Independent Review into the Delivery of Forensic Mental Health Services: Scottish Government response

Theme Five: Specific Populations - Recommendations 43-58

People with Learning Disabilities

Recommendation 43. There must be a presumption that people with a learning disability who are accused of an offence will be supported to go through the criminal justice system. They should only be diverted to hospital where this has not been possible.

Recommendation 44. The Scottish Government should commission a study to examine the experiences of offenders with a learning disability compared with offenders in the general population and offenders with a mental illness

Whilst decisions on procedure and disposal are for independent courts, the Scottish Government agrees that people with learning disability who are accused of an offence should be supported. We have provided funding for Supporting Offenders with Learning Disabilities (SOLD), a third sector organisation which aims to ensure that nobody in the justice system is at a disadvantage because they have a communication support need. Work includes a "Practice Guide for Defence Solicitors in Scotland: representing clients with communication support needs" and a short life working group to improve the identification of those with communication support needs in police custody.

In addition, the Scottish Government will commission a study drawing on current literature and the experiences of offenders with a learning disability, those with mental illness and offenders in the general population

Recommendation 45. Low secure and community forensic learning disability services should be managed under the local Health Board/Health & Social Care Partnership generic learning disability services. This arrangement should be reviewed within 3-5 years of the new Forensic Board being established.

Recommendation 46. The new Forensic Board should collaborate with generic learning disability services to develop appropriate standards for forensic learning disability services.

Recommendation 47. In areas without forensic learning disability services, generic learning disability services should be supported to embed professionals with forensic training and expertise within their workforce.

Recommendation 48. The new Forensic Board should establish mechanisms to provide consultation, advice, and professional supervision for all staff involved in the care and treatment of people with learning disabilities who have forensic needs.

The Scottish Government agrees that collaboration between forensic and general services is needed to put the needs of people with learning disability at the forefront. We consider that alignment with the ongoing work to implement the recommendations of the Coming Home report Coming home: complex care needs and out of area placements 2018 - gov.scot (www.gov.scot) is crucial to achieve best outcomes for people with learning disability.

Recommendation 49. Health and Social Care Partnership commissioners must ensure community accommodation can be adapted to meet the sensory and other needs of people with a learning disability.

Recommendation 50. Health and Social Care Partnership commissioners must ensure that people with a learning disability have a choice about whether to move into single person or communal accommodation in the community.

The Scottish Government agrees that community provision is a crucial component of the forensic mental health system and the principle of providing least restrictive care. Accommodation is an important part of community provision, and we agree that it must be fit for purpose and meet the needs of people with learning disability.

People with Neurodevelopmental Disorders

Recommendation 51^*. The new Forensic Board should undertake a needs assessment related to neurodevelopmental disorders and forensic mental health services. This should inform future service provision.

The Scottish Government agrees that any planning for future service provision must be based on needs assessment. Patients with neurodevelopmental disorders will be included in the work to define forensic mental health services that will be carried out by the short life working group. As part of this work, the group will also consider models of needs assessment, planning and provision linked to forensic mental health services.

Children and Young People

Recommendation 52. The Review recommends that the National Secure Adolescent Inpatient Service does not fall under the remit of the new Forensic Board. This position should be reviewed within 5 years of the National Secure Adolescent Inpatient Service opening to ensure this continues to provide the best pathway for young people.

The development of the National Secure Adolescent Inpatient Service is underway. Additional to the remit of the short life working group previously outlined, the group will also consider the relationship of forensic mental health care to new services.

Recommendation 53. The National Secure Adolescent Inpatient Service should set up a service to provide access to forensic specialist expertise for local CAMHS teams to support clear pathways into and out of the National Secure Adolescent Inpatient Service.

The National Secure Adolescent Inpatient Service will work closely with regional CAMHS Specialist Pathway Hubs which are being established to ensure access to specialist expertise for CAMHS teams as well as support clear pathways into and out of NSAIS.

Recommendation 54^*. A clearly defined pathway should be agreed between the new Forensic Board and the National Adolescent Secure Inpatient Service for young people who do need to transition to adult forensic mental health services.

The Scottish Government considers that work to establish suitable transition arrangements between services will be part of the specification for the new National Adolescent Secure Inpatient Service. We recognise that transitions for children and young people are known to increase risks, particularly for the most vulnerable. The Scottish Government published the Transition Care Planning Guidance in 2018 which describes the standards required in the planning of robust transitions for young people moving from CAMHS to Adult Mental Health Services.

Recommendation 55. Clear interim arrangements need to be put in place for young people in Scotland who require forensic or learning disability inpatient facilities prior to the National Adolescent Secure Inpatient Service facility being opened. This should be actioned by the end of 2021.

The Scottish Government agrees that interim arrangements are needed for young people who need forensic or learning disability inpatient facilities whilst the National Adolescent Secure Inpatient Service is developed. This includes recruitment to build knowledge and expertise in staffing capacity, which will allow phased introduction of specialist services.

Older Adults

Recommendation 56*. The new Forensic Board should make an assessment of age-related needs across all forensic mental health services and, based on current and projected demand, develop an older adults' pathway that reflects the care and risk management needs of this group.

Recommendation 57*. The new Forensic Board should conduct an assessment of staff training gaps around the age-related health needs of older adults, particularly around dementia, and make provisions to improve staff skills and confidence in this area.

The Scottish Government agrees that a needs assessment is required to understand the changing needs of the aging population, pathways and services including within the community, in the context a changing Health and Social Care landscape. This needs assessment will include a consideration of the training needs of existing services. Part of the remit of the short life working group considering an improved governance, planning and collaboration approach for forensic mental health services in Scotland will be to consider models of needs assessment, planning and provision.

Northern Ireland

Recommendation 58. The Review recommends that the State Hospital introduces charges for the care and treatment of people from Northern Ireland. These costs should be benchmarked against the costs incurred by NHS Scotland for the high secure care and treatment currently provided to women from Scotland at Rampton Hospital.

The Scottish Government will work with the State Hospital Board for Scotland both in understanding the historical reasons for the current system and in moving to a system of charging for high secure care provided to patients from Northern Ireland.

^* This recommendation refers to a new Forensic Board having responsibility. See response to recommendation 1