Where are we at in forensic LD? Subspecialities in forensic psychiatry.

Eliz WilloxConsultant Forensic LD Psychiatrist

Recent developments

• Community facilities– National LD study:

• Local low secure facilities except Inverness & Grampian ( LD Bed Audit, 2011)– Not necessarily sufficient beds– Continue to have different operational policies

• MATRIX 2011– ?progression of psychological therapies

Progression of the NRSS

• 16 medium secure beds• Managed primarily by NHSGGC• Bed use overseen also by rep outwith• Biyearly meeting of forensic LD psychiatrists– Yearly review of all patients – Discuss bed use throughout LD forensic estate

TSH

• 24 reduced to 12 beds• Overuse, currently 15– Positive development of local services– Lack of robust forensic LD adolescent services– Admit as default when lack of other appropriate

beds.

Medicolegal aspects

• Criminal Justice & Licensing (Scotland) Act 2010– Unfitness for trial– Redefined insanity at the time of the offence– Diminished responsibility: murder only and

excludes singular Dx of psychopathy• Needs time to bed in• Thresholds for criteria continue to vary

Medicolegal Aspects

• Discussion Paper on Adults with Incapacity, Scottish Law Commission– Article 5 ECHR: right to liberty– Lacks clarity on deprivation of liberty– HL v United Kingdom (2005) 40 EHRR 32: Lack of

capacity to consent appeared to preclude voluntary or informal admission

– Lack capacity due to: LD, MI, neuro, or ABI– 120,000 mild-moderate, 15-20,000 profound– Residential facilities

Convention on the Rights of Persons With Disabilities, 2006http://www.un.org/disabilities/default.asp?id=259

Article 1 - Purpose

• The purpose of the present Convention is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity.

• Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others.

Article 2 - Definitions

• "Discrimination on the basis of disability" means any distinction, exclusion or restriction on the basis of disability which has the purpose or effect of impairing or nullifying the recognition, enjoyment or exercise, on an equal basis with others, of all human rights and fundamental freedoms in the political, economic, social, cultural, civil or any other field. It includes all forms of discrimination, including denial of reasonable accommodation

Article 4 - General obligations

• b) To take all appropriate measures, including legislation, to modify or abolish existing laws, regulations, customs and practices that constitute discrimination against persons with disabilities;

• h) To provide accessible information to persons with disabilities about mobility aids, devices and assistive technologies, including new technologies, as well as other forms of assistance, support services and facilities;

Article 12 - Equal recognition before the law

• 4. States Parties shall ensure that all measures that relate to the exercise of legal capacity provide for appropriate and effective safeguards to prevent abuse in accordance with international human rights law. Such safeguards shall ensure that measures relating to the exercise of legal capacity respect the rights, will and preferences of the person, are free of conflict of interest and undue influence, are proportional and tailored to the person's circumstances, apply for the shortest time possible and are subject to regular review by a competent, independent and impartial authority or judicial body. The safeguards shall be proportional to the degree to which such measures affect the person's rights and interests.