Accessible summary: How do women with learning disabilities ‘move on’ through secure units?

Rebecca Fish and Hannah Morgan

People with learning disabilities have to stay in secure units if they have broken the law or if they are a risk to themselves or other people. It is important that people can move on through these services, and then back out into the community.

We asked 16 women and 10 staff from a secure unit in England in 2012 what it was like to live and work there. They told us about how women can ‘move on’ through the secure service. The women and staff told us about things that can help, and things that don’t help. We have written an article about this. This is what the participants told us:

Relationships

When women had good relationships with staff, this helped them to move on. It was better when changes were made slowly.

When Jane came to the unit at first, she had to be watched by staff all the time in case she hurt herself. She built some good relationships with staff. They worked together to make sure she felt safe, and then let her have longer times on her own. Slowly, Jane felt safe enough to move on.

Dawn (staff): We started off allowing Jane to go in the toilet on her own and we’d stand outside the door and just have voice contact with her. . .Very gradual, very slowly, and Jane can ask any time. So she’s in control and it’s really helped.

Jane herself said that the staff had helped her to move on.

Jane (resident): Well at first I got like five minutes in my room, then ten minutes. And I’m just off it now.

When Elaine came to the unit, she wanted to live alone. She felt that she was moving on because she was sharing a flat with Teresa now.

Elaine (resident): Well I am moving on now because I’m living with someone now, living with Teresa and I’m getting on alright with her all the time.

Many staff said that trust is important in relationships, especially when a woman might self-harm.

Monica (staff): I think she managed to get quite a lot of good relationships on that ward for the first time ever, because that was around the time things started changing with the attitudes to self-harm. We had a better approach and they began to trust us more.

However, other staff said that too many good relationships can hold women back, stopping them from moving on.

Karen (staff): They feel safe.  And it’s the trust and the relationships they make with the staff – they don’t want to leave them.

Incidents (this means arguments or fights)

Some staff said that people are in secure units so they can change their behaviour. These staff said that ‘incidents’ can hold people back.

When there has been an argument or fight, this goes in a daily report, but the reports sometimes miss good behaviour.

John (staff): I find that when they do the ward round reports they look at the trips out and the bad behaviours, because nobody has got the time to go through the daily notes.  

Sarah said that she had to put up with incidents without hitting back.

Sarah (resident): I got hit last week. And I just sat there and let her do it, I didn’t want to hit back and that’s why the staff said, ‘That’s good that you didn’t hit back.’  So that’s why they’re going to move me on.

Some staff said that they learn from incidents, and they are not always a set back. When staff learn from incidents, they can help the person to move on.

Wendy (staff): You might have an incident but you’ve got to learn from that incident and think you might have to do it differently the next time and do it another way round.  

How to move on?

Some women residents said that the best way to move on was to do what the staff say.

Kate (resident): We just have to do what the staff tell us to do because at the end of the day they’ve only got our best interests at heart.  Do whatever they say.

Tanya said she had to act happy and relaxed, rather than being too quiet or too noisy. This was difficult to do.

Tanya (resident): You have to be talkative and happy.

Kate said that she had been to therapy sessions. These had made her feel much happier and helped her to move on.

Kate (resident): Yes, it took a hell of a long time but we have we’ve worked through it together. No, it doesn’t upset me any more, it doesn’t upset me.

Conclusion 

Jane, Kate and Elaine had moved on in different ways with the help of staff. These are good ways that people can move on.

We found that staff made many of the decisions about how women can move on. We think that people who stay in units should have more of a say about what they need. They should be in charge of talks about moving on. Moving on should be the most important thing to talk about. This includes learning more skills for moving to the community.

It is very important that there are good services and housing in the community to support women who are moving out of secure services.

by Rebecca Fish and Hannah Morgan

All images from CHANGE Changepeople.org 

You can read the article here https://onlinelibrary.wiley.com/doi/10.1111/jar.12586 It is Open Access which means it is free for anyone to read.

Fish, RM & Morgan, H 2019, ”Moving on’ through the locked ward system for women with intellectual disabilities’ Journal of Applied Research in Intellectual Disabilities. https://doi.org/10.1111/jar.12586

This work was funded by the ESRC as part of Rebecca Fish’s PhD study in 2012.

ESRC Ref: ES/H037594/1