Butler Trust Workshop: management and care of people with learning disabilities who offend

1. Butler Trust Workshop:management and care of people with learning disabilities who offend Jenny Talbot Prison Reform Trust 7 October 2014 1

2. What I will cover: • Film clip: Danny and Graham • What is a learning disability and what does it mean? • Background/context and prevalence • Specific issues; people’s experiences of the criminal justice system • Implications for justice, health and social care • Research project (if time…): • Offenders with intellectual disabilities and social care.

3. What is a learning disability? • The World Health Organisation defines learning disability as a ‘reduced level of intellectual functioning resulting in diminished ability to adapt to the daily demands of a normal social environment.’ • An IQ of 50-69 is indicative of ‘mild mental retardation’ or mild learning disability • Variations on this definition are followed by the four UK administrations. 3

4. Learning disabilities – so what? • Limited language ability, comprehension and communication skills: • Difficulty understanding certain words • Difficulty understanding and responding to questions • Difficulty reading body language and following social cues • Limited memory capacity: • Difficulty recalling information • Take longer to process information • Difficulty ordering and sequencing • Can be acquiescent and suggestible; under pressure, might try to appease others • Frequently unable to read and write very well, or at all.

5. Background/context: • Closure of long stay institutions • Home Office circular 66/90 • Reed Report, 1992 • Disability Discrimination Act 1995/2005 • No One Knows, 2006 – 2009 (PRT) • Anne Owers ‘Kafka-esque’, 2008 • UK Joint Committee on Human Rights 2008 • Bradley Report, 2009 (review from 2007) • Autism Act 2009 • Equality Act 2010 • CJJI of the treatment of offenders with LD within the CJS – phase 1, 2014 • Care Act 2014.

6. UK Joint Committee on Human Rights: • Expressed concerns about: • “…the rights of people with learning disabilities to a fair hearing, as protected by common law and by Article 6 ECHR” • “…serious failings in the criminal justice system that gives rise to the discriminatory treatment of people with learning disabilities” • “We are deeply concerned that… because of a failure to provide for their needs, people with learning disabilities may serve longer custodial sentences than others convicted of comparable crimes” (March 2008).

7. The Bradley Report: • Review of people with mental health problems or learning disabilities in the criminal justice system; 82 recommendations • “The first step to the effective management of offenders [with mental health problems or learning disabilities] is the existence of good early identification and assessment of problems, which can inform how and where they are most appropriately treated.” • Recommendation that all police custody suites and criminal courts have access to liaison and diversion services (Department of Health, 2009) • NHS England, by 2017.

8. Criminal Justice Joint Inspection: • Police: • “Many detainees learning disabilities were not adequately assessed or recorded • Appropriate adults were not always called even when it was recorded that the detainee had a LD • Referrals were not always made to relevant adult care services, leaving adults with LD vulnerable when released from custody.” • Courts: • “For someone with a learning disability, the court environment and process is confusing and possibly frightening • Specialist training… to ensure defendants with learning disability are supported appropriately at court, was needed.”

9. Criminal Justice Joint Inspection: • Probation/PSR writers: • “The majority of reports and assessments were timely and provided useful information to the court • Reports and assessments failed to take account of the likely impact of the offender’s learning disability on their ability to engage with their order • Offender managers gave too much weight to the offender’s needs at the expense of possible risk of harm factors.” (CJJI on the treatment of offenders with LD within the CJS - phase 1, 2014).

10. Prevalence: • 25% of children who offend have an IQ <70 (Bailey et al, 2005) • 60% of children who offend have communication difficulties (Bryan et al, 2007) • 20 – 30% of offenders have learning disabilities or difficulties that interfere with their ability to cope within the criminal justice system (Loucks, 2007) • 7% of prisoners have an IQ <70; a further 25% have an IQ <80 (Mottram, 2007) • Between 5 – 10% of adult offenders have a learning disability (slightly more than 2% of the general adult population has a learning disability).

11. Specific issues, generally: • Reading: four-fifths of prisoners with learning disabilities had problems reading prison information • Writing: three-quarters had problems with writing and filling in forms • Understanding: screening tool results showed that around two-thirds had problems with verbal comprehension • Being understood: two-thirds said they had problems making themselves understood (Talbot, 2008).

12. Experiences at the police station: • I didn't know I was charged, they didn’t read me my rights. I didn’t know what was happening. • The way they looked at you was scary. When you go up to the counter in the custody suite lots of people watched and they read out your charge. People look at you and then you are allowed to leave. • There was a solicitor, one police lady and two other people. I don’t know why they were there, police talk maybe. It was somebody I didn’t know before I got in trouble with the police. I didn’t know if it was somebody who could have helped me.

13. Experiences in court: • I couldn’t really hear. I couldn’t understand but I said, “yes, whatever” to anything because if I say, “I don’t know” they look at me as if I’m thick. Sometimes they tell you two things at once. • I sat behind the glass and there were three ladies sitting there. I didn’t know what ‘remanded’ meant. I thought it meant I could come back later. • I am not good at speaking and they don’t listen. I needed more time to explain myself. • I understand that I have done something wrong, but I’m still not quite sure as to what that is.

14. Specific issues, in prison: • Prisoners with LDD were five times as likely to have been subject to control and restraint techniquesthan prisoners without such conditions • And they were three times as likely to have spent time in segregation • They were almost three times as likely to have clinically significant depression or clinically significant anxiety than prisoners without such conditions, and many experienced both.

15. Experiences in prison: • When I first came in I was petrified. The first one and a half years were really bad. I tried to commit suicide three times. • You get a meal sheet but it comes through the door. You have to hand it in before you get out of your cell and loads of the meals I get aren’t what I want. Everything is one big problem. • I am a bit scared in the shower. Someone got raped in the shower by eight lads and then two days later he killed himself and that scared me. So now I feel nervous in the shower. • I don’t know how to use the phone; it’s that PIN thing isn’t it?

16. Implications: • Adhere to the principles of equality and inclusion • Joint working and shared learning: justice, health and social care (equality awareness and specific training ) • Information sharing • Screening – knowing who needs support at the earliest possible stage • Ask those directly involved – experts by experience • ‘Pathways’: staff knowing what they should do; multi-agency liaison; specialist referrals, where necessary; timely provision; a different way of doing things? • Leadership.

17. Offenders with ID & social care (OFFSCA-ID): • Study led by professor Glynis Murphy (University of Kent and Canterbury and NHS National Institute for Health Research) on the costs and benefits of social care support for ex-offenders with LD. Key questions: • Does social care input affect the mood, behaviour and quality of life of ex-offenders with LD? • What are the costs of social care for these offenders? • How does the social care input alter outcomes in terms of re-offending?

18. Thank you jenny.talbot@prisonreformtrust.org.uk www.prisonreformtrust.org.uk