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.

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.

An evaluation of the implementation of Safewards on an assessment and treatment unit for people with an intellectual disability

2020 ◽  
pp. 174462952090163 ◽  
Author(s):  
Bronwen Davies ◽  
Jade Silver ◽  
Scarlett Josham ◽  
Emma Grist ◽  
Lewis Jones ◽  
...  
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Health Services ◽  
Future Research ◽  
Treatment Unit ◽  
Positive Approach ◽  
Shift Report ◽  
Assessment And Treatment ◽  
Containment Measures ◽  
The Impact

This study evaluates the implementation of Safewards on an assessment and treatment unit (ATU) for people with an intellectual disability. There are no previous studies evaluating this model in this context and previous research has focused largely on acute mental health services. The ‘Patient–Staff Conflict Shift Report’ was used at baseline for 1 month and 1 year later, after all the interventions had been implemented, to evaluate the impact of Safewards. Significant reductions were found in conflict and containment measures used within the service after the implementation of Safewards. Staff who led on the interventions were also asked to give feedback on their experiences, the challenges they faced and how they would like to move forward. Safewards was generally seen as a positive approach by the team. Limitations of this study are highlighted and suggestions for future research are made.

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.

Supporting carers during assessment and treatment unit admissions

2016 ◽  
Vol 10 (2) ◽  
pp. 116-127 ◽  
Author(s):  
Neil James
Keyword(s):  
Intellectual Disability ◽  
Effective Communication ◽  
Small Sample ◽  
Practical Significance ◽  
Future Research ◽  
Treatment Unit ◽  
Content Type ◽  
Assessment And Treatment ◽  
Facilitators And Barriers ◽  
The Impact

Purpose – Currently there is no research that explores professionals’ perspectives in supporting carers of a person with an intellectual disability during their relatives admission to a specialist in-patient setting. The purpose of this paper is to report the findings from the second stage of a study that explored the experiences of family carers whose relative was admitted to a specialist National Health Service assessment and treatment unit (ATU) in Wales, UK (James, 2016). Design/methodology/approach – Aim: to obtain the views of professionals in relation to what they consider are the barriