A survey of consultant psychiatrists in intellectual disability based in England

2016 ◽  
Vol 10 (4) ◽  
pp. 258-270 ◽  
Author(s):  
Ashley Guinn ◽  
Sujeet Jaydeokar ◽  
Jane McCarthy ◽  
Ashok Roy ◽  
Angela Hassiotis
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Social Care ◽  
Community Mental Health Services ◽  
Evidence Base ◽  
Community Services ◽  
Content Type ◽  
Current State ◽  
Service Models ◽  
The Government

Purpose Community mental health services are of increasing importance for people with an intellectual disability (ID), as the government aims to reduce the number of people treated within inpatient services. However, due to limited evidence base, it is unclear which service models are most effective for treating people with both ID and a mental health condition. Therefore, the purpose of this paper is to carry out a survey in order to gain a better understanding of the current state of ID community services. Design/methodology/approach The survey was e-mailed to 310 consultant psychiatrists based in England and whose main specialism was in ID. In total, 65 consultants responded to the survey with 53 complete data sets. Findings In total, 84 per cent of consultants identified themselves as working in a generic community ID team. The majority of services were not integrated with social care (71 per cent). Regional differences were found. In contrast to the rest of England, the majority of services in London were integrated with social care. The Health of the Nation Outcome Scale for people with Learning Disabilities (HoNOS-LD) was found to be the most common outcome measure used by services. A range of interventions are widely available across services including psychological therapies and specialist memory assessments. The survey also provides evidence for increased decommissioning of specialist inpatient units and a need for more robust community services. Research limitations/implications Findings limited by low return rate (21 per cent) and because responses could not be matched to specific services. The implications of this survey are that there is still a variable level of integration with social care and that lack of integration could affect the quality of service. While HoNOS-LD is used consistently across services, there may be a need to supplement it with other outcome measures. There is a need for larger scale and higher quality studies in this area to strengthen the evidence base and therefore demonstrate the benefits of integration and specialisation more convincingly to health professionals and commissioners. Originality/value This survey presents an overview of the current state of community services for adults with ID in England. This information can be harnessed to add to revised approaches to mental health service models for people with ID.

The development and results of the European Mental Health Integration Index (2014)

2015 ◽  
Vol 14 (4) ◽  
pp. 205-210
Author(s):  
Peter John Huxley
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Best Practice ◽  
Mental Health Problems ◽  
Community Mental Health Services ◽  
Health Problems ◽  
Community Services ◽  
Content Type ◽  
People With Mental Illness ◽  
Mental Health Integration

Purpose – The purpose of this paper is to report on the development and results of the Mental Health Inclusion Index. Design/methodology/approach – Data gathering and interviews with key policy makers in 30 countries in Europe (the EU28 plus Switzerland and Norway). Data gathered enabled the production of an 18 indicator benchmarking index ranking the 30 countries based on their commitment to integrating people with mental illness. Findings – The main findings were: mental illness exacts a substantial human and economic toll on Europe, and there is a substantial treatment gap, especially for people with common mental health problems. Germany’s generous social provision and strong healthcare system put it number one in the Mental Health Integration Index. The UK and Scandinavian states come next. The lowest-scoring countries in the index are from Europe’s south-east, where there is a long history of neglect of mental illness and poorly developed community services. One needs to understand that the leading countries are not the only ones providing examples of best practice in integrating those with mental illness. Employment is the field of greatest concern for people with mental illness, but employment is also the area with the most inconsistent policies across Europe. A distinction can be made between countries whose policies are aspirational and those where implantation is support by substantial and most importantly sustained, resource investment. Europe as a whole is only in the early stages of the journey from institution- to community-based care. Lack of data makes greater understanding of this field difficult, and improvement can only be demonstrated by repeated surveys of this kind, based on more substantial, comprehensive and coherent information. Research limitations/implications – Usual caveats about the use of surveys. Missing data due to non-response and poverty of mental health inclusion data in many European countries. Practical implications – The author reflects on the findings and considers areas for future action. The main implications are: better services result from substantial, but most importantly, sustained investment; and that employment is most important to people with mental health problems, but is one of the most inconsistent policy areas across Europe. Social implications – Supports the need for consistent investment in community mental health services and more consistent employment policies in Europe. Originality/value – This survey is the first of its kind in Europe, and was conducted by the Economist Intelligence Unit in London, and sponsored by Janssen.

