Learning Disabled Offenders

1
Learning Disabled Offenders

• Dr Elisabeth Milne
• Consultant Psychiatrist
• Rampton Hospital

2
What is Learning Disability?

• Not such a stupid question in an international
  context
• Not the same as learning or educational
  difficulties
• ICD10 diagnostic categories F70 F79
• DSM IV diagnostic categories 317 319

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What is Learning Disability?

• Internationally accepted term is Mental
  Retardation
• Legal term in the UK is Mental Impairment or
  Severe Mental Impairment for most purposes.
• Not surprisingly the use of many different terms
  leads to significant confusion

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What is Learning Disability?

• Impairment of intelligence is key, although
  lesser degrees of impairment with significant
  social/language/behaviour deficits could/should
  be included
• My personal view is that if a person fulfils the
  criteria for a diagnosis of Learning Disability
  then they should be allowed to receive specialist
  services irrespective of gender, other diagnoses
  and where they live.

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Who are the Learning Disabled Offenders?

• More males than females mirrors situation in
  non-LD offenders.
• Service provision reflects this
• Most identified LD offenders are functioning in
  the mild LD/borderline range
• Frequent history of childhood behaviour disorder
• Deprived or abusive background

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Who are the Learning Disabled Offenders?

• High rates of co-morbidity with other psychiatric
  diagnoses more marked in Medium and High Secure
  cohorts
• Excess of epilepsy in 5 year study of offenders
  admitted to Northgate
• Excess of speech/language dysfunction even when
  IQ corrected for ?

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Vulnerability factors

• Inadequate/faulty socialisation skills
• Impaired self-control
• Inability to resist temptation
• Naïvety or gullibility
• Lack of understanding of social norms often
  aggravated by reluctance of caregivers to
  appropriately deal with offending behaviour

8
Vulnerability factors

• Immature sexuality or disinhibited sexual
  behaviour
• Inability to manage finances
• Low self-esteem/poor self image
• Inability to adequately/appropriately express
  emotions affection, dissent, anger or
  frustration

9
Typologies in Forensic LD - 1

• Those with similar needs Aggressive/Impulsive
  acts Without intent Lack mens
  rea Moderate or severe LD or Autistic
  Spectrum Disorders
• Not well served by Forensic LD services need
  diversion at an early stage to appropriate
  service provision

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Typologies in Forensic LD - 2

• The vulnerable/gullible victim of
  circumstance Involved in petty
  crime encouraged by more skilled
  mates may be a co-defendant
• Fitness to plead often an issue

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Typologies in Forensic LD - 3

• The decompensated typically mild/borderline
  LD not thought to be an issue pre
  remand/trial Unable to cope with
  incarceration Features of underlying PD or
  concurrent mental illness
• Require transfer from custody

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Typologies in Forensic LD - 4

• The impaired criminal Belong to a criminal
  subculture Present with features of PD rather
  than LD Frequent co-morbid
  alcohol/substance misuse
• Get directed from custody at end of sentence if
  still thought to pose a risk

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Risky Typologies

• Type 1 Bad luck gives rise to provocation
  or temptation
• Type 2 Individual seeks out risky
  situations by choice
• Type 3 Individual constantly vigilant for
  opportunities to offend
• Type 4 Individual contrives to create
  offending situations
• Walker 1991

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Types of offending

• Most studies have been of hospital in-patients
• Offence types seen vary according to the level of
  security in which you are assessing or treating
  the person and where the person is in the
  therapeutic pathway
• Property offences constitute majority
• High recidivism rate (Robertson 1981) and wide
  range of other offence types also committed

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Types of offending

• Walker and McCabe (1973) and Day (1990) found an
  excess of arson and sex offenders in LD patients
  made subject to hospital orders
• LD offenders possibly under represented in crimes
  of serious personal violence including homicide
• High Security only for those who are believed
  to represent a grave and immediate risk
  homicide, serious sexual crimes, arson

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And finally..

• What cross cultural comparisons?