Lewis, a 19-year-old male, is arrested for grabbing a woman outside the pub and trying to rip her top off. He is diagnosed as having a mild learning disability (LD) and comes across as rude and remorseless. He minimises the process by saying 'you ain't got nothing on me, she wanted me'.
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1. What aspects of this case might you need to consider as the LD nurse and why?
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Correct answer:
- A number of issues need to be considered, including the fact that Lewis was outside a pub: was alcohol intake a contributing factor to his behaviour? Would he have acted like this if he was sober?
- Take into account his level of social skills: did he misread the cues and interactions from the woman? Does he know the appropriate way to interact sexually?
- What sex education has Lewis had? It is possible that he think this is the norm, and this the way he has learnt to interact with women due to a lack of appropriate sexual education.
- Also consider if there were others with him at the time, as Lewis may have been trying to impress, was he encouraged/misled into doing it? The recently highlighted phenomenon 'mate crime' identifies several cases where individuals with LD have been exploited and misled into committing crimes they may not previously have considered doing.
- Also focus on looking at education around social skills and appropriate touch and relationship boundaries – social skills groups and so on.
- Is he known to the health services already?
- Does he understand why he has been arrested? Does he have capacity, and does he realise the potential consequences?
- What is his relationship with the woman? Do they know each other, and did she report him?
- Has Lewis a history of this type of behaviour, and has he any previous dealings with the police?
- Has he been diagnosed with any associated mental health issues, personality disorder, has he got an autistic spectrum disorder, depression?
- Is he on prescribed medication, is he currently taking his medication?
- What are his present social circumstances, economic education employment, housing family relationships?
- Are there any personal factors which need to be taken into account?
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2. What are the key supports that need to be in place for Lewis?
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Correct answer:
- The need to be assessed by a learning disabilities team.
- He needs to have the support of an approved social worker, trusted family member.
- He needs to be diverted away from the justice system.