Reflections on the use of a specialist acute assessment and treatment unit for adults with intellectual disability

2015 ◽  
Vol 9 (3) ◽  
pp. 132-138 ◽  
Author(s):  
Kiran Purandare ◽  
Anusha Wijeratne
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Care Pathway ◽  
Average Distance ◽  
Community Services ◽  
Discharge Process ◽  
Treatment Unit ◽  
Content Type ◽  
Catchment Areas ◽  
The Impact

Purpose – The purpose of this paper is to evaluate the impact of a changing commissioning landscape on the provision of specialist acute inpatient care from the perspective of a small category 2 unit in London. Design/methodology/approach – The authors conducted a retrospective survey of all referrals to the unit in 2012 and 2013. Findings – There has been an increase in the referrals and admissions to the unit with referrals covering a wider catchment area. This has resulted in a doubling of the average distance between the unit and the respective catchment areas that patients and their relatives have to travel. The majority of admissions were transfers from mainstream mental health services. There has been a reduction in the mean length of stay. Research limitations/implications – This survey looks at trends in one category 2 unit in an outer London Borough and therefore, limits generalisability. The data collection was retrospective and there was no information on patients requiring admission but not being referred to the unit. Practical implications – There continues to be a need for category 2 admission units to serve the needs of a small group of patients with intellectual disability presenting with mental health needs and behavioural problems. Consideration needs to be given to the entire mental health and challenging behaviour care pathway, including the small but crucial element of specialist inpatient management if services are to remain local and responsive to the needs of this group of patients and their carers. Social implications – An ill-planned reduction in the number of specialist inpatient units without viable community services, risks perpetuating a situation where patients and their relatives have to travel long distances to obtain appropriate specialist help. Longer geographical distances could also potentially hamper closer liaison between the unit and the community services, thereby reducing the degree of oversight and prolonging the transition and discharge process. Originality/value – This survey highlights the impact of recent commissioning and service changes on delivery of specialist in patient services for adults with intellectual disability in the immediate aftermath of the Winterbourne Review.

Predictors of challenging behaviour in adults with intellectual disability

2015 ◽  
Vol 9 (6) ◽  
pp. 312-326 ◽  
Author(s):  
Stella Koritsas ◽  
Teresa Iacono
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Living Arrangement ◽  
Evidence Base ◽  
Challenging Behaviour ◽  
Content Type ◽  
Future Assessment ◽  
Severity Of Disability ◽  
And Gender ◽  
Challenging Behaviours

Purpose – The purpose of this paper is to determine the extent to which mental health, physical health, communication, learned function of the behaviour(s), severity of disability, living arrangement, age, and gender, alone or in combination, predicted challenging behaviours in adults with intellectual disability. Design/methodology/approach – In total, 74 adults with intellectual disability and their paid carers were recruited into the study from adult disability services in Victoria, Australia. Paid carers provided information about participants with intellectual disability on a range of measures targeting each variable of interest. Findings – Based on principle components analyses of three challenging behaviour measures, two topographies of challenging behaviour emerged: contact and non-contact behaviours. Multiple regression analysis revealed that contact behaviours were predicted by anxiety scores and severity of disability. In addition to severity of disability and anxiety scores, non-contact behaviours were also predicted by sensory scores. Practical implications – The results of the current study indicate that contact and non-contact behaviours were determined by multiple factors. Clinicians and others who work with people who display challenging behaviour may, therefore, find it helpful to utilise the biopsychosocial model in their formulations of possible reasons that motivate a person to engage in challenging behaviour. Originality/value – These results contribute to the evidence base available to clinicians and researchers to guide future assessment for challenging behaviour. Expansion of functional assessment methods to explore factors not traditionally included, such as mental health and severity of intellectual disability, as causes of challenging behaviour, may prove helpful.

