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PurposeTraditionally, services for people with learning disabilities (LD) and forensic needs are underdeveloped. This paper aims to describe the setting up of a tiered model of LD forensic service provision in Leicester, Leicestershire and Rutland, facilitated and driven by a core team of professionals who have the skills and expertise in this area.Design/methodology/approachWith no dedicated funding, this team is virtual in nature and provides support for the community and in‐patient teams in the assessment and management of offenders with LD. A care pathway including a process map is included to represent a visual idea of the referral, assessment, intervention and disposal strategies across the four tiers of service delivery. The service has a unique partnership arrangement with the independent sector that allows for staff training in order to deliver quality outcomes. The virtual team can support patients with learning disabilities and forensic needs in the community and in‐patient settings, both by avoiding unnecessary in‐patient admissions and by improving the treatment outcomes of those discharged from in‐patient settings.FindingsFurther research is required to demonstrate the clinical and social outcomes for offenders with LD using the tiered model of care and care‐pathway.Originality/valueThe virtual team and the LD forensic care pathway were developed because of a gap in service that was identified as part of a mapping exercise and stakeholder discussion. In the current economic climate, additional resources to address this gap in service may not be readily available; therefore, an innovative way of addressing this gap in service was by developing a care pathway for use by community LD teams based on lean principles and evidence‐based medicine and the pooling of specialist skills to develop the virtual team to enable and support the implementation of the care pathway.

PurposeThere have been few studies about the prevalence of substance abuse and links to offending behaviour among those with intellectual disabilities. This paper aims to address this issue.Design/methodology/approachThis baseline audit describes: the prevalence of alcohol and substance misuse in patients within a forensic intellectual disability service; and the introduction of a Drug and Alcohol Awareness Course. In total, 74 patients were included in the audit.FindingsRoughly half of the patients audited had co‐morbid harmful use or dependence with the problem being equally prevalent in men and women. Whilst alcohol and cannabis were the commonest drugs of abuse, cocaine, stimulants and opiates were abused by a small but significant number. Of those with harmful use or dependence, 35 per cent had used the drug in the immediate lead up to their index offence. A diagnosis of personality disorder and past history of convictions for violent offences was significantly more likely to be present in the group with harmful use or dependence. There were no differences on major mental illnesses or pervasive developmental disorders.Practical implicationsThe high prevalence of substance abuse makes it an important risk factor that could determine treatment outcomes. Forensic intellectual disability units need replicable substance abuse targeted treatment programmes that can be formally audited and evaluated.Originality/valueFindings are discussed in relation to service planning and treatment outcomes from forensic intellectual disability services.

BackgroundTo describe the characteristics of those with autism spectrum disorder (ASD) treated within a forensic intellectual disability hospital and to compare them with those without ASD.MethodService evaluation of a cohort of 138 patients treated over a 6‐year period.ResultsOf the 138, 42 had an ASD. Personality disorders and harmful use or dependence on drugs were significantly lower in the ASD group. The ASD group was less likely to be subject to criminal sections or restriction orders. Self‐harm was significantly higher in the ASD group. There were no differences in the length of stay and direction of care pathway.ConclusionsAlthough the ASD and non‐ASD groups differ on clinical and forensic characteristics, their treatment outcomes appear similar. This suggests that the diagnostic category of ASD alone may be inadequate in predicting the treatment outcome. There is a case to identify distinct typologies within the ASD group.

AbstractBackgroundWe examined whether a series of variables were related to the number of psychiatric inpatients using publicly available data about English psychiatric bed utilisation and NHS workforce.MethodUsing linear regression, with auto‐regressive errors, we examined relationships between variables over time using data from December 2013 to March 2021.ResultsOver time, the number of inpatients reduced by either 6.58 or 8.07 per month depending upon the dataset utilised, and the number of community nurses and community nursing support staff reduced by 7.43 and 2.14 nurses per month, respectively. Increasing numbers of consultant psychiatrists were associated with fewer inpatients over time. More care and treatment reviews (CTRs) were associated with more admissions over time, while more post‐admission CTRs were associated with increased discharges over time.ConclusionsFuture studies should examine whether psychiatric bed utilisation elsewhere within the NHS by people with intellectual disabilities has increased.

BackgroundThere is a developing evidence base to support the use of risk assessment instruments in offenders with intellectual disability (ID). The aim of this study was to try to develop this literature with the inclusion of a control group of mentally disordered offenders without anID, using theHCR‐20 andVRAG.Materials and MethodsTheVRAGand theHCR‐20 were completed for a group of offenders with anID(n = 25) and a control group (n = 45), in four medium‐secure units across theUK. The outcome measure was physical aggression measured over 6 months.ResultsBoth instruments consistently produced large effect sizes predicting any physical aggression and severe physical aggression. The structured clinical judgement based on theHCR‐20 was especially good.ConclusionsTheHCR‐20 and theVRAGhave excellent predictive efficacy in offenders with anID. A structured clinical judgement based on theHCR‐20 was especially predictive.

AbstractThe current COVID‐19 pandemic is a pressing world crisis and people with intellectual disabilities (IDs) are vulnerable due to disparity in healthcare provision and physical and mental health multimorbidity. While most people will develop mild symptoms upon contracting severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2), some will develop serious complications. The aim of this study is to present guidelines for the care and treatment of people with IDs during the COVID‐19 pandemic for both community teams providing care to people with IDs and inpatient psychiatric settings. The guidelines cover specific issues associated with hospital passports, individual COVID‐19 care plans, the important role of families and carers, capacity to make decisions, issues associated with social distancing, ceiling of care/treatment escalation plans, mental health and challenging behavior, and caring for someone suspected of contracting or who has contracted SARS‐CoV‐2 within community or inpatient psychiatric settings. We have proposed that the included conditions recommended by Public Health England to categorize someone as high risk of severe illness due to COVID‐19 should also include mental health and challenging behavior. There are specific issues associated with providing care to people with IDs and appropriate action must be taken by care providers to ensure that disparity of healthcare is addressed during the COVID‐19 pandemic. We recognize that our guidance is focused upon healthcare delivery in England and invite others to augment our guidance for use in other jurisdictions.

AbstractBackgroundAntipsychotic medications are used among 19%–58% of adults with intellectual disabilities to manage challenging behaviour against the NICE guideline recommendations. Studies show that it is possible to completely withdraw antipsychotics in about one third of adults with intellectual disabilities and a dose reduction of 50% or more in another third.MethodIn Cornwall, over three years the present authors developed a structured pathway to withdraw antipsychotics among adults with intellectual disabilities which involved people with intellectual disabilities and their carers, GPs, community learning disability team members and pharmacists.ResultsThe present authors managed to withdraw antipsychotics totally among 46.5% (33/71) and reduced over 50% of dosage in another 11.3% (8/71) of adults with intellectual disabilities. At three months follow‐up no one required hospital admission or change in placement.ConclusionIt is possible to withdraw/reduce antipsychotics in a high proportion of adults with intellectual disabilities if a concerted effort is made involving all stakeholders from the outset.