1. Forensic Issues in Learning Disability Psychiatry Dr Jayne Kerridge Consultant Psychiatrist in Intellectual Disabilities

2. What I would like to cover Specific relatively common offences Fitness to Plead Clinical Assessment and Risk Group Discussion-Autism and Offending, Mild/Borderline IQ and Deprivation,

3. Assessment Who What Where With whom Setting the scene for the offence, looking at patterns with prior offences, predicting future offence-cultivating environments, preventing Can use HCR 20 (new version will be more suitable) or START (good for looking at areas of strength and weakness)

4. Specific Offences Scapegoat-Driving and antisocial offences Sexual Offending Assault

5. Scapegoating Young person with borderline LD Areas of Social Deprivation Under-parented Wanting to fit in, feel part of a group, be cool TWOC/Driving without license, Drugs, Petty crime, antisocial behaviour Used by members of group- person left on crime scene, not able to cover tracks so well, not able to deal with police so well

6. Sexual Offending May have issues as for general population May be inappropriate enthusiastic attempts to find a partner/sex due to lack of social skills “Stalking” and autism May not know what social rules are for sex May not be able to differentiate ages (ie use of height) May never have learned to masturbate

7. Assault Challenging Behaviour vs Assault Impulsivity, poor communication and poor social skills make violence more likely, and possibly at higher level Disposition of society and services to violence from PWLD Protective vs punitive Can lead to problems flagging up serious risk to police, services if not processed Consequences can be useful Prison is a very difficult environment if you aren’t mentally agile

8. Fitness To Plead Curious concept- would be better as a capacity assessment? Ability to: Instruct Counsel, Challenge Jurors Follow Evidence of Court Understand Pleas Understand Charge

9. Fitness To Plead 2 Depends on case law how you look at it- Court can be bewildering for anybody If not fit to plead limits disposal- either case dropped, Hospital Order of some kind or Guardianship Guardianship where person has Mental Disorder and significant risk to them or others and Guardianship might modify risks

10. Guardianship Sec 37 Dictate where a person resides Grants access to relevant professionals Can specify attendance at appointments, occupation Initially made for 6 months (like 3) then can be renewed yearly 3 monthly review by appointed individual (usually Care Manager/AMHP but may not be) Needs some degree of cooperation.

11. Autism Think in small groups about the features of Autism and how those features might contribute in an individual to offending risk

12. Young person in area of social deprivation What might predispose a young person with an LD living in an area of social deprivation to offend? Think about factors in the following: Family Community Education The Environment

13. Any Questions and Things you might have wanted covered that weren’t Enough discussion? More or less of anything? Anything else that would help specifically with exams?