Attitudes towards offenders with intellectual disability

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Rachel Worthington ◽  
Sarah Rossetti
Keyword(s):  
Intellectual Disability ◽  
Protective Factor ◽  
Implicit Theories ◽  
Public Attitudes ◽  
Community Integration ◽  
Quality Care ◽  
Well Being ◽  
Community Services ◽  
Content Type ◽  
The Government

Purpose Public attitudes are considered influential in the successful reintegration of offenders into society after release, however research into attitudes towards offenders with intellectual disability (ID) has received little attention. The purpose of this study is firstly to see if people hold differing attitudes towards the reintegration of offenders with ID compared to those without ID and secondly, to investigate whether this difference in attitude is because of differing implicit theories of intelligence (TOI). The effects of familiarity with ID were also measured. Design/methodology/approach In total, 200 participants read crime vignettes depicting crimes committed by offenders with and without ID and completed Dweck’s “TOI” scale. Findings Participants were found to have greater entity views of intelligence towards ID yet displayed more positive attitudes towards their reintegration than offenders without ID. The influence of demographics was mixed. It would appear attitudes towards offenders with ID are not as negative as initially thought. Research limitations/implications Implications of these findings are discussed in terms of desistance and community integration. Practical implications While some care must be taken when interpreting the results, this study demonstrates positive results regarding the reintegration of offenders with ID. Attitudes may be changing for the better towards those with disabilities, which is positive in terms of the government and National Health Service (NHS) objectives to reintegrate people with ID successfully back into the community. Although limited in number, it is noted that community forensic mental health teams have been effective in managing offender risk and providing good quality care (Dinani,et al.,2010; Benton and Roy, 2008). They can provide more person-centred and specialist treatments options and have links with other community services, probation and the police (Royal College of Psychiatrists, 2014). Social implications Community care is thought to lead to more timely treatments with more accessible support teams and services that those with ID would struggle to access in prison (Bradley, 2009). It can also lead to greater well-being and support as individuals are in a less restrictive environment and are closer to their social networks, acting as a protective factor against further reoffending (Benton & Roy, 2008; Bradley, 2009). Furthermore, it has been indicated significant financial savings would be achieved for the criminal justice system by reducing inpatient care and increasing community services and sentences, in addition to reducing the demand on prison spaces (Bradley, 2009; Benton & Roy, 2008). Originality/value To date, very few studies have used TOI to examine attitudes towards offenders, with none examining attitudes towards offenders with ID.

Expert opinions on community services for people with intellectual disabilities and mental health problems

2013 ◽  
Vol 7 (3) ◽  
pp. 169-174 ◽  
Author(s):  
Colin Hemmings ◽  
Alaa Al‐Sheikh
Keyword(s):  
Mental Health ◽  
Intellectual Disabilities ◽  
Mental Health Problems ◽  
Evidence Base ◽  
Health Problems ◽  
Community Services ◽  
Service Users ◽  
Content Type ◽  
Accessible Information ◽  
Service Components

PurposeThere has been limited evidence on which to base services in the community for people who have intellectual disabilities and coexisting mental health problems. Recent research involving service users, carers and professionals has identified a number of key service components that community services should provide. More detail is needed to explore how best these components could be implemented and delivered. This paper aims to discuss these issues.Design/methodology/approachA total of 14 multidisciplinary professionals from specialist intellectual disabilities services in the UK were interviewed about their opinions on four key areas of community service provision. These included the review and monitoring of service users, their access to social, leisure and occupational activities, the support, advice and training around mental health for a person's family or carers and “out of hours” and crisis responses. The interview data was used for coding using the NVivo 7 software package and then analyzed using thematic analysis.FindingsAnalysis of participants' views on these key essential service components produced wider themes of importance. The ten major emergent themes for services were: their configuration/structure, their clarity of purpose/care pathways, their joint working, their training, their flexibility, their resources, their evidence‐base, being holistic/multidisciplinary, being needs‐led/personalised and providing accessible information.Originality/valueThese views of experts can help inform further research for the development and the evaluation of services.

