‘Very Difficult People?’ Women with Learning Disabilities in Secure Services

1. ‘Very Difficult People?’ Women with Learning Disabilities in Secure Services Rebecca Fish

2. Background to study • Calderstones Partnership NHS Foundation Trust • Low and medium secure units + rehabilitation service for people with learning disabilities • 22% service users (only 37 women) • Single sex flats of 3-5 women

3. Woodview Medium Secure Unit Reception

4. Background to study • The Reed Report: A Review of Health and Social Services for Mentally Disordered Offenders and Others Requiring Similar Services (1992): ‘In male dominated environments, women’s needs including their more personal female needs are liable to be overlooked. They are sometimes subject to sexual harassment and other demeaning behaviour… Services need to be responsive and proactive in order to counteract these problems, in order that women receive appropriate care, treatment, accommodation and rehabilitation with proper attention to their personal dignity’

5. Background • ‘Research on offenders with learning disabilities seldom includes women and when women participants are included, the findings tend to be presented in a non-gender specific manner.’ (Hayes, 2007:190) • There is a ‘significant need for women with intellectual disabilities to be heard and ... the meaning that they ascribe to their lived experiences acknowledged’ (Taggart et al, 2008: 205). • The Corston Report, a review of women with particular vulnerabilities in the criminal justice system (2007:2): ‘women have been marginalised within a system largely designed for men for far too long’ and there is a need for a ‘champion; to ensure that their needs are properly recognised and met.’

6. Women in Secure Hospitals • women service users are perceived by staff to be the most difficult to deal with. • Women in secure hospitals: • are more likely to be classified as having a personality disorder, • are more likely to have experienced sexual and/or physical abuse and • are more likely to stay longer than men in secure care (Stafford, 1999) • are involved in more incidents of aggression than men (Sequeira and Halstead, 2001; Alexander et al, 2005) • are more likely to self-harm (Maden, 1996), • are construed by staff as more ‘volatile’ than men (Crawford, 2001)

7. Staff Quotes • ‘I think that being in a minority affects the service that the women are given, and I think as well that even though they might not be aware of it they’re living with quite a few sex offenders and quite a few of the women will have suffered sexual abuse in the past. So it’s psychologically not very good for them.’ • ‘Because the women, and I don’t mean to be horrible to them, but they’re very difficult people, they’re very very complex, very damaged people. And they burn out the staff.’

8. Women with learning disabilities (Traustadottir and Johnson, 2000) • Women with learning disabilities and their experiences remain marginal in the discussions of feminists, both non-disabled and feminists with physical and sensory impairments. • Medical discourse constituted people with learning disabilities as sick and in need of medical attention. • Issues about gender and learning disabilities neglected within the disability movement. • Problems with attitudinal barriers and • Theorising from personal experience problematic.

9. Women in Secure Hospitals (Warner, 1996) • Women’s behaviour is more likely than men’s to be viewed as pathological: • ‘Turning rage and depression inwards may have less to do with women’s biological inadequacies and more to do with their social manipulation and subjugation. We should be careful not to pathologise individuals for what might be better understood as being the result of social inequality and restricted choice.’ (p267) • Because systems focus on which symptoms are present, rather than the contexts in which they arise, the social constitution of mental disorder is seldom explored.

10. Research Objectives • Ethnographic study – participant observation and staff and service user interviews • WAG – Women’s Action Group as consultants • Inclusive research – • Research must address issues which really matter to people with learning disabilities, and which ultimately leads to improved lives for them • Research must access and represent their views and experiences • People with learning disabilities need to be treated with respect by the research community (Walmesley and Johnson, 2003)

11. Research Questions • How do women service users see their future? What would they consider good outcomes from using the service? • What could help women to achieve their preferred outcomes? • How do women service users and staff feel the service is implementing the 4 guiding principles of the Department of Health strategy Valuing People Now (2009): • rights, • independent living, • control and • inclusion? • How do women experience enhanced observations and physical intervention? – This will result in development of a PROM • What are the support needs of staff working with women on the unit, including training and resource needs?

12. Service User Quote - Physical Intervention as retraumatisation • Researcher:So does it matter to you who restrains you? • Service User: Yeah, if it’s men I go ballistic. • Researcher: Why is that? • Service User: I don’t know. ‘Cause I were raped by me dad and I don’t feel that, it’s like men shouldn’t restrain me. There were men on me foot and even on me hand.

13. Service User Quote – Self Harm and the service response • ‘No-one accepts it, they don’t like it. They feel they have to stop me. They have to be seen to be doing something. Nobody’s bad for cutting up, you shouldn’t be punished either for cutting up, I don’t think. You do it to yourself don’t you? Not others. Other people regularly attack all the time don’t they and they get things in their room, it’s all wrong. They don’t want to understand.’

14. Service User Quote – Enhanced Observation • ‘They don’t come to your house do they and sit and watch you? I’ve no privacy and that’s difficult. It’s frustrating for me, you wouldn’t like it. I’ve had to lock myself in somewhere before now, because everywhere I go there’s staff.’ • “…they check your pockets, check your socks, totally degrading, things like that, open your mouth, make sure you’re taking your tablets when you’re on medication and that really irritated me.”

15. Thanks for listening R.Fish1@lancaster.ac.uk