Risk Assessment in People With Learning Disabilities E-Book

Carol Sellars

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 353

Veröffentlichungsjahr: 2011

Beschreibung

Risk Assessment in People with Learning Disabilities, Second Edition reflects legislative updates made over the past decade while continuing to demystify the process of assessing risk for people with intellectual impairment (previously called 'learning disabilities').

• Revisits techniques of risk assessment outlined in First Edition in light of the recent legislative changes, most notably the 2005 Mental Capacity Act
• Covers methods of assessing a person's capacity to consent in a range of situations, from the everyday, to complex medical or psychological scenarios
• Covers implications of new guidelines issued in relation to the Care Programme Approach (CPA)

Leseprobe

Contents

Cover

Title Page

Copyright

Preface: Introduction to Second Edition

Chapter 1: Assessing Risks in the Lives of People with Intellectual Impairment

A Life Any Like Other?

Moving into Community Settings – Benefits and Risks

Choices and Responsibilities – Legal, Moral and Social

Protection versus Choice

Summary

Chapter 2: The Problem of Predicting Risk

Understanding Risk

Risk versus Outcome

Personal Choices about Risk

A Duty of Care

Summary

Chapter 3: Assessing Risks and Establishing Care Plans

Assessing Risk to Self and Others: Looking at Past History

Other Factors which Affect Risk

Weighting Decisions and Weighty Decisions

What will Happen if You are Wrong?

Recording Risks and Making Decisions

Assessing Risks for Mary

Summary

Chapter 4: Everyday Risks

Risks at Home

Planning Services to Minimize Risk

Problems with Skills Teaching

In Sickness and in Health – Medical Risks

The Process of Education

Whose Choice?

Relationships, Choice and Consent

Sexual ‘Offending’

Summary

Chapter 5: Parents with Intellectual Impairment

Choosing to be Parents Versus Contraception, Abortion or Sterilization

Sex Education, Contraception and the Risks of Sexually Transmitted Diseases

Sterilization and Abortion

Choosing to be Parents

Assessment of Skills and Abilities

The Implications for Providing Support to Parents

Particular Problems for Parents with Intellectual Impairment

The Need for Support – Helping and Monitoring Care

Areas of Concern

Possible Outcomes (Short and Long Term)

When Things go Wrong

Trying to Avoid Serious Risks

Summary

Chapter 6: Self-harm, Mental Illness and Risk

Risks Related to Self-harm in People with Intellectual Impairment

Determining the Reasons for Self-harm

Understanding and Managing Deliberate Self-harm

Self-harm or Attempted Suicide?

Mental Illness

Diagnosis of Mental Illness in Those with Intellectual Impairment

Assessing Risks in Those with Mental Illness

Summary

Chapter 7: Other Mental Disorders and Associated Risks

Personality Disorder

Assessing Risk in Those with Personality Disorder

Ageing and Dementia

Diagnosis of Dementia

Risk Assessment in Dementia

Head Injury

Diagnosis of Head Injury

Risk Assessment in People with Head Injury

Epilepsy

Diagnosis of Epilepsy

Risk Assessment in People with Epilepsy

Drug or Alcohol Abuse

Diagnosis of Substance Abuse as a Problem

Summary

Chapter 8: Violence and Offending in People with Intellectual Impairment

People with Intellectual Impairment who are Violent

Predicting Violence

People with Intellectual Impairment who Offend – How are they Different?

Social and Personality Factors

The Role of Mental Illness in Offending

Dealing with the Law

The Nature of Offences and Their Context

Looking at Previous History – Frequency, Patterns and Opportunities

The Role of Supervision and Management

The Use of Probation Orders

The Courts and the Penal System in Relation to People with Intellectual Impairment

Court Diversion Schemes

People with Intellectual Impairment in Court

Problems with Lack of Accountability

Summary

Chapter 9: Sex Offenders with Intellectual Impairment

Sexuality in People with Intellectual Impairment

Expressing Sexuality in Socially Acceptable Ways

More Worrying Behaviour

Victim or Victimizer?

