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The "forensicisation" of challenging behaviour: the perils of people with learning disabilities and severe challenging behaviours being viewed as "forensic" patients
- Authors:
- DOUDS Fergus, BANTWAL Ashwin
- Journal article citation:
- Journal of Learning Disabilities and Offending Behaviour, 2(3), 2011, pp.110-113.
- Publisher:
- Emerald
Since the closure of long stay learning disability hospitals in 2005, focus in Scotland has shifted on to developing robust community services to cater for the healthcare needs of people with learning disabilities. A small number of individuals with learning disabilities and associated severe challenging behaviours do inappropriately get referred and sometimes admitted to forensic learning disability services. This study investigated this area of clinical practice in the context of referrals to the high secure forensic setting of The State Hospital, Carstairs, Scotland. Five referrals made to the State Hospital's forensic learning disability service between 2005 and 2010 were reviewed. Findings revealed that the identified determinants leading to the making of these referrals were classifiable into psychiatric, environmental and staffing themes. In conclusion, there is a requirement for a specialist in-patient service to meet the needs of this complex group of patients, which demonstrates ‘gaps’ within current services.
Challenging behaviour, inpatient services and governance in England
- Author:
- JOYCE Theresa
- Journal article citation:
- Tizard Learning Disability Review, 25(3), 2020, pp.125-132.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to describe the current situation in relation to restrictive interventions, and some actions that could be taken to reduce them. The quality of care provided by inpatient services for people with intellectual disabilities has come under increasing scrutiny in recent years – from Winterbourne View in 2011 to Whorlton Hall in 2019, there has been increasing concern that admission to hospital does not always result in a good outcome for the patients. For some people, it has resulted in further deterioration in their physical and mental health, separation from families and supports and reduced probability of living as part of their community. This is in spite of knowledge and evidence of what good practice looks like. Design/methodology/approach: This paper examines the extent to which inpatient services deliver good practice in treatment and care and, where this is not happening, the extent to which they are subject to effective governance. Findings: People admitted to inpatient services can be at risk of poor-quality care and the overuse of restrictive interventions. There is guidance available that addresses what should be in place for them to receive high-quality care and treatment, and this clearly is available to many people. However, others can find themselves placed in increasingly restrictive environments and in circumstances where their human rights are at risk of being breached. There is increasing evidence that these services do not follow good practice guidance in terms of staff skills, development and implementation of effective care plans and governance arrangements that address these issues. Regulators, commissioners and managers could, and should, focus on these issues to ensure that the most vulnerable receive the care and treatment they need while in hospital. Originality/value: Service providers are aware of the difficulties in developing alternative community services. This places even more importance on the need to ensure that care and treatment in hospital is of a good standard, and that the use of restrictive interventions is minimised. McGill et al. (this issue) describe the features of a capable environment and it may be that hospitals consider that the requirements are unlikely to be implemented effectively in a ward/unit setting. However, a shift of focus in doing this could result in a reduction in restrictive interventions and a better experience – potentially for both the staff and the patients. And families could have some reassurance that their relative was receiving the best quality care and treatment, and that their human rights were being upheld. (Edited publisher abstract)
Care services for people with learning disabilities and challenging behaviour: fifty-first report of session 2014-15: report, together with formal minutes relating to the report
- Author:
- GREAT BRITAIN. Parliament. House of Commons. Committee of Public Accounts
- Publisher:
- TSO
- Publication year:
- 2015
- Pagination:
- 20
- Place of publication:
- London
Examines progress made in fulfilling the government commitment, following the Winterbourne View scandal in 2011, to discharging inpatients with learning difficulties and challenging behaviour back to their homes and communities. The inquiry found that the number of people with learning disabilities remaining in hospital has not fallen, and has been broadly stable at around 3,200. The report recognises the complexity of the task in designing and commissioning a model of community based care and welcomes the commitment to set out, within the next six months, a closure programme for large mental health hospitals, and to provide a transition plan for people within these hospitals, from 2016–17. The report recommends that proper consideration be given not just to building capacity in the community, but also to enshrining in law patients’, and their families’, right to challenge the decisions taken, whether they are about treatment, admission to mental health hospital, or community care services provided. (Edited publisher abstract)
Learning disabilities census report: England, 30th of September 2013
- Author:
- HEALTH AND SOCIAL CARE INFORMATION CENTRE
- Publisher:
- Health and Social Care Information Centre
- Publication year:
- 2013
- Pagination:
- 28
- Place of publication:
- Leeds
This report presents initial findings from the 2013 Learning Disability Census, which provides a snapshot of inpatients with learning disabilities, autistic spectrum disorder and/or challenging behaviour, and the services they receive. The survey was one of the initiatives commissioned in response to the abuse at Winterbourne View Hospital. Sections cover the profile of service users; ward security level and length of stay; service users by region, local authority and distance between residence and placement; and types of provider. The Census data was collected on 30 September 2013. Responses from 104 provider organisations were received on behalf of 3,250 service users. (Edited publisher abstract)
Incidence, types and characteristics of aggressive behaviour in treatment facilities for adults with mild intellectual disability and severe challenging behaviour
- Authors:
- TENNEIJ N. H., KOOT H. M.
- Journal article citation:
- Journal of Intellectual Disability Research, 52(2), February 2008, pp.114-124.
- Publisher:
- Wiley
Inpatient aggression in treatment facilities for persons with intellectual disability (ID) can have aversive consequences, for co-clients and staff, but also for the aggressors themselves. To manage and eventually prevent inpatient aggressive incidents, more knowledge about their types and characteristics is necessary. In four facilities, totalling 150 beds, specialized in the treatment of adults with mild ID or severe challenging behaviour, aggressive incidents were registered during 20 weeks using the Staff Observation Aggression Scale-Revised. Characteristics of auto-aggressive and outwardly directed incidents and differences in their incidence in male and female clients in these facilities were compared. During the observation period of 20 weeks, 639 aggressive incidents were documented. Most of these (71%) were outwardly directed, predominantly towards staff, while most of the remaining incidents were of an auto-aggressive nature. Of the 185 clients present during the observation period, 44% were involved in outwardly directed incidents (range per client 1–34), and 12% in auto-aggressive incidents (range per client 1–92). Auto-aggressive and outwardly directed incidents differed regarding source of provocation, means used during the incident, consequences of the incident and measures taken to stop the incident. The proportion of men and women involved in each type of incident was comparable, as well as the majority of the characteristics of outwardly directed incidents caused by men and women. Although approximately half of all clients were involved in aggressive incidents, a small minority of clients were responsible for the majority of incidents. Therefore, better management and prevention of aggressive incidents for only a small group of clients could result in a considerable overall reduction of aggressive incidents in treatment facilities. Comparability of aggressive behaviour in these facilities shown by men and women and differences in characteristics of auto-aggressive and outwardly directed incidents are discussed.
Effects of relocation on the communication and challenging behaviours of four people with severe learning disabilities
- Authors:
- MACLEOD Fiona J., et al
- Journal article citation:
- British Journal of Learning Disabilities, 30(1), March 2002, pp.32-37.
- Publisher:
- Wiley
Describes an evaluation of the effects of relocation on the challenging and communicative behaviours of four individuals with severe learning disabilities who moved from a hospital for people with learning disabilities into a community project home. The study was longitudinal, spanning a period of 3 years. Results found that there was an overall decrease in the individuals' adaptive behaviours and inactivity levels, whilst there were increases in their communicative and challenging behaviours. Concludes that the participants appeared to increase all their interactions within the community environment, including their communication and challenging behaviours.
Restraint, segregation and seclusion review: progress report (December 2021)
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2021
- Place of publication:
- Newcastle upon Tyne
This short report comments on the progress following publication of ‘Out of sight – who cares?’ report and highlights the main areas where further work is still needed. ‘Out of sight – who cares?’, published in October 2020, looked at the use of restraint, seclusion and segregation in care services for people with a mental health condition, a learning disability or autistic people. The health and care system has taken action to understand the needs of people with a learning disability and autistic people in inpatient units. However, there is still much to be done. Too many people have still not seen their care improved. While the health and care system has made a commitment to increase the range of community support available to help prevent hospital admissions, this commitment now needs to be converted into real change. The findings of this report show that too many people are still in inpatient wards and they are spending too long in hospital. Getting the right care provision, support services and early intervention in the community will prevent hospital admissions, reduce the time it takes to discharge people into the right support and enable people to live their best lives. (Edited publisher abstract)
DHSC's response to CQC's 'Out of sight – who cares?: restraint, segregation and seclusion' report
- Author:
- GREAT BRITAIN. Department of Health and Social Care
- Publisher:
- Great Britain. Department of Health and Social Care
- Publication year:
- 2021
- Place of publication:
- London
The Government response to the Care Quality Commission's report on the use of restraint, seclusion and segregation in care services. The report described the current state of the care system for children, young people and adults who are subject to restrictive interventions, and who are cared for in a range of settings, focusing on learning disabilities and autism. The report made four key recommendations: people with a learning disability and or autistic people who may also have a mental health condition should be supported to live in their communities; people who are being cared for in hospital must receive high-quality, person-centred, specialised care in small units; there must be renewed attempts to reduce restrictive practice by all health and social care providers, commissioners and others; there must be increased oversight and accountability for people with a learning disability, and or autistic people who may also have a mental health problem. (Edited publisher abstract)
Out of sight: who cares? A review of restraint, seclusion and segregation for autistic people, and people with a learning disability and/or mental health condition
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2020
- Pagination:
- 74
- Place of publication:
- Newcastle upon Tyne
This report describes the current state of the care system for children, young people and adults who are subject to restrictive interventions, and who are cared for in a range of settings. While the focus of this report is learning disabilities and autism, the findings have also implications and learning for settings that support people who have a mental health condition and/or who are living with dementia. The review found that often people were not getting the care they need, when they need it. There were many examples of care that was undignified, inhumane and that potentially breached people’s basic human rights. While it is possible to support people well in the community, care packages are often not available; and people are frequently not receiving the hospital care that they are entitled to. While the use of restrictive practice is not inevitable, nearly all of the services (hospitals and adult social care services) visited as part of this review used some form of restrictive practice. Where there was evidence of people being restrained, secluded or segregated, it was claimed that this was for their own safety or the safety of others. The report makes four key recommendations: people with a learning disability and or autistic people who may also have a mental health condition should be supported to live in their communities; people who are being cared for in hospital must receive high-quality, person-centred, specialised care in small units; there must be renewed attempts to reduce restrictive practice by all health and social care providers, commissioners and others; there must be increased oversight and accountability for people with a learning disability, and or autistic people who may also have a mental health problem. (Edited publisher abstract)
Development and Introduction of “Communication Passport” in an adult inpatient psychiatric unit for persons with intellectual disabilities: a brief report from Singapore
- Authors:
- SAJITH Sreedharan Geetha, TEO Yafen, LING Candice Sarah
- Journal article citation:
- Journal of Policy and Practice in Intellectual Disabilities, 15(2), 2018, pp.166-170.
- Publisher:
- Wiley
Persons with intellectual disabilities may present with multiple and complex needs including communication difficulties which may contribute to their challenging behaviours. Having a holistic account of each individual in terms of his or her needs, likes, and dislikes and behavioural issues may help to prevent communication breakdown between the persons with intellectual disabilities and caregivers which may in turn improve their quality of life and reduce their challenging behaviours. Communication passport is a practical and person‐centred document providing a special and efficient way of sorting and presenting important and complex information about the person into an accessible manner. The development and introduction of communication passports in an acute inpatient unit for adults with intellectual disabilities at the Institute of Mental Health, a tertiary psychiatric hospital in Singapore, is described. The study team developed a communication passport through literature review, focus group discussions and liaison with caregivers and patients with intellectual disabilities. After an initial pilot for 6 months, improvements were made in the content and presentation. It was designed in such a way that useful information about the patient's personal and communication needs as well as behavioural problems and interventions were easily passed on to the community caregivers at the point of patient's discharge from the hospital. The final format of the communication passport consisted of a 12‐page document encompassing multiple aspects including communication and behavioural profile. Our work may provide the necessary framework and directions in developing communication passports for services providers caring for people with intellectual disabilities. (Edited publisher abstract)