London Wide Health Network Agenda

1. London Wide Health Network Agenda Jenny Talbot Prison Reform Trust 16 July 2012 1

2. What I will cover: . PRT research, No One Knows People with learning disabilities and learning difficulties Liaison and diversion services.

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. What does it mean to have a learning disability? • People with learning disabilities frequently have difficulties: • Reading and writing • Telling the time • Understanding what is expected of them, certain words and ordinary social cues • Making themselves understood and in expressing themselves • Reading body language • Remembering things, such as new information, sequences, and routines • Adapting to new situations.

5. Learning disabilities and learning difficulties... • Specific learning difficulties: • Used to describe a range of impairments (including dyspraxia, dyscalculia, ADD, ADHD), of which dyslexia is the most common • Occurs regardless of intelligence levels • General learning difficulties: • Often used to describe people with poor reading, writing and comprehension abilities, and those who experience difficulties learning, for example, due to a disrupted education or lack of support.

6. How many people? • General population, around 2% • Adult offender population, between 5 – 10% • Juvenile (<18) offender population, 23% have an IQ <70 • Many more have difficulties with communication (over 60% for juveniles) and low rates of literacy.

7. Finding out... • 2006: No One Knows programme • First report in 2007, based on research involving prison staff from over half of prisons in England and Wales: • Limited information on arrival into prison and limited screening to identify learning disabilities • Gaps in provision; limited awareness of what support is available or of referral procedures • Silo working • Limited awareness training for prison officers • Greater strategic and operational direction.

8. Experiences of prison staff: • They have difficulty understanding information, difficulty integrating with peers, and difficulty following the daily regime. • Some are seen as disruptive and are dealt with in this way. • They are vulnerable, prone to bullying. • They are frightened to keep asking questions.

9. Experiences of prison staff: • One prisoner with learning disabilities worked as a support for the civilian grounds cleaner because she offered excellent one-to-one support. • Buddying is provided to encourage prisoners with a low IQ to access education. • We have nothing to be proud of in relation to prisoners with LD. We are struggling to meet the needs of the ordinary population.

10. Experiences of prisoners with learning disabilities and difficulties: Prisoners Voices: experiences of the criminal justice system by prisoners with learning disabilities and difficulties http://tinyurl.com/7o4ufp3

11. Headlines: • Two-thirds of prisoners had difficulties reading prison information, which rose to four-fifths for prisoners with LDis • Three-quarters had difficulties filling in prison forms, which rose to three-quarters for those with LDis • Two-thirds of prisoners experienced difficulties in verbal comprehension skills • Just over half said they had difficulties making themselves understood in prison, which rose to two-thirds for those with LDis.

12. Experiences of prisoners with learning disabilities: • Less likely than other prisoners to: • have a job in prison • know when their parole or release date was • be in touch with family and friends • ask if they didn’t know what was happening • know what to do if they felt unwell • have participated in CBTPs.

13. Experiences of prisoners with learning disabilities: • Almost three times as likely as prisoners without LDis to experience clinically significant depression and anxiety • More likely to: • spend time alone and have fewer things to do • feel frightened while in prison and to have been victimised • be subject to control and restraint • have positive ideas about what might help.

14. What prisoners said: • What would you do if you felt unwell? • I would have to get somebody to fill in the form, you shouldn’t have to do that, you should just be able to go down and just say so. You should be able to phone them like on the outside. • I would go to work because I would be too scared about getting into trouble. That happens here. I daren't not go to work. • I see healthcare every two weeks; one, to have a good chinwag and second to have my blood pressure checked and my weight. I have a CPN nurse who I can go to talk to as well.

15. What prisoners said: • Being scared: • I have been scared through bullying; I can hear people planning things and talking about it... I am scared in the shower, there are no cameras and no officers so if you are going to get ‘done’, that’s where it will happen. I have seen it happen. • I hate seeing fights; I always run to my room and lock the door.

16. What prisoners said: • What might have helped in prison? • There should be someone who has the time to come over and find out what’s happening and talk to us rather than just being put in a suicide cell. • It would help if someone would help me make a phone call and help me sort my sentence plan. I am also having nightmares and waking up frightened in the night.

17. What prisoners said: • What might have helped in prison? • I would like someone to have a sit down and talk with, to tell me what’s happening and how to do things. • I would like to do a one on one to help me read and write. In my class I’m the lowest person there and they are teaching things way above me. I don’t know where I am going to or coming from. • There should be things for you to do, like activities, but there’s nothing for you to do. There’s in-cell hobbies; but you have to fill in a form for that too.

18. Knowing who has/might have a learning disability in prison: • Limited information on entry into prison – hopefully this will improve • Prison officers can be helped to recognise when prisoners might have LD, especially following LD awareness training and supported by clear and effective referral routes • Information sharing: prison, healthcare and education – information sharing protocols • Screening tool: Learning Disability Screening Tool (LDSQ).

19. Liaison and diversion services: • Recognition at the point of arrest by the custody sergeant • Appropriate Adult • Referral to L and D services • Liaison with relevant services and support during police and court proceedings; possible diversion away from criminal justice.

20. Special measures in court: • Limited support for vulnerable defendants in statute; must rely on discretion of the court and of requirement for ‘reasonable adjustment’ • L and D services should: • help to ensure effective participation in court proceedings and right to a fair trial • Work with probation on pre-sentence reports • Help to inform appropriate community orders • See PRT briefing paper, Fair Access to Justice?

21. Resources: http://tinyurl.com/4pcwat4 http://tinyurl.com/cct9d4

22. Thank you Jenny.talbot@prisonreformtrust.org.uk www.prisonreformtrust.org.uk/nok