Family and caregivers’ experience of mental illness in migrants with intellectual disability – reflections on practice

2019 ◽  
Vol 13 (2) ◽  
pp. 76-88
Author(s):  
Jane Margrete Askeland Hellerud ◽  
Trine Lise Bakken
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Intellectual Disability ◽  
Mental Health Services ◽  
Health Services ◽  
Psychiatric Inpatient ◽  
Community Services ◽  
Cultural Dimensions ◽  
Content Type ◽  
The Impact

Purpose The purpose of this paper is to investigate the families’ and professional caregivers’ experience of mental health services for patients in the migrant population with intellectual disability (ID). Design/methodology/approach To highlight this rarely studied topic, the authors chose a qualitative approach, using a semi-structured interview guide. The authors performed a search for relevant articles. Three families of former patients of a specialized psychiatric inpatient unit and 12 professional caregivers were interviewed. The interviews were taped, transcribed and analyzed using a thematic analysis. Findings In total, 17 themes from the families’ answers and 14 themes from the caregivers’ answers were grouped into four main themes each. Two main themes were identical for both groups: perspectives on mental illness and “the Norwegian system.” Additionally, the families were concerned about the impact on the patient and family and coping strategies. The caregivers highlighted patient–caregiver interaction and family–caregiver interaction. Research limitations/implications Further research should include the patients’ opinions based on the findings of this study. Also, studies including larger samples from both specialist services and community services are needed to develop evidence-based services for these patients. Practical implications Proposed adaptations to enable assessment and treatment of mental illness in migrants with ID should be adapted to cultural preferences. The following adaptations are proposed: inclusion of the entire family, awareness of cultural dimensions, information about the health care system, education in mental illness, the use of interpreters and adequate time spent with the families. Originality/value Mental health services for this group are an understudied topic. Clinical experience indicates that professionals struggle when providing services for such patients.

Foetal alcohol spectrum disorder (FASD) – its relevance to forensic adolescent services

2014 ◽  
Vol 5 (3) ◽  
pp. 124-137 ◽  
Author(s):  
Ernest Gralton
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Criminal Justice ◽  
Young People ◽  
Social Care ◽  
Alcohol Exposure ◽  
Adoptive Parents ◽  
Spectrum Disorder ◽  
Content Type ◽  
Health And Social Care

Purpose – There needs to be an increased recognition of fetal alcohol spectrum disorder (FASD) in services that deal with young people with disruptive and offending behavior, not just those services that deal with adolescents with a recognized intellectual disability. The paper aims to discuss these issues. Design/methodology/approach – This is a general review of the current available evidence on FASD and how it is likely to predispose affected young people to have contact with secure mental health services and the criminal justice system. Findings – FASD is likely to have become a more common cause of intellectual disability and behavioral disturbance but the history of significant alcohol exposure in utero if often missed. There is evidence that the hyperactivity is less responsive to psychotropic medication and may represent a different condition to conventional ADHD. However the majority of those affected are in the low normal IQ range. Research limitations/implications – There is so far very limited research in what is likely to be a relatively common disorder with significant costs to criminal justice, mental healthcare and social services. Epidemiological information from the UK is lacking and urgently needed. Practical implications – Professionals who work with mentally disordered young people need to be more aware of FASD and its potential contribution to the problems and disabilities in their population. Social implications – Social workers, foster carers and adoptive parents need to be more aware of FASD and how it can contribute to the breakdown of social care. Originality/value – There is currently no other review of FASD and the implications for criminal justice, secure mental health and social care for young people.

