EXCLUSIVE: Future strategies for behaviour that challenges
A one-day event, organised by the Prison Reform Trust, University of Leeds, NHS Improvement and the National Autistic Society, was held in London to discuss future strategies for people who have learning disabilities and have committed a sexual offence.
People with learning disabilities and/or autism are some of the most vulnerable people in society. What then about those who have learning disabilities and/or autism and who have committed sexual offences? How do the health, social care and criminal justice systems treat them and how can those services be improved when staff do not even speak a common professional language?
These questions provided the backdrop to a one-day event focusing on behaviour that challenges. It was held in London and saw nurses, social care, the police, probation service, courts, as well as the voluntary sector in England seeking new ways to improve services and enable agencies to work together better, improve access to therapies to help people stop offending and improve their lives.
Date of Bradley Report
Eight years ago the Bradley Report recommended providing alternatives to prison and improving rehabilitation services for those offenders with mental health problems and learning disabilities. It recommended that mental health and learning disabilities should be seen differently. Police custody suites should have access to liaison and diversion services to enable people who have mental health problems or learning disabilities to be identified so prosecutors can divert people away from prison, and signpost local health and social care services. It also recommended awareness training for police and probation staff.
A follow-up report in 2014 identified new and innovative methods of dealing with such offenders including street triage – joint initiatives between the police and health aimed at early intervention to identify those in mental health crisis.
Case studies and research presented at the event outlined how those with learning disabilities who go on to commit sexual offences may have been abused themselves. Issues reported range from ‘sexting’ and touching bottoms involving young people with learning disabilities in schools, to exposure and more violent crimes in older men such as anal penetration. However, there is also evidence that people who have spent time in a long-stay specialist learning disability forensic secure service, successfully completed a sex offender treatment programme and received ongoing support in a community home after discharge, can go on to live better lives and lower the risk posed to the public.
Change and innovation
The UK’s first joint mental health and police street triage response car was launched in 2012. Since then the Serenity Integrated Monitoring System, involving Hampshire police, the Isle of Wight NHS Trust and Wessex Academic Health Science Network, has worked on improving lives of patients in complex mental health situations.
Now a jointly commissioned police officer works alongside NHS mental health practitioners and teams. Significant reductions in admissions to emergency departments and mental health wards, plus less police and ambulance call outs have been reported. It is also reported that service users have been helped to re-engage with their community and employment, and have achieved a medical discharge.
One police officer1 involved in the Hampshire initiative asked: ‘Is there a specific role for police officers to work in an integrated model with the learning disability community?’
Figures from NHS England show that the numbers of people in prison who have committed sexual offences is at its highest rate since 2002, accounting for 15% of the total prison population. Many in prison will have mental health problems, but identifying those with learning disabilities or autism is difficult and delegates heard that an assessment might only be carried out after another prisoner notices a cellmate may have a cognitive ability issue.
Organised by the Prison Reform Trust, University of Leeds, NHS Improvement and the National Autistic Society, the event was intended to inform future strategy. Lord Bradley outlined the questions being discussed: ‘wrap around support’ and continuity of care and treatment in social networks. ‘I do not think the issues of mental health and learning disability have ever been higher in the public’s mind,’ he commented. ‘We need more and better services for the most vulnerable people that we have in our society.’
Health and police street triage begins
One senior police officer1 told delegates that progress has been made in identifying people in mental health crisis. There is awareness training of how someone with a learning disability might react if arrested and in custody. There is also more awareness of ‘troubled families’ and the part this plays in offending behaviour. However, it was emphasised that protecting the public, prosecution where necessary and reducing offending would remain priorities.
‘We need more and better services for the most vulnerable people that we have in our society’
England’s only specialist learning disabilities hospital is due to close in 2019. Mersey Care Whalley Hospital, formerly known as Calderstones, in Lancashire once supported a village of 6,000 people. It now has about 130 beds and will see a phased closure with provision towards community care including support from community forensic support teams.
Planned final closure of last specialist learning disability hospital in England
Chief executive Joe Rafferty said much behaviour can be modified at a community level, but emphasised that a small proportion of inpatient services would still be needed to provide medium and low secure services. He said they recognised that good learning disability nurses were as rare as ‘hen’s teeth’ and efforts are being made to secure jobs for nurses in the new units.
The event generated many ideas such as understanding each others’ services better, using a common language, different sentencing options for the courts, a new Mental Health Act, better integrated services, establishing digital networks and extending street triage services to those with a learning disability and/or autism. This extension would involve a learning disability nurse going out with police in a response car or working alongside them in the control room to advise on clients and how they should be managed.
A briefing paper for commissioners, providers and the government on the ideas the event generated is due in the autumn.
Essex integrated system
Essex County Council are working on an integrated system involving prison and community provision linking with street triage, police custody and healthcare including seven clinical commissioning groups, NHS England, police, HMP Chelmsford, probation, its own learning disabilities and mental health teams, and other councils.
The plan is to have one pot of money and accountability coming through organisations such as the local criminal justice board.
Head of commissioning for public health and well-being Ben Hughes says the overall aim is to reduce crime and reoffending and improve health and well-being by providing support to ‘historically underserved’ groups of individuals, their families and carers.
‘In Essex we are working with multiple partners to develop a truly joined-up system of support for individuals in crisis and are engaged with the criminal justice system to support more effective diversion out of the wider criminal justice system and into appropriate support.’
Some of the elements of the system are already live and it is hoped that it will be working fully by April.
Bradley Report (2009) Lord Bradley’s review of people with mental health problems or learning disabilities in the criminal justice system. Department of Health, London.
Duncan G, Saunders A, Gadsby B et al (2014) The Bradley Report Fives Years On. An independent review of progress to date and priorities for further development. Centre for Mental Health, London.
1 The event was held under Chatham House Rule where names were withheld from reporting to encourage free discussion. Names stated here were given with permission.