Clinical Models of Care for Adults With Intellectual Disabilities in Forensic Mental Health Services: A Scoping Review.

Abstract

Background: People with intellectual disabilities (ID) and forensic histories face significant health inequalities, including reduced quality of life and prolonged stays in mental health hospitals. This is a global health issue, and there is an urgent need for evidence-based specific forensic interventions, models of care and service models to allow for effective discharge in the community, improve long-term outcomes and reduce healthcare costs.

Method: This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. We have adapted Morrisey's framework to report outcomes of clinical models of care to include (i) effectiveness of treatment; (ii) patient safety; (iii) patient and family experience of care; and (iv) staff outcomes, skills and attributes.

Results: Fifty-six studies were included in this review, reporting on 49 interventions, models of care and service models (referred to as 'models'). Four forensic models of care were identified as best practice: the Discharge Pathway Protocol, the Care Pathway-Based Approach, the Psychological Treatment Pathway and the Forensic Intellectual Disability Secure Services (FIDSS) Model of Care. The first three have demonstrated effectiveness in reducing length of stay, facilitating timely discharges and improving patient outcomes for individuals with ID, while the FIDSS Model of Care represents a holistic and culturally sensitive approach emphasising person-centred care, rehabilitation and quality of life. The findings underscore the need for larger studies to explore predictors of successful discharge and long-term outcomes.

Conclusions: This is the first review to bring together 'clinical effectiveness' studies and those reporting on patient and family experience, as well as staff's needs, attributes and experiences. Policymakers and practitioners should consider the models identified here as frameworks for developing effective, person-centred care pathways, ensuring appropriate staff training and support, meaningful communication and work with the patient and their family/peers/support network and integrating community services to address the complex needs of this vulnerable population.