approach to the assessment process for adults with ASD presenting with a possible co-occurrent psychiatric disorder. Design/methodology/approach – A review of the recent literature was undertaken focusing on key papers that describe the assessment of mental health problems in adults with ASD. Findings – The presentation of psychiatric symptoms is influenced by the underlying developmental disorder and it is often quite different from the one of the general population. Thus, it is essential to undertake a comprehensive psychopathological assessment including a diagnostic assessment of ASD. There is a very small evid...

A review of risk factors associated with suicide in adults with intellectual disability

Purpose – Suicide is one of the top three leading causes of death amongst those aged between 15 and 44 years; and tenth leading cause of death in the wider population. The base rates of suicide, suicide attempts and suicide-related behaviours are comparably low in the general population with between 17 and 68 per cent of individuals who successfully commit suicide having made a previous attempt to take their own life. As recently as the 1980s it was still a widely held belief that individuals with intellectual disability (ID) did not have the cognitive capacity to experience mental health problems and this acted as a “buffer” against suicidal behaviour. The paper aims to discuss these issues. Design/methodology/approach – The literature review covered the time period 1993-2013 and returned 117 studies, 77 of which related to individuals with ID, 37 of which related to adults. Following screening titles and abstracts 28 articles were removed. A total of nine studies were found to be eligible for inclusion...

Screening and diagnostic assessment of neurodevelopmental disorders in a male prison

Purpose – The purpose of this paper is to identify neurodevelopmental disorders and difficulties (NDD) in a male prison. The study used standardised tools to carry out screening and diagnostic assessment of the attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID). Design/methodology/approach – The ADHD self-report scale, 20-item autism quotient and the Learning Disability Screening Questionnaire were used to screen 240 male prisoners. Prisoners who screened positive on one or more of these scales or self-reported a diagnosis of ADHD, ASD or ID were further assessed using the diagnostic interview for ADHD in adults, adapted Autism Diagnostic Observation Schedule and the Quick Test. Findings – Of the 87 prisoners who screened positive for NDD and were further assessed, 70 met the study’s diagnostic criteria for ADHD, ASD or ID. Most of those with NDD (51 per cent) had previously gone unrecognised and a high proportion (51 per cent) were identified ...

Historical and clinical items of the HCR-20 as predictors of risk within an intellectual disability population

Purpose – The use of violence risk assessment measures within intellectual disabilities (ID) services is now the norm and a growing target for research. The purpose of this paper is to examine the clinical utility of the historical and clinical factors of the HCR-20 in predicting violence. Design/methodology/approach – The study took place within a national low secure service for adults with ID examining all completed admissions over a six-year period, (N=22). Clinical records covering the first three months of admission were examined along with historical reports and incident data recorded at three, six, nine and 12 months admission using the Modified Overt Aggression Scale (MOAS). Findings – Significant positive relationship between Historical score and total number of incidents was established. Patients with challenging behaviour less likely to have a previous history of violence, and more likely to be older at first violent incident than patients without challenging behaviour. Incidents involving pati...

Does substance use predict contact with the criminal justice system for people with intellectual disabilities

Purpose – The purpose of this paper is to examine how substances misuse impacts on exposure to the criminal justice system for people with intellectual disabilities (ID). Design/methodology/approach – An electronic case-register of mental health patients was used to examine the clinical records of 411 patients with ID. χ2 analysis was performed to test the association between variables and logistic regression to generate estimates for statistically significant association variables. Findings – Of 411 cases, 98 (23 per cent) of patient had a history of substance use, with affective disorders strongly associated with alcohol misuse χ2=4.135, df=1 (p<0.042), similarly statistically significant predictor for alcohol misuse OR: 1.7, 95 per cent CI (1.02-2.72) (p<0.043). Patients with a history of offending behaviour had three-folds higher risk to misuse drugs compared to those without a forensic conviction OR: 3.17, 95 per cent CI (1.35-7.44) (p<0.008). Those with a history of offending were more likely to hav...

ASD and hate crime

Purpose This paper offers an overview of hate Crime relating to people with Autism Spectrum Disorders (ASD). Design/methodology/approach This is a discussion outlining some of the key evidence relating to ASD and hate crime. Findings For too long the issue of hate crime and autism has been neglected b in spite of significant numbers of people with ASDs experiencing hate crime and/or harassment on a regular basis Originality/value Although people with ASD are thought to be subject to high rates of hate crimes the literature is sparse when compared to other strands of hate crime such as race or religion.Purpose n n n n nThe purpose of this paper is to offer an overview of hate crime relating to people with autism spectrum disorders (ASD). n n n n nDesign/methodology/approach n n n n nThis is a discussion outlining some of the key evidence relating to ASD and hate crime. n n n n nFindings n n n n nFor too long the issue of hate crime and autism has been neglected in spite of significant numbers of people with ASDs experiencing hate crime and/or harassment on a regular basis. n n n n nOriginality/value n n n n nAlthough people with ASD are thought to be subject to high rates of hate crimes the literature is sparse when compared to other strands of hate crime such as race or religion.

Is “transforming care” failing people with autism?

Abstract Purpose – The purpose of this paper is to comment on the development and implementation of transforming care (TC) and whether it has failed people with autism. Design/methodology/approach – This paper is a commentary. Findings – The number of people with autism being admitted to assessment and treatment units is increasing despite the aims of TC. The authors argue that TC, in serving such a diverse group of people, may have failed to identify the heterogeneity of such groups or recognise the different needs of people with mental illness and people with behaviours that challenge; and that TC could be regarded as a policy that only affects people with an intellectual disability. Originality/value – Policymakers, policy implementers and health and social care staff may consider reviewing their practice to ensure that TC works for people with autism and their family and carers. Keywords Autism, Commissioning, Mental illness, Intellectual disability, Transforming care, Care support services

Commentary on “Autism, mental health and offending behaviour: a mother’s quest for healthcare”

Purpose n n n n nThe purpose of this paper is to provide a commentary on “Autism, mental health and offending behaviour: a mother’s quest for healthcare” by Sue Larch. n n n n nDesign/methodology/approach n n n n nCommentary. n n n n nFindings n n n n nAlongside specialist secure services more needs to be done to develop highly skilled specialist services. n n n n nOriginality/value n n n n nA commentary on an original viewpoint piece published in this special edition on autism and offending behaviour.