Becoming Aware of Potential Victimization

Dealing with Abusive Situations

Minimizing Future Risk of Sexual Offending

Summary

Chapter 10: Assessment of Risk with Those You Care For: the Way Forward

The Life of Someone with Intellectual Impairment – What does it Include and Why?

Safety Versus Freedom – Who Decides?

Defining Problem Areas

Making Decisions

Using ‘Risk Assessment’ Forms or Not?

Bringing it All Together

Communicating Decisions

Monitoring Outcomes and Re-assessing Risk

Summary

References and Suggested Further Reading

Index

This edition first published 2011 by the British Psychological Society and John Wiley & Sons Ltd.

© 2011 Carol Sellars

Edition history: Blackwell Publishing Ltd. (1e, 2002)

BPS Blackwell is an imprint of Blackwell Publishing, which was acquired by John Wiley & Sons in February 2007.

Blackwell's publishing program has been merged with Wiley's global Scientific, Technical, and Medical business to form Wiley-Blackwell.

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Library of Congress Cataloging-in-Publication Data

Risk assessment in people with learning disabilities / Carol Sellars. – 2nd ed.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-470-97485-8 (paper)

1. Learning disabilities. 2. Risk assessment. I. Sellars, Carol.

[DNLM: 1. Mental Retardation-complications. 2. Disabled Persons.

3. Risk Assessment. WM 300]

RC394.L37S445 2011

616.85'889–dc22

2011009313

Preface: Introduction to Second Edition

Since starting to write the first edition of this book, approximately 10 years ago, there have been a number of changes in the way government, at least in the United Kingdom, has promoted the care of people who suffer from intellectual impairment, or learning disabilities. (In writing this second edition), I have opted to use the former term rather than the latter, which tends to cause confusion. There has been increasing awareness of the needs and rights of those with intellectual impairment. As they have moved out of the long-stay hospitals and into the community, and become aware of what they have been missing, the more able members of this group have also become increasingly vocal and assertive in demanding that they deserve ‘a life like any other’.

The UK government's White Paper ‘Valuing People’, published in 2001, was a major step forward in government policy, recommending a number of practical ways in which the lives of those with intellectual impairment might be improved. While it did have an impact, the overall rate of change in services has been slow, and remains slow. Some might dismiss it as an exercise in rhetoric, but at least it documented a set of ideals for services to aspire to, and it presented a number of challenges to existing services.

The acceptance and implementation of the Human Rights Act (1998) was another important step on this road, although it has taken a long time to filter through to services in practical ways. People with intellectual impairment are still too often seen and treated as second-class citizens. The majority of the community does not understand them, and are even a little frightened of them. This can lead to unbelievable acts of cruelty and neglect in what is supposed to be a caring society. In 2008, The House of Lords and House of Commons Joint Committee on Human Rights published their seventh report on the extent to which the Human Rights Act had improved life for those with intellectual impairment, and it makes depressing reading. Taking evidence from a wide range of sources, it is clear that the lives of those with intellectual impairment can still be very hard and very limited, when compared to the majority of other people. Victimization is common, and many people with intellectual impairment live limited and lonely lives. Entitled ‘A Life Like Any Other?’ it is clear that most people with intellectual impairment still have a long way to go to achieve this.

Other relatively recent legislation, which has a central role in determining how services for those with intellectual impairment, will develop is the Mental Capacity Act (2005). This piece of UK legislation states that any adult is deemed to have the mental capacity to make decisions for themselves, unless good evidence can be provided to prove that they cannot do so. Moreover, it introduces the idea that people cannot be ‘written off’ as incapable for an indeterminate period. Capacity to make decisions may change over time, with education, illness or age all having an effect. Before anyone has a decision made on their behalf, those around them have a legal duty to assess whether they are capable at that point of making an informed choice. If they are not, then attempts must be made to help them understand and make that choice for themselves. Only if these attempts fail, can any decision be made for them, and it must be made in their best interests.

In assessing risk in the lives of those with intellectual impairment, it is easy to become over-protective. Often people are denied the right to make choices and take risks, even when most other people would do so, simply because those around them are too worried to let them take chances. Life is risky. We all take chances every day. It is not fair to ask those with intellectual impairment to assess risk for themselves more comprehensively that most adults do. This is discussed more fully in Chapter 1.

