In the wilderness? Services for people with mild/borderline learning difficulties with/without autistic spectrum disorders or mental health needs at risk of offending or reoffending

This thesis explores two ways in which people with mild/borderline learning difficulties (with or without autistic spectrum disorders or mental health needs) who are at risk of offending or reoffending are supported by health and social services - community based services and residential services. Existing literature on offending by people with learning difficulties and mental health needs is summarised and the response of the criminal justice systems to "mentally disordered offenders" is explored. The methodology of service evaluation is also reviewed. Study One reviews the effectiveness of a pilot multi-disciplinary team set up to meet the needs of people with mild/borderline learning difficulties, mental health needs and high functioning autistic disorders (in particular Asperger's syndrome) with offending/reoffending behaviour from the perspectives of mainstream professionals, team members, service users and carers. Study One concludes that the availability of flexible, person centred support services such as those provided by the team are fundamental to the prevention of offending behaviour and the development or maintenance of independent living skills for this group of people. Study Two explores the quality of support provided in out of borough residential placements, including a secure unit. Study Two concludes that, with the notable exception of the secure unit, attention to individualised person centred planning including behavioural programmes and the development of independent living skills is patchy. Links with placing authorities are not always robust and there is a lack of suitable community based provision and move-on accommodation. Organisational rules and routines appear to impose unacceptable restrictions on basic choices in everyday life. The thesis concludes that people with mild/borderline leaming difficulties (with or without autistic spectrum disorders or mental health needs) who are at risk of offending/reoffending can be better supported by a particular model of community based teams and key components of this service are described. These teams should be:

• Based upon principles of user empowerment, particularly in the management of risk

• User centred, flexible and responsive in their approach

• Based upon a whole team approach to providing a service so that an immediate response to someone does not depend on the service user's case worker being available

• Use a care programme approach and have a no closure policy

• Offer individually tailored expertise to meet peoples' needs, in particular access to a psychologist or challenging behaviour specialist

• Offer individually tailored practical support packages which enable both an increase in independent living skills and access to mainstream facilities, including employment

• Offer therapeutic input, particularly groups which enable people to deal with sexual relationships and anger management