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Introduction
The National LD Professional Senate (2015) states that current service delivery for people with learning disabilities (LD) must be:
[…] based on strong community support services, planned around people in the environment that they are in, focussing on person-centred care, and looking at each individual’s needs. This approach should be applied to all, including people with very complex support needs. Services must be committed to achieving the outcomes of “rights, inclusion, independence and choice” […] [with] two critical priorities for action: Reducing Restrictive Practices and Reducing Health Disparities (National LD Professional Senate, 2015, p. 4).
Evidence of the health and social inequalities experienced by people with LD, when compared to the general population, is now well-established (Emerson and Baines, 2011). This is especially true for people with LD within the criminal justice system, who are vulnerable to experiencing health and social inequalities (Michael, 2008; Loucks, 2007). The reasons suggested for this can be broadly discussed as comprising factors relating to LD and issues relating to service provision. For example, factors associated with LD include: communication difficulties affecting the ability to request assistance or express problems (Betts, 2015); a lack of basic literacy skills preventing completion of appointment request forms (National Offender Management Service (NOMS), 2013); requiring assistance with daily activities (Betts, 2015); confusion or difficulty understanding the language and processes of the criminal justice system (Department of Health (DH), 2009a; Talbot, 2008); lacking capacity to make informed choices and decisions (Betts, 2015). Equally, people may try to obscure their LD out of embarrassment, shame and fear of bullying (Talbot, 2008) or not be aware they have an LD (Betts, 2015). Whilst issues relating to service provision include: a lack of accessible information (Talbot, 2008); a lack of appropriately trained, knowledgeable personnel throughout the criminal justice system (NOMS, 2013) which can lead to misinterpretation of actions, behaviours and mannerisms (Talbot, 2008); limited resources (Loucks, 2007); not meeting the inclusion criteria for health and social services provided (Offender Health Research Network (OHRN), 2011; Loucks, 2007). Furthermore, there is evidence of non-compliance with the Equality Act (2010), within prisons and probationary services, (Criminal Justice Joint Inspection (CJJI), 2015). Consequently, the specific health and social care needs of people with LD are not being met and inequalities are...