Prevalence of intellectual disabilities in three NorthWest Prisons

1
Prevalence of intellectual disabilities in three
North-West Prisons

• Dr Pat Mottram
• Senior Research Fellow
• University of Liverpool
• Cheshire Wirral Partnership NHS Trust

Specialised Services Commissioning Team Cumbria
Lancashire
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Contents

• Overview and aims
• Description of LD
• Study aims
• Description of sample
• Results
• Prevalence
• HASI
• Conclusions

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Aims objectives

• Prevalence study
• Validation/calibration of HASI

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Definition of LD

• Intellectual performance low
• Life/adaptive behaviour skills low
• Onset at birth or early childhood lt18 (ICD 10)
• Epidemiology
• 2-3 of the population (Emerson et al. 1998)
• 80 have mild LD

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Normal distribution of IQ scores
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Classification
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Degree of learning disability
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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

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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

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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

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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

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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

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Ethnicity all sites

• Self reported
• 88.07 - White
• 5.4 - Black
• 3.5 - Mixed race
• 2.7 - Asian

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Age

• Mean age Hindley 18.08
• Mean Age Styal 30.05
• Mean Age Liverpool 33.5

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Education Truancy
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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

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Education School Exclusions (Hindley)

• 85 of individuals had been excluded from school

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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

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Analysis Head Injuries
48 reported head injury much higher than
community rates
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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

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History of drug problems
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Alcohol Problems

• Hindley - 3.3 (2) reported alcohol problems
• Styal 6.6 (4) reported alcohol problems
• Liverpool 7.9 (11) reported alcohol problems

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History of alcohol problems
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Prevalence ID

• Styal 8.3
• Expect 33-34 prisoners
• Liverpool 7.1
• Expect 102-103 prisoners
• Hindley 3.3
• Expect 14-15 prisoners

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IQ comparison across 3 prisons
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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)

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HASI

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

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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 IQlt70

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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 lt70)

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HASI
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Vineland Adaptive Behaviour ScaleVABS

• Attempt to measure adaptive behaviour
• Survey Form Informant Questionnaire
• Used self report
• Communication
• Daily living skills
• Socialisation

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VABS

• 44 showed deficits in one or more area
• 82 of those with IQ lt70
• All deficits were mild
• Research staff thought unhelpful

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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

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Overall IQ Definitions

• lt70 LD?
• 70-79 borderline LD
• 80-89 Low average
• 90-109 Average
• 110-119 High average
• 120-130 Very high average

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IQ scores and categorisations
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Reminder General Population
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Analysis ID and Borderline ID

• IQ lt70 6.7 over 3 sites
• gt5,000 in prison
• IQ lt75 14.2
• gt11,000 in prison (cumulative)
• IQ lt80 ID 32.0 (LD Borderline)
• gt20,000 in prison (cumulative)
• (Based on prison population of 80,000)

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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

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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 Aspergers

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Limitations

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

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Conclusions

• 6.7 of sample had IQlt70
• Mean IQ 13 less than in general population
• Implications for prison health and education

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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