National policy in England is now directed towards keeping patients with intellectual disability (ID) presenting with forensic problems for time limited treatment. The result is that secure hospital services are expected to work much more proactively to discharge patients to community-based services. However, there is little evidence in recent years on the outcome of discharged patients with ID from secure hospitals. This study describes the outcomes of a patient group discharged from a specialist forensic ID service in London, England.
This is a descriptive retrospective case note study of patients with ID admitted to and discharged from a secure service with both low and medium secure wards, over a six-year period from 2009 to 2016. The study examined patient demographic, clinical and outcome variables, including length of stay, pharmacological treatment on admission and discharge, offending history, and readmissions to hospital and re-offending following discharge.
The study identified 40 male patients, 29 of which were admitted to the medium secure ward. 27 patients (67.5%) were discharged into the community with 14 patients having sole support from the community intellectual disability services and four from the community forensic services. 20% of patients were readmitted within the study period and 22.2% of patients received further convictions via the Criminal Justice System following discharge.
This was a complex group of patients with ID discharged into the community with a number at risk of requiring readmission, and of reoffending. Community based services providing for offenders with ID must have sufficient expertise and resourcing to manage the needs of such a patient group including the ongoing management of risks. The national drive is significantly to reduce the availability of specialist in-patient services for this group of patients but this must occur alongside an increase in both resources and expertise within community services.
Leah Wooster, Jane McCarthy, Eddie Chaplin
Journal of Intellectual Disabilities and Offending Behaviour, 2018