Prevalence of intellectual disabilities in three North-West Prisons

1. University of Liverpool 1 Prevalence of intellectual disabilities in three North-West Prisons Dr Pat Mottram Senior Research Fellow University of Liverpool & Cheshire & Wirral Partnership NHS Trust

2. Contents Overview and aims Description of LD Study aims Description of sample Results Prevalence HASI Conclusions

3. Aims & objectives Prevalence study Validation/calibration of HASI

4. Definition of LD Intellectual performance – low Life/adaptive behaviour skills – low Onset at birth or early childhood <18 (ICD 10) Epidemiology 2-3% of the population (Emerson et al. 1998) 80% have mild LD

5. Normal distribution of IQ scores

6. Classification

7. Degree of learning disability

8. Clinical features – Mild LD Difficulties coping with stress Require help in complex areas of social functioning Parenting Finances Majority able to live independently and sustain some employment

9. Presentation to services Challenging behaviours Aggression Self harm and self injury Disruption Stereotypy Poor impulse control Low self esteem Poor ability to form relationships (social and sexual) Poor social networks

10. Assessment issues Poor numeracy and literacy skills Truancy/exclusions Rule breaking behaviours/ impulsivity Drug and/or alcohol histories Head injuries (early onset LD or acquired brain injury) Support network (friends vs. associates) Criminal behaviour/employment Financial skills Parenting skills

11. Instruments & Data Collection WAIS IIIUK Vineland Adaptive Behaviour Scale HASI Semi structured interview – demographics, truancy, head injury, substance misuse, mental health, medication etc Offending information

12. Analysis Liverpool Prison 140 (10% sample) 67% uptake of randomly selected Styal Prison 60 interviewed 75% uptake of randomly Hindley YOI 60 interviewed 81% uptake

13. Ethnicity – all sites Self reported 88.07 - White 5.4% - Black 3.5% - Mixed race 2.7% - Asian

14. Age Mean age Hindley 18.08 Mean Age Styal 30.05 Mean Age Liverpool 33.5

15. Education: Truancy

16. Education: School leaving age One person did not attend school 6.5% left before age 12 26.9% between 13-14 57.7% left between 15-16 8.5% over age of 16

17. Education: School Exclusions (Hindley) 85% of individuals had been excluded from school

18. Analysis: Head Injury Identification of traumatic brain injury Self reported head injury Leading to loss of consciousness Number of incidents Car accidents Fights Childhood injuries/abuse Aneurism, drug induced coma

19. Analysis – Head Injuries

20. Analysis – Problematic Drug Use Hindley - 82% reported drug and/or alcohol problems Styal – 68.3% reported drug and/or alcohol problems Liverpool – 65.6% reported drug and/or alcohol problems

21. History of drug problems

22. Alcohol Problems Hindley - 3.3% (2) reported alcohol problems Styal – 6.6% (4) reported alcohol problems Liverpool – 7.9% (11) reported alcohol problems

23. History of alcohol problems

24. Prevalence – ID Styal – 8.3% Expect 33-34 prisoners Liverpool – 7.1% Expect 102-103 prisoners Hindley – 3.3% Expect 14-15 prisoners

25. IQ comparison across 3 prisons

26. Male/Female IQ IQ = 86.28 (CI 84.88, 87.68) Male IQ = 87.12 (CI 85.5, 88.74) Female IQ = 83.48 (CI 80.72, 86.25) Significant difference between Male/Female IQ mean difference of 3.64 (CI 0.33, 6.94)

27. HASI Brief screening instrument developed in Australia (Hayes 2000) Self reported items Spelling Puzzle – trail finding Clock drawing Five to ten minutes administration

28. HASI 259 sets of data (WAIS/HASI) Cut of 84 recommended on HASI HASI identified 22% as requiring further screening Missed 35% of those with IQ<70

29. HASI Sensitivity 65% Specificity 81% Positive Predictive Value (PPV+) 19% that is if a person has a score below 84 then only 19 out of 100 will have an IQ <70)

30. HASI

31. Vineland Adaptive Behaviour ScaleVABS Attempt to measure adaptive behaviour Survey Form – Informant Questionnaire Used self report Communication Daily living skills Socialisation

32. VABS 44% showed deficits in one or more area 82% of those with IQ <70 All deficits were ‘mild’ Research staff thought unhelpful

33. Intellectual Impairment Group Remand 52% (38%) Slightly higher age 33.49 (29.35) Drug/Alcohol problems 71% (72%) No significant difference in the incidence of head injury Only 3 had contact with LD services in the past

34. Overall: IQ Definitions <70 – LD? 70-79 – borderline LD 80-89 – Low average 90-109 – Average 110-119 – High average 120-130 – Very high average

35. IQ scores and categorisations

36. Reminder: General Population

37. Analysis – ID and Borderline ID IQ <70 – 6.7% over 3 sites >5,000 in prison IQ <75 – 14.2% >11,000 in prison (cumulative) IQ <80 ID – 32.0% (LD & Borderline) >20,000 in prison (cumulative) (Based on prison population of 80,000)

38. Incarceration in prison services Lack of appropriate adult in initial interviews Vulnerability to coercion by others offending Vulnerability to bullying within prison – stigma issues ? Recidivism rates ? Appropriate interventions ? Staff responses

39. Limitations WAIS behaving oddly in this sample large differences between VIQ and PIQ Hindley may be atypical – may have to screen a further YOI No information on under 16s Not picked up Autism or Asperger’s

40. Limitations No formal diagnosis of LD Only one under 18 9 over 35 years Confounders: High drug problems Head injury Mental Health Drugs/medication

41. Conclusions 6.7% of sample had IQ<70 Mean IQ 13 less than in general population Implications for prison health and education

42. Acknowledgements Phil Shackell, Secure Commissioner HMP Liverpool, Styal & Hindley Rachel Lancaster, Research Fellow Anne-Marie Kingdon, Consultant Nurse Lorna Duggan, Consultant Psychiatrist Dave Spurgeon, NACRO Jenny Talbot, Prison Reform Trust George Dodds, Hindley YOI Susan Hayes, University of Sydney