Accessible summary
• Nobody knows how many people with learning difficulties get into trouble with the police.
• This article is about a project called No One Knows. It is finding out what happens when people with learning difficulties get into trouble with the police.
• Sometimes when people with learning difficulties get into trouble with the police they have to go to court. Sometimes they are sent to prison or have to visit a probation officer. Young people with a learning difficulty might have to go to a youth offending team.
• Some people with learning difficulties find it hard to understand what is happening. This can be upsetting.
• When people talk about the police, courts, prison, probation and youth offending they call it the criminal justice system. People who work in the criminal justice system do not always know how to support people with a learning difficulty. We want to know what people with a learning difficulty think about this. We want to know what people who work in the criminal justice system think as well.
• At the end of the project we will write a report about what people have told us. The report will tell the government what they should do to make things better for people with learning difficulties when they get into trouble with the police.


Summary
The prevalence of offenders with learning difficulties and learning disabilities is not agreed upon. What is clear, however, is that, regardless of actual numbers, many offenders have learning difficulties that reduce their ability to cope within the criminal justice system, for example, not understanding fully what is happening to them in court or being unable to access various aspects of the prison regime, including some offending behaviour programmes. Offenders with learning difficulties are not routinely identified and, as a result, often do not receive the support they need. No One Knows is a UK wide programme led by the Prison Reform Trust that aims to effect change by exploring and publicizing the experiences of people with learning difficulties who come into contact with the criminal justice system. The article highlights the aims of No One Knows and describes what, for the purpose of the programme, we mean by ‘learning difficulties and learning disabilities’. Problems in identifying precise numbers of offenders with learning difficulties and learning disabilities are discussed and attention drawn to recent research on prevalence. The context and some of the challenges of ‘prison life’ are identified and a number of early research findings from No One Knows are presented.

No One Knows: offenders with learning difficulties and learning disabilities

The Convention on the Rights of Persons with Disabilities (CRPD) has generated new ideas and standards in healthcare and disability law and policy. In the mental health context, the CRPD directs governments to ensure people with mental impairments are treated equally before the law, including ensuring people have access to the resources necessary to enjoy their rights. But what this means in practice remains unclear. In addition, current domestic laws that authorise involuntary psychiatric interventions stand at cross-purposes with the CRPD, which requires respect for the 'will, preference and rights' of persons with disabilities 'on an equal basis with others'. This book explores the implications of the CRPD for law, policy and practice that respond to the complex issues raised by mental health impairment and disability. It argues that the support framework of the CRPD holds the potential to address persistent shortcomings in mental health law and policy.

A New Era for Mental Health Law and Policy: Supported Decision-Making and the UN Convention on the Rights of Persons with Disabilities

Background In recent years, academic debate has (re)focused on the extent of the co-occurrence of intellectual disability (ID) and criminality, although findings from prevalence studies examining this link have been inconsistent. In April 2004, a process for transferring responsibility for commissioning healthcare services in UK prisons to Primary Care Trusts (PCTs) commenced. This development meant that it was important for PCTs to ascertain the need for specialist ID services in prisons in their areas. Because there were no reliable prevalence data, this research was commissioned by one such PCT.



Method  Using a stratified random sampling frame, data were collected from 185 young adult male prisoners aged 18 and 21 years old. Participants completed a semi-structured research questionnaire, the Kaufman Brief Intelligence Test (Second Edition) (KBIT2) and the Vineland Adaptive Behavior Scales (Second Edition) (VABS2).



Results  Ten per cent had an IQ composite of 69 or below, indicating a significant impairment in cognitive functioning. A further 10% had IQ composite scores between 70 and 74, and 14% between 75 and 79. None of the sample had an Adaptive Behavior Composite (ABC) score of 69 or less, although 15% scored between 70 and 79 on this measure. While none of the sample could be classified as having an ID in strict diagnostic terms, 4% scored 69 or below on the KBIT2 and in the borderline (71–79) range on the VABS2, 4% had borderline ABCs and IQs between 70 and 74; and 3% had borderline ABCs and IQs less than 79. This equates to a point prevalence of borderline ID of 11%.



Conclusions  Eleven per cent of the sample had borderline ID, supporting suggestions that this group are prevalent – and easily hidden – in mainstream criminal justice settings. Differences between borderline ID inmates and non-ID counterparts are discussed, and implications for service delivery are considered.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2788.2008.01150.x

Assessing the Prevalence of Intellectual Disability among Young Male Prisoners.

Background The objective of the study was to calculate the prevalence of inmates with intellectual disabilities (ID), and identify historical, medical and criminological characteristics of a certain impact.



Methods  A random sample of 143 inmates from a Norwegian prison cross sectional sample was studied. The Hayes Ability Screening Index (HASI) was validated with the Wechsler Abbreviated Scale of Intelligence (WASI).



Results  The prevalence of inmates with ID, IQ < 70, was 10.8%. Some essential characteristics of inmates with ID were more frequent medication for mental disorders, a higher number of imprisonments, less drug abuse and less education than the other inmates. The results indicated that the HASI is a valid tool for screening of ID for the Norwegian inmates.



Conclusions  The prevalence of ID in Norwegian inmates is significant, measured by WASI and HASI. Identification, rehabilitation and care, concerning an intellectual handicap, are mostly absent in the Norwegian criminal justice system.

The Prevalence and Nature of Intellectual Disability in Norwegian Prisons.

Persons with cognitive disabilities such as intellectual disability, borderline intellectual disability, and acquired brain injury are overrepresented in Australian criminal justice systems both as victims and as offenders. Data obtained in Australia and internationally indicate that up to 12% of the prison population has an intelligence quotient (IQ) of less than 70, with up to 30% having an IQ of between 70 and 80, indicating substantially higher representation of intellectual disability and borderline intellectual disability than in the general population. Indigenous Australian adults in prison are significantly more likely to have intellectual disability than their non-Indigenous counterparts. Points of intervention throughout individuals' trajectories into and through the criminal justice and human service system are investigated, allowing new ways of understanding how persons with intellectual and other cognitive disabilities are vulnerable to the harms of control-and-punishment systems. Using an innovative data-linking and data-merging method, the authors compiled longitudinal administrative data from all criminal justice and human service agencies in New South Wales, Australia, to create life-course pathways for 2,731 persons who had served time in prison in New South Wales and whose mental health and cognitive disability diagnoses were available. Mapping service agency responses and institutional trajectories of these persons from an early age reveal a picture of early police contact and enmeshment in juvenile and adult corrections with high frequency, but often of low duration. Poor recognition of cognitive disability coupled with the presence of mental disorders and substance use disorders is associated with multiple and compounding social disadvantage and vulnerability to harm. This group is subject to multiple, simultaneous, and continuing human service agency interventions, which have only limited impact on their offending and (re) incarceration. Provision of appropriate support before, during, and after imprisonment is likely to reduce these individuals' vulnerability to harm and improve their experiences of community integration. Language: en

Reducing vulnerability to harm in adults with cognitive disabilities in the Australian criminal justice system

Accessible summary
• This research aimed to find out how many people in a big English prison had a learning disability.
• One-tenth of the people in the prison were chosen to take part. There were 140 prisoners involved in the study.
• The prisoners were asked questions about their lives and took tests to see if they had a learning disability.
• The researchers found there were more people with learning disabilities in prison than people had thought before.
• People in prison who have a learning disability need extra help.
• People who have a learning disability also need special help when they leave prison and go back to live in the community.


Summary
Over-representation of people with learning disability in prisons has been demonstrated in many Western jurisdictions. This was the first comprehensive research in a UK prison. The research used a random 10% sample of a prison population (n = 140). A semi-structured interview, the Wechsler Adult Intelligence Scale – III (UK version) and the Vineland Adaptive Behavior Scales (VABS) Interview Edition were administered. On the Wechsler Adult Intelligence Scale – III, UK version (WAIS-III (UK)), 7.1% of participants achieved standard scores below 70 and a further 23.6% were in the 70–79 (borderline) range. The VABS results indicated that 10.1% had standard scores below 70 and a further 33.3% were in the borderline range. The results indicate that the prevalence of intellectual (or learning) disability as measured on either or both of the WAIS-III (UK) or the Vineland Adaptive Behavior Scales is higher than previous research in the UK has indicated. The results have implications for provision of services in prison and post-release.

Rachel Lancaster

Papers

The prevalence of intellectual disability in a major UK prison