A novel care pathway for prisoners with intellectual disability designed through a Delphi process [2018]

Individuals with an intellectual disability form a significant minority in the Irish prison population and worldwide prison populations. There is growing recognition that specialist services for such individuals are in need of development. In this paper, we propose a care pathway for the management of individuals with an intellectual disability who present in prison, based on expert elicitation and consensus.

A convenience sample of professionals with a special interest in forensic intellectual disabilities were invited to participate in a Delphi exercise. Twelve agreed to participation and 10 subsequently completed the study (83.3%). Expert views were elicited using a semi-structured questionnaire. Content analysis was completed using NVivo 11 software. A care pathway was subsequently proposed, based on the outcomes of the analysis, and circulated to participants for debate and consensus. A consensus was reached on management considerations.

Ten experts across a range of disciplines with a combined experience of 187 years participated in the study. Current provision of care was seen as limited and geographically variable. The vulnerability of prisoners with intellectual disability was highlighted. The need for equivalence of care with the community through multidisciplinary input and development of specialist secure and residential placements to facilitate diversion was identified. Consensus was achieved on a proposed care pathway.

This study proposes a care pathway for the assessment and management of prisoners with an intellectual disability and is, therefore, potentially relevant to those interested in this topic internationally who may similarly struggle with the current lack of decision-making tools for this setting. Although written from an Irish perspective, it outlines key considerations for psychiatrists in keeping with international guidance and, therefore, may be generalisable to other jurisdictions.

Gautam Gulati, Stephen Quigley, Valerie Elizabeth Murphy, Evan Yacoub, John Bogue, Anthony Kearns, Conor O’Neill, Mary Kelly, Aideen Morrison, Gerard Griffin, Mary Blewitt, Elizabeth Fistein, David Meagher, Colum P. Dunne

International Journal of Prisoner Health, 2018