Transcript Where are we at? Subspecialities in forensic psychiatry.

Where are we at in forensic LD?
Subspecialities in forensic psychiatry.
Eliz Willox
Consultant 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
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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, 2006
http://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.