A novel care pathway for prisoners with intellectual disability designed through a Delphi process

• DOI: https://doi.org/10.1108/IJPH-08-2017-0037
• Published date: 17 December 2018
• Pages: 276-286
• Date: 17 December 2018
• Author: Gautam Gulati,Stephen Quigley,Valerie Elizabeth Murphy,Evan Yacoub,John Bogue,Anthony Kearns,Conor O’Neill,Mary Kelly,Aideen Morrison,Gerard Griffin,Mary Blewitt,Elizabeth Fistein,David Meagher,Colum P. Dunne
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

A novel care pathway for prisoners with

intellectual disability designed through a

Delphi process

Gautam Gulati, Stephen Quigley, Valerie Elizabeth Murphy, Evan Yacoub, John Bogue,

Anthony Kearns, Conor O’Neill, Mary Kelly, Aideen Morrison, Gerard Griffin, Mary Blewitt,

Elizabeth Fistein, David Meagher and Colum P. Dunne

Abstract

Purpose –Individuals with an intellectual disability (ID) form a significant minority in the Irish

prison population and worldwide prison populations. There is growing recognition that specialist

services for such indivi duals are in need of development. The purpose of this paper is to p ropose

a care pathway for the management of individuals with an ID who present in prison, based on expert

elicitation and consensus.

Design/methodology/approach –A convenience sampleof professionals with a special interest in forensic

intellectual disabilities was invited to participate in a Delphi exercise. In total, 12 agreed to participation and 10

subsequently completed the study (83.3 per cent). Expert views were elicited using a semi-structured

questionnaire. Content analysis was completed using NVivo 11 software. A care pathway was subsequently

proposed, based on the outcomes of the analysis, and circulated to participants for debate and consensus.

A consensus was reached on management considerations.

Findings –Ten experts across a range of disciplines with a combined experience of 187 years participated in

the study. Current provision of care was seen as limited and geographically variable. The vulnerability of

prisoners with ID was highlighted. The need for equivalence of care with the community through

multidisciplinary input and development of specialist secure and residential placements to facilitate diversion

was identified. Consensus was achieved on a proposed care pathway.

Originality/value –This study proposes a care pathway for the assessment and management of prisoners

with an ID and is, therefore, potentially relevant to those interested in this topic internationally who may

similarly struggle with the current lack of decision-making tools for this setting. Although written from an Irish

perspective, it outlines key considerations for psychiatrists in keeping with international guidance and,

therefore, may be generalisable to other jurisdictions.

Keywords Ireland, Prison, Learning disability, Intellectual disability, Mental retardation, Prisoner

Paper type Research paper

Introduction

A diagnosis of intellectual disability (ID) is typically made if an individual meets three criteria: first, a

score below 2 standard deviations from the mean on a validated test of intelligence; second,

evidence of significant impairments in adaptive functioning relative to same-age peers; and,

finally, a developmental history suggesting onset of difficulties before the age of 18 years. The

two major diagnostic systems currently in use are the International Classification of Diseases,

10th edition (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition

(DSM-5). The prevalence of intellectual disabilities in Ireland is 6.13 per 1,000 population based

on National Intellectual Disability Database (NIDD) data from 2015 and using 2011 population

census data. The prevalence rate for mild ID is 1.99 per 1,000, and the rate for moderate, severe

or profound ID is 3.59 per 1,000 (Doyle and Carew, 2016).

Received 22 August 2017

Revised 5 January 2018

9 January 2018

Accepted 9 January 2018

(The authors affiliations can be

found at the end of this article.)

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VOL. 14 NO. 4 2018, pp. 276-286, © Emerald Publishing Limited, ISSN 1744-9200 DOI 10.1108/IJPH-08-2017-0037