Breaking the Cycle: Better Help for People with Learning

Disabilities at Risk of Committing Offences

Glynis MurphyProfessor of Clinical Psychology Univ of Lancaster

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

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 don’t know how to meet their needs

Often away for years Not always formally detained Not the least restrictive provision

possible

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

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)

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

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?

Support & services: Community Teams

Children’s 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)

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

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

Residential services:Where 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)

Intermediate services

Ordinary community based services

Hi secure

Medium & low secure

Vaughan’s diagram

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) – still too high?

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

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)

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

Prisons (16 in NW!): what is needed

We need to know how many people with LD in prison? (probably <1% 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

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

Andrew Riley, ‘On the Move’, Burnley

Consultation: comments from…..

Gill Brown, Paul Withers & Mark Horrocks, on behalf of LD psychols

Tracey Dean, SALT, on behalf of speech therapy services (Burnley, Pendle & Rossendale PCT)

Michelle Montrose Liverpool Partnership Board

High McNamee, Merseycare NHS Trust

Sarah Heaton, Independent Options Stockport

Mari Saeki, on behalf of NAS, Manchester

Wendy Silberman, NDT

Comments

Widely 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 !

Comments

How do we get Partnership Boards to take an interest?

What do Specialist Commissioners do? Need more emphasis on diversion

schemes (eg the Bolton MDO diversion scheme)

Examples of good practice (eg Liverpool forensic LD project)

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?

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

Front page of easy read version – does it mean its about football?

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

Comments

Can CLDTs take on lead role? Shouldn’t 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?

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

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

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