Psychodynamic psychotherapy in severe and profound intellectual disability

2020 ◽  
Vol 14 (3) ◽  
pp. 45-60
Author(s):  
Julian Himmerich
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Case Studies ◽  
Critical Review ◽  
Psychodynamic Psychotherapy ◽  
Quality Evaluation ◽  
Evidence Base ◽  
Inclusion Criteria ◽  
Content Type ◽  
Mental Health Difficulties

Purpose Psychodynamic psychotherapy is increasingly adapted and used with individuals with intellectual disability (ID) and mental health difficulties. However, the evidence base is still small and largely based on case studies and small trials whose participants mainly have mild to moderate ID. This paper aims to review and critique the literature in regards to the adaptations; and the effectiveness of psychodynamic psychotherapy for those with severe and profound ID. Design/methodology/approach A systematic literature search of PsycINFO, Social Policy and Practice, Medline, Cumulative Index to nursing and allied health literature and applied social sciences index and abstracts was conducted. Six studies met inclusion criteria and underwent a quality evaluation and critical review. Findings Six papers (all case studies) met inclusion criteria and underwent a quality evaluation and critical review. Some adaptations to therapy were reported, such as a more flexible therapeutic frame and increased use of the physical environment as a therapeutic tool. Due to significant methodological weaknesses of the included studies, it is yet unclear whether psychodynamic psychotherapy is an effective intervention for individuals with severe and profound ID. Research limitations/implications Only a small number of case studies met the inclusion criteria. Further research should use more robust outcome measures, larger samples and compare psychodynamic psychotherapy to alternative interventions. Originality/value This paper is the first to review the psychodynamic psychotherapy literature with regard to its effectiveness as a treatment specifically for individuals with severe and profound ID and mental health difficulties.

Costs of Schizophrenia and Other Psychoses in Urban Australia: Findings from the Low Prevalence (Psychotic) Disorders Study

2003 ◽  
Vol 37 (1) ◽  
pp. 31-40 ◽  
Author(s):  
Vaughan J. Carr ◽  
Amanda L. Neil ◽  
Sean A. Halpin ◽  
Scott Holmes ◽  
Terry J. Lewin
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Psychotic Disorders ◽  
Community Services ◽  
Societal Costs ◽  
Metropolitan Regions ◽  
Lost Productivity ◽  
Average Patient ◽  
The Government ◽  
Low Prevalence

Objective: To estimate the costs associated with the treatment and care of persons with psychosis in Australia based on data from the Low Prevalence Disorders Study (LPDS), and to identify areas where there is potential for more efficient use of existing health care resources. Method: The LPDS was a one-month census-based survey of people with psychotic disorders in contact with mental health services, which was conducted in four metropolitan regions in 1997–1998. Mental health and service utilization data from 980 interviews were used to estimate the economic costs associated with psychotic disorders. A prevalencebased, ‘bottom-up’ approach was adopted to calculate the government and societal costs associated with psychosis, including treatment and non-treatment related costs. Results: Annual societal costs for the average patient with psychosis are of the order of $46 200, comprising $27 500 in lost productivity, $13 800 in inpatient mental health care costs and $4900 in other mental health and community services costs. Psychosis costs the Australian government at least $1.45 billion per annum, while societal costs are at least $2.25 billion per annum (including $1.44 billion for schizophrenia). We also report relationships between societal costs and demographic factors, diagnosis, disability and participation in employment. Conclusions: Current expenditure on psychosis in Australia is probably inefficient. There may be substantial opportunity costs in not delivering effective treatments in sufficient volume to people with psychotic disorders, not intervening early, and not improving access to rehabilitation and supported accommodation.

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.

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