Learning Disability - medium secure

Based on a Therapeutic Community (TC) approach, Thoresby is a specialist medium secure service for men with a learning disability, who have learned to use challenging ways of behaving in order to cope with routine challenges in life. 

Thoresby features a unique approach to care by encouraging patient empowerment and involvement through the democratisation of daily decision making, working alongside staff to establish care and treatment plans and participate in all aspects of running and living in an inpatient ward.
Our Therapeutic Community approach is a living, learning environment which combines direct treatments with a residential culture, providing patients with increased opportunities to develop and rehearse new skills whilst simultaneously receiving feedback designed to increase their awareness of their risk factors and criminogenic needs.

Admissions criteria

People referred will have a history of challenging or risk behaviours, and are detained under the Mental Health Act. These individuals may have identifiable mental health difficulties, in particular affective disorders, adjustment and separation-related disorders, and psychotic illnesses. Thoresby can accept male patients:

  • aged between 18 and 60 years
  • who have a primary learning disability (sub-average general intellectual functioning; difficulties in functioning in two or more specified areas)
  • who have an intellectual disability and co-morbid mental illness
  • significant challenging behaviours which are not manageable in lower levels of security
  • a forensic history of index offence which requires a medium secure environment.

A therapeutic community

The TC approach enables therapeutic opportunities to take place throughout the whole day, rather than within defined treatment sessions, with community members providing feedback to each other, allowing patients to learn about the impact of their behaviour.

By working together to maintain the running of the ward a sense of community is maintained and consideration for each other and positive attachments are promoted.
Patients form part of a structured group setting, which focuses on four key areas of functioning:

  • recognising and managing feelings
  • learning about behaviour
  • understanding thoughts and thinking
  • developing healthy relationships.

The patients are involved in a range of core practices, for example:

  • morning meetings: an opportunity to plan the day and discuss management of risky behaviours
  • safe ‘ME’ programme: a rolling offender behaviour programme based on the treatment needs matrix
  • interpersonal groups: focussing on trauma, offending and day to day behaviours.
  • living without violence: a community review of violent incidents, seclusion episodes etc.

The groups and residential setting allow for this work to take place in a validating and nurturing environment that aims to challenge the core schema associated with the trauma of the patients’ early lives.

As a specialist service, the extensive in house multidisciplinary team (MDT) has received training specifically in supporting individuals with learning disability and, as a minimum, will understand:

  • the nature, development and cause of learning disability
  • its impact on personal, social, educational and occupational functioning
  • interaction with the social and physical environment
  • the impact of other coexisting mental and physical disorders and their management
  • the potential discrepancy between intellectual functioning, as measured by IQ, and adaptive functioning, e.g. difficulties in planning and performing activities of daily living including education or employment.

Next steps

Our ultimate objective is to help our patients feel safe enough to learn new ways of behaving, develop new skills and reduce risk behaviours to a level where they can move towards community living.

For those requiring bespoke packages of care Winslow may provide a suitable solution.

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