When I wrote the first edition, I several times referred to the need for cognitive, or intellectual assessment as a part of deciding whether an individual could make a choice to take a risk or not. In discussing the idea of capacity to consent, I also looked at a series of questions, which could be asked about the person's understanding and ability to make use of relevant information in their decision making. The Mental Capacity Act has formalized this. The Act specifies the following series of questions to ask in making the decision whether a given person has capacity or not:

1.Can they understand the information relevant to the decision which is to be made, including understanding the likely consequences of making, or not making the decision?

2.Can they retain (remember) that information?

3.Can they use or weigh up that information as part of the process of making the decision?

4.Can they communicate their decision, whether by talking, signing or any other means?

This assessment can be undertaken by anyone who knows the person well. However, it also carries the caveat that the person must also have had the opportunity to obtain the necessary information, and have this given to them in a way which is meaningful to them. Thus, in the case of complex decisions around health issues for example, every effort should be made to teach the person about the problem that they have, and the possible treatments available to them. They need also to know about the implications of making a choice either way. Only when this has been done, and it is clear that the person is not able to remember and use the information effectively, can a decision about a lack of mental capacity be made.

In assessing risk for those with intellectual impairment, a decision about capacity should now be the first step. The only exception to this would be where the person concerned is posing a serious risk to those around them. Where it is clear that the person does have capacity, then their right to make a decision, even if others feel it is unwise, should still be protected. We all make unwise decisions from time to time.

On the other hand, in the push to try and ensure that those with intellectual impairment are seen as an integral part of the community, it has sometimes been evident that some professionals and carers have lost sight of the fact that this group of people do have real problems in dealing with everyday life. Expectations in some quarters have been unrealistic and politically driven. It is to be hoped that the use of the test of capacity advocated by the Mental Capacity Act will result in more effective and realistic support for those who need it.

One of the major problems that arises when considering how people with intellectual impairment can be helped towards ‘a life like any other’ is the lack of money available to provide adequate levels of care and support. This is likely to be an ongoing problem. Those with milder levels of intellectual impairment have been increasingly vocal about their wishes just to have the freedom to live their lives as they choose, like everyone else. Often they do not wish for high levels of support. They have influenced both services and government policy, and this can only be to the good for this group of people.

However, for those who are less able, the situation is much more difficult. Those with mild impairment are not the best advocates for those with more severe impairment. They probably have much less awareness of their fellows' difficulties than the families and carers. Usually the ability of this more seriously impaired group to have a ‘normal’ life depends on the presence of others to help them to do so. Moreover, those who care for this group of people need to have a good understanding of the problems they present, and the best ways to help. This requires training and commitment, and often both of these are in short supply. Staff turnover is often high, and the level of pay and training minimal. In the current financial climate it is hard to see how this will improve very much, regardless of the rhetoric or even compulsion provided by new legislation.

Nevertheless, there is scope, for those who are committed to providing appropriate help and good-quality care to those with intellectual impairment, to improve services. An awareness of the requirements of the Mental Capacity Act, a commitment to supporting the human rights of those in their care, and a systematic approach to risk assessment, can all help to improve the lot of a group of people who are still one of the most underprivileged in our society. The aim of this book is to help you, as a carer, on your way.

Finally, please note that all the case illustrations in this book are purely fictitious, and based on the author's clinical experiences. Any likeness to any real person, living or dead, is purely coincidental.

Chapter 1

Assessing Risks in the Lives of People with Intellectual Impairment

A Life Any Like Other?

Over the last 20 years there has been increasing attention given to the rights and needs of those people whose intellectual abilities are less than those of the average person. As noted in the introduction to this second edition, changes in government policies and new legislation have both tried to ensure that those who are less able than average, or otherwise impaired, have the same human rights and opportunities as the rest of society. In 2001, the UK government's ‘Valuing People’ White Paper looked at what needed to change in the way that services were provided in order to improve choice and freedom in the lives of the less able, while the Human Rights Act (1998) and the more recent Mental Capacity Act (2005) have both led to explicit statements about the legal and moral rights of those who are less able to have a life like everyone else.