Risk for intellectual disability populations in inpatient forensic settings in the United Kingdom: A literature review.
Sam Quinn, Sarah Rhynas, Susan Gowland and 3 others
PMID 35995572WHAT IT FOUND
Patients with intellectual disabilities in UK forensic settings face higher risks of violence and self-injury than those without, but restrictive ward environments worsen their mental health.
Physical health issues like obesity and vitamin D deficiency are prevalent but under-addressed. Patients are willing to engage in risk planning.
Key findings
01Inpatients with intellectual disabilities have higher rates of serious physical assaults on staff and other patients (47%) compared to those without intellectual disabilities (21.5%), and higher rates of self-injury (77.3% vs 61.2%).
02Restrictive measures and lack of freedom in secure settings are associated with increased anxiety, depression, and self-injury, while physical health risks like obesity (87% overweight/obese at admission) and vitamin D deficiency (87% deficient/insufficient at baseline) are common but less prioritized than forensic risk.
03Patients with intellectual disabilities are willing to participate in risk assessment and management; when allowed to complete these tasks separately from the multidisciplinary team, they were significantly more likely to draft their own risk management plans.
STILL TO COME
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What it does not show
The review is restricted to UK settings, so findings may not apply to other healthcare systems or legal frameworks. Only English-language papers published since 2000 were included, potentially missing relevant international or older evidence. The included studies used diverse methodologies (qualitative, quantitative, case reports), making direct comparison and synthesis difficult. Grey literature was excluded from the final analysis, which may have omitted important contextual information. The review highlights a gap in evidence regarding the long-term health consequences of forensic detention, suggesting current data is sparse.
Declared interests
The authors declared no conflict of interest. The work was funded by the Burdett Trust for Nursing.
The easy way to misread this
Do not interpret the higher rates of violence and self-injury in patients with intellectual disabilities as an inherent trait of the condition. The review indicates that restrictive ward environments and lack of autonomy are significant contributors to these behaviors, meaning that changes in care environment and patient involvement can potentially reduce these risks.