The role of specialist inpatient rehabilitation services for people with intellectual disability, autism and mental health, behavioural or forensic needs

2019 ◽  
Vol 13 (5) ◽  
pp. 204-215
Author(s):  
Mahesh Odiyoor ◽  
Samuel Joseph Tromans ◽  
Regi T. Alexander ◽  
Srinaveen Akbari ◽  
Gill Bell ◽  
...  
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Outcome Measures ◽  
Community Support ◽  
Inpatient Rehabilitation ◽  
High Standard ◽  
Standard Of Care ◽  
Rehabilitation Services ◽  
Content Type ◽  
The Uk

Purpose The purpose of this paper is to provide a professional consensus position with regard to the provision of specialist inpatient rehabilitation services for people with intellectual disability (ID), autism and mental health, behavioural or forensic needs in the UK. Design/methodology/approach The concept of rehabilitation is discussed, as well as the functions and goals of specialist inpatient rehabilitation services with regard to the aforementioned contexts. Current use of rehabilitation beds is considered, both on a regional and national scale, as well as various outcome measures, including effectiveness, patient safety and patient experience. Findings There is a clear need for specialist inpatient rehabilitation services, though historically there have been instances of inappropriate admissions, as well as lengthy inpatient stays that could have been significantly reduced with the right type of community support package. Such services should be subjected to rigorous measurement of outcome measures, to determine that patients within such services are receiving a consistently high standard of care. Additionally, amendments to current legal frameworks should be considered, with a view to accommodating for individuals with capacity who require continuous community-based supervision. Originality/value To the best of the author’s knowledge, this is the first article detailing a professional consensus position for specialist inpatient rehabilitation services for people with ID, autism and mental health, behavioural or forensic needs.

Mental health services for people with intellectual disability in the United Kingdom

2018 ◽  
Vol 12 (3/4) ◽  
pp. 91-98 ◽  
Author(s):  
Bhathika Perera ◽  
Ken Courtenay
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Intellectual Disabilities ◽  
Social Care ◽  
Community Support ◽  
Content Type ◽  
Health And Social Care ◽  
People With Intellectual Disabilities ◽  
The Uk

Purpose Services for people with intellectual disabilities in the UK have evolved over the years from hospital-based care to more community provision. There are multiple reasons for these changes, however, often it was due to changes in social policy or following a scandal in provision. The paper aims to discuss these issues. Design/methodology/approach Providing services to meet the health and social care needs of people with intellectual disabilities is well-established in the four countries of the UK with support from legislation. There are often specialist mental health and social care teams. Dedicated professionals work with people with intellectual disabilities who experience mental health problems with a focus on support in the community. A range of services for children and adults and for offenders exist across the UK that often vary in composition and structure. Findings The challenges in providing mental health services for children and adults with intellectual disabilities in the future include recruitment and training of the workforce with the remit of enhancing community support and reduced in-patient care. Practical implications This paper helps the reader to understand how ID mental health services are organised in the UK. Originality/value This paper gives a summary of the ID mental health services in the UK. Even though there are various papers looking at different aspects of mental health services for people with ID in the UK, this paper brings all that information together to help reader get a better understanding of the mental health services for people with ID.

Does training adequately equip psychiatrists for intellectual disability?

2020 ◽  
Vol 14 (3) ◽  
pp. 69-82
Author(s):  
Geraldine Lines ◽  
Jodie Allen ◽  
Caryl Jane Marshall
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Mental Health Services ◽  
Health Services ◽  
Online Survey ◽  
Significant Proportion ◽  
Training Programme ◽  
Practical Experience ◽  
Content Type ◽  
The Uk

