VOL: 96, ISSUE: 50, PAGE NO: 41
Nicole Hollingsworth, RNMH, is a community nurse, Community Team Learning Disabilities (West), Hull and East Riding Community Health NHS TrustThe criminal justice system is designed to punish and deter; it is not a therapeutic system. According to the Insanity and Unfitness Act (Home Office, 1991), if a client is fit to plead, they are considered responsible for their actions. Therefore, it is important to make sure that people with learning disabilities are not disadvantaged and that they receive the same considerations as other individuals with additional needs (such as people who require an interpreter).
The criminal justice system is designed to punish and deter; it is not a therapeutic system. According to the Insanity and Unfitness Act (Home Office, 1991), if a client is fit to plead, they are considered responsible for their actions. Therefore, it is important to make sure that people with learning disabilities are not disadvantaged and that they receive the same considerations as other individuals with additional needs (such as people who require an interpreter).
An 18-month secondment to the Diversion from Custody team in Hull gave me a valuable insight into the needs of offenders with learning disabilities. It enabled local services to start identifying and addressing their needs. There appeared to be a major lack of knowledge about learning disabilities within the criminal justice system and a correspondingly poor understanding of the criminal justice system within learning disability services.
Professionals in the criminal justice system have the age-old problem of differentiating between mental health problems and learning disabilities. To overcome this, I developed a basic information leaflet.
There is a need for ongoing education, incorporating written and verbal information, formal presentations and workshops.
I have made a start by attending probation meetings and court user groups. I have also had meetings with various professionals to inform them about my role and educate them about people with a learning disability. This extends to training for custody sergeants and police probationers to enable the needs of learning disabled individuals to be addressed at the point of arrest. This is just the tip of the iceberg and I aim to expand the training to all professionals within the criminal justice system.
Learning Disabled Offenders' Forum
There were often a number of professionals involved with individual clients, but communication between professionals and agencies was poor. To address this, I developed the Learning Disabled Offenders' Forum. This was initially a support group where members of the trust who worked with these individuals could meet and discuss relevant issues.
It has become an excellent example of multidisciplinary working. The core group now consists of representatives from health, police, probation, housing, youth offending, social services and Mencap, as well as a defence solicitor, psychiatrist and GP.
The meeting not only allows interagency communication but, due to the experience and skills of core members, has been instrumental in improving services and their delivery.
My experience with the Diversion from Custody team, and feedback from clients, carers and colleagues, has supported creating a community forensic nurse post within the learning disability services (Box 1).
This role has to be proactive, both with clients and colleagues. It has been necessary to constantly demonstrate the benefits of any interventions as it is very easy for clients to float through the system saying 'yes' and 'no' in the right places and for their disability to go unnoticed.
It is not until clients are distressed or disruptive that the need for additional support is highlighted. I spend a lot of time working with individuals in the court system and building bridges and allegiances between services.
The Reed report (Department of Health, 1992) identified the need to establish court diversion schemes, but it is important to recognise that learning disability services may need to adopt a slightly different approach from our colleagues in mental health services.
Although the number of people with learning disabilities who offend is relatively small, their needs are often very diverse and complex. Due to learning disabilities, clients often need intensive support. Joint working with probation services can reduce costly and often lengthy inpatient admissions and also allows clients to remain in the community when appropriate.
There is growing pressure to support people in the community who offend or might offend if not properly supervised (Department of Health, 1999).
The case study (p41) highlights how confusing court procedures can be for someone with learning problems. It was due to this and other, similar experiences that I decided to try to improve learning disabled offenders' access to the courts. There was little evidence to suggest that this issue had been addressed previously. The main area that had been considered was supporting witnesses with learning disabilities, not defendants.
Following a meeting with the principal court clerk, I developed a court protocol to reduce some of the difficulties faced by clients (Box 2). This has been very successful and a number of other courts have expressed an interest in it.
The community forensic post continues to develop. It is hoped that the post will reduce the number of clients with learning disabilities who offend/reoffend and resolve the current inequality of service provision between mentally disordered and learning disabled offenders.
Nationally, support for learning disabled offenders remains inconsistent. Although there are a number of diversion/court liaison teams for people with mental health problems, very few areas have a skilled practitioner to identify and support clients with a learning disability.
This client group constitutes a major hidden health care problem and consideration should be given to the time and intensity required to support these individuals. Clear communication must be a priority to ensure a consistent approach.
A recent report (Flynn and Bernard, 1999) has identified how people with learning disabilities who appear in court can be helped. The court protocol and community forensic nurse role resolve a number of these issues, but we need to continue to raise the profile of learning disability services and the needs of the clients.
We must invest in working with offenders in the community to prevent costly inpatient admissions and out-of-area placements.
This role is essential not only for our clients, but also as a resource for colleagues and other professionals. We must ensure that people with a learning disability are given equitable access to the justice system and not immediately disadvantaged by its confusing practices.
Facing the Facts (DoH, 1999) identified inadequate community forensic services in a number of areas, and it is necessary for community forensic posts to be recognised on a national basis.
We must work with other agencies to develop support packages to reduce reoffending. We can no longer ignore the needs of people with learning disabilities who appear in court.