Purpose People with intellectual disability (ID) experience significant health and social inequality compared to their non-disabled peers. Individuals with ID who access mental health services can have complex comorbidities and presentations. In the UK, a significant proportion of individuals with ID are supported within general adult mental health services not by specialist ID teams. The purpose of this study is to explore whether psychiatry trainees in the Maudsley Training Programme (MTP) feel adequately skilled to support individuals with ID. Design/methodology/approach An online survey of trainee psychiatrists in the MTP was completed to evaluate self-perceived skills and knowledge in the care of individuals with ID in mental health services. Statistical analysis of the results was completed. Findings Experience of working in specialist ID teams is positively associated with greater confidence and skills among trainees in the care of people with ID; this is beyond what would be expected based on seniority alone. Research limitations/implications The response rate was 16.7 per cent; a larger sample size would add strength to the study. Like all online surveys, there exists the risk of selection bias. Practical implications UK Policy states that people with ID should be supported to access mainstream services where possible, including psychiatric care. Practical experience for all psychiatry trainees involving specialist ID services and people with ID could improve the care given to that particularly disadvantaged group. Originality/value This is the only paper known to the authors that has focused specifically on the skills and knowledge of psychiatry trainees in the UK with regards to ID.

scholarly journals Multidisciplinary team meetings in community mental health: a systematic review of their functions

2016 ◽  
Vol 21 (2) ◽  
pp. 119-140 ◽  
Author(s):  
Caoimhe Nic a Bháird ◽  
Penny Xanthopoulou ◽  
Georgia Black ◽  
Susan Michie ◽  
Nora Pashayan ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Community Mental Health ◽  
Multidisciplinary Team ◽  
Community Mental Health Services ◽  
Content Type ◽  
Team Members ◽  
Team Meetings ◽  
Unwarranted Variation ◽  
The Uk

Purpose – Previous research has identified a need for greater clarity regarding the functions of multidisciplinary team (MDT) meetings in UK community mental health services. The purpose of this paper is to identify the functions of these meetings by systematically reviewing both primary research and academic discussion papers. Design/methodology/approach – Papers relating to adult community mental health teams (CMHTs) in the UK and published between September 1999 and February 2014 were reviewed and appraised using NICE quality checklists. The search was broad in scope to include both general CMHTs and specialist CMHTs such as early intervention psychosis services and forensic mental health teams. A thematic synthesis of the findings was performed to develop an overarching thematic framework of the reported functions of MDT meetings. Findings – None of the 4,046 studies identified directly investigated the functions of MDT meetings. However, 49 mentioned functions in passing. These functions were categorised into four thematic domains: discussing the care of individual patients, teamwork, team management and learning and development. Several papers reported a lack of clarity about the purpose of MDT meetings and the roles of different team members which hindered effective collaboration. Practical implications – Without clearly agreed objectives for MDT meetings, monitoring their effectiveness is problematic. Unwarranted variation in their functioning may undermine the quality of care. Originality/value – This is the first systematic review to investigate the functions of CMHT MDT meetings in the UK. The findings highlight a need for empirical research to establish how MDT meetings are being used so that their effectiveness can be understood, monitored and evaluated.

Micro‐enterprise:

2013 ◽  
Vol 21 (1) ◽  
pp. 26-33 ◽  
Author(s):  
Sian Lockwood
Keyword(s):  
Health Inequalities ◽  
Design Methodology ◽  
Social Care ◽  
Community Support ◽  
Well Being ◽  
Local Health ◽  
Content Type ◽  
Local Case ◽  
The Uk ◽  
Health And Well Being

PurposeThis paper seeks to explore the potential of micro‐enterprises to assist local health and well‐being boards in delivering their strategies, especially in relation to tackling health inequalities, prevention and community support.Design/methodology/approachThis paper draws on experience gained by Community Catalysts from its work supporting social care and health micro‐enterprise across the UK. There has been little formal research into social care and health micro‐enterprise and so the paper relies heavily on data gathered by Community Catalysts in the course of its work and uses local case studies to illustrate points.FindingsThe paper explains the importance of social care and health micro‐enterprise to the work of health and well being boards, emphasising its potential to help tackle health inequalities and contribute to effective health and well‐being strategies.Originality/valueThere are no examples as yet of imaginative health and well‐being boards engaging effectively with micro‐providers, but boards can draw on learning from local authorities actively stimulating and supporting local micro‐enterprise.

Creating a culture of employability in mental health

2014 ◽  
Vol 18 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Naomi Boycott ◽  
Justine Schneider ◽  
Michael Osborne
Keyword(s):  
Mental Health ◽  
Supported Employment ◽  
Implementation Process ◽  
Lessons Learned ◽  
Service Development ◽  
Content Type ◽  
The Individual ◽  
The Uk ◽  
Early Intervention In Psychosis ◽  
The Impact

Purpose – The purpose of this paper is to draw out the lessons learned from the implementation of the Individual Placement and Support (IPS) approach to supported employment in two contrasting adult mental health teams; one “standard” CMHT, and one early intervention in psychosis (EIP) team. Design/methodology/approach – These inferences are based on the evidence from a four-year study of IPS in one mental health care provider in the UK, which began by setting up a new service, and went on to run a RCT looking at the impact of psychological input as an adjunct to IPS alone. Findings – In attempting to introduce IPS to mental health teams in Nottingham the authors came across numerous barriers, including service reorganisation, funding cuts and the wider context of recession. Differences were observed between mental health teams in the willingness to embrace IPS. The authors argue that this variability is due to differences in caseload size, recovery priorities and client profiles. The authors have learnt that perseverance, strenuous efforts to engage clinical staff and the use of IPS fidelity reviews can make a positive difference to the implementation process. Practical implications – The experience suggests that setting up an IPS service is possible even in the most challenging of times, and that EIP services may be a particularly fertile ground for this approach. The authors also discuss potential barriers to implementing new services in mental health teams. Originality/value – This paper will be of value to service development and the science of implementation in mental health.

London Fire Brigade's screen and treat approach to the Grenfell Tower incident

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Craig Steel ◽  
Zoe Travers ◽  
Lynette Meredith ◽  
Deborah Lee ◽  
Michael Conti ◽  
...  
Keyword(s):  
Mental Health ◽  
Design Methodology ◽  
Stress Disorder ◽  
National Guidelines ◽  
Line Managers ◽  
Content Type ◽  
Health Response ◽  
The Uk ◽  
Post Disaster ◽  
Practical Implications

PurposeThe purpose is to report on the mental health response to the Grenfell incident within the London Fire Brigade (LFB).Design/methodology/approachThe LFB implemented screening for the symptoms of posttraumatic stress disorder (PTSD) at 28 days, 3 months and 6 months for all personnel directly involved in the incident.FindingsThe prevalence of PTSD within frontline personnel was 13.4% at 28 days, falling to 7.6% at 6 months. The LFB's internal Counselling and Wellbeing Service offered treatment to those scoring above the cut-off for PTSD along with accepting self-referral and referrals from line managers and occupational health. There were 139 referrals within the 12-month period following the incident.Research limitations/implicationsThe outcomes for those who engaged in treatment are broadly in line with other studies evaluating post-disaster interventions. Issues for consideration within national guidelines are discussed.Practical implicationsThe screen and treat approach adopted by LFB was shown to be a feasible approach to use within such a scenario.Originality/valueThe current study reports on a screen and treat approach to one of the largest single incidents in the UK in recent years.

A retrospective cohort study describing characteristics of those repeatedly detained under Section 136 of the Mental Health Act over a 5-year period and the association with past abuse

2021 ◽  
pp. 002580242110454
Author(s):  
Laureen Adewusi ◽  
Isabel Mark ◽  
Paige Wells ◽  
Aileen O’Brien
Keyword(s):  
Mental Health ◽  
Past History ◽  
Significant Proportion ◽  
Community Support ◽  
White Ethnicity ◽  
Demographic Profiles ◽  
Mental Health Act ◽  
History Of ◽  
Self Harm ◽  
The Uk

Individuals repeatedly detained under Section 136 (S136) of the Mental Health Act account for a significant proportion of all detentions. This study provides a detailed analysis of those repeatedly detained (‘repeat attenders’) to a London Mental Health Trust, identifying key demographic profiles when compared to non-repeat attenders, describing core clinical characteristics and determining to what degree a past history of abuse might be associated with these. All detentions to the S136 suite at South West London and St George's Mental Health NHS Trust over a 5-year period (2015–2020) were examined. Data were collected retrospectively from electronic records. A total of 1767 patients had been detained, with 81 patients identified as being a ‘repeat attenders’ (having had > = 3 detentions to the S136 suite during the study period). Repeat attenders accounted for 400 detentions, 17.7% of all detentions. Repeat attenders included a higher proportion of females (49.4%, p = 0.0001), compared to non-repeat attenders, and a higher proportion of them were of white ethnicity (85.2%, p = 0.001). 52 (64%) patients reported being a victim of past abuse or trauma. Of repeat attenders who reported past abuse or trauma, a high proportion had diagnoses of personality disorders, with deliberate self-harm as the most common reason for detention. They were more commonly discharged home with community support, rather than considered for hospital admission. In light of these findings, this paper discusses support potential strategies for those most vulnerable to repeated S136 detention, thereby minimising the ever-growing number of S136 detentions in the UK.

Inpatient treatment of borderline personality disorder in adults with intellectual disability: reflections on practice

2019 ◽  
Vol 13 (2) ◽  
pp. 67-75
Author(s):  
Trine Elisabeth Iversen ◽  
Kristin Horndalsveen ◽  
Espen Matre ◽  
Tine Finstad Henriksen ◽  
Sarah Fusche ◽  
...  
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Inpatient Treatment ◽  
Borderline Personality ◽  
Behaviour Problems ◽  
Mental Health Symptoms ◽  
Health Symptoms ◽  
Content Type

Purpose There are few publications on personality disorder in adults with intellectual disability (ID), and on borderline personality disorder (BPD) specifically. Publications concerning treatment are sparse, despite the high symptom burden in these patients. This paper aims to discuss these issues. Design/methodology/approach Six patients with BPD and ID were recruited from the same inpatient unit. Behaviour problems and mental health symptoms were scored on admission and discharge. Information about treatment, length of stay, etc. was taken from case files. Findings Both mental health symptoms measured by the SCL-90-R, and behaviour problems measured by the Aberrant Behaviour Checklist were significantly reduced on discharge. In the active treatment period, the two main aspects of treatment were validation and practicing new solutions when emotional and behavioural problems occur, i.e. skills training. Research limitations/implications The limitations related to this study are that the study is conducted in one milieu only. Another limitation is that the patients were admitted over a five-year period, where, some changes were made in the treatment approach. Practical implications Inpatient treatment of this patient group seems to be effective if individually adjusted to the patient’s psychopathology, ID and communication style. Close co-operation between the individual therapist and milieu therapists is essential. Originality/value There is a need for intervention studies on BPD in ID. This study may be a valuable contribution.

The use of the mental health treatment requirement (MHTR): clinical outcomes at one year of a collaboration

2018 ◽  
Vol 8 (3) ◽  
pp. 215-233 ◽  
Author(s):  
Clive G. Long ◽  
Olga Dolley ◽  
Clive Hollin
Keyword(s):  
Mental Health ◽  
Social Adjustment ◽  
Work Experience ◽  
Mental Health Treatment ◽  
Short Term ◽  
Health Treatment ◽  
Content Type ◽  
Cognitive Behavioural ◽  
The Uk ◽  
Relevant Work

Purpose In the UK, the mental health treatment requirement (MHTR) order for offenders on probation has been underused. A MHTR service was established to assess the effectiveness of a partnership between a probation service, a link worker charity and an independent mental healthcare provider. Short-term structured cognitive behavioural interventions were delivered by psychology graduates with relevant work experience and training. Training for the judiciary on the MHTR and the new service led to a significant increase in the use of MHTR orders. The paper aims to discuss these issues. Design/methodology/approach A total of 56 (of 76 MHTR offenders) completed treatment in the first 12 months. A single cohort pre-post follow-up design was used to evaluate change in the following domains: mental health and wellbeing; coping skills; social adjustment; and criminal justice outcomes. Mental health treatment interventions were delivered under supervision by two psychology graduates who had relevant work experience and who were trained in short term, structured, cognitive behavioural (CBT) interventions. Findings Clinically significant changes were obtained on measures of anxiety and depression, and on measures of social problem solving, emotional regulation and self-efficacy. Ratings of work and social adjustment and pre-post ratings of dynamic criminogenic risk factors also improved. This new initiative has addressed the moral argument for equality of access to mental health services for offenders given a community order. Originality/value While the current initiative represents one of a number of models designed to increase the collaboration between the criminal justice and the mental health systems, this is the first within the UK to deliver a therapeutic response at the point of sentencing for offenders with mental health problems. The significant increase in the provision of MHTR community orders in the first year of the project has been associated with a decrease in the number of psychiatric reports requested that are time consuming and do not lead to a rapid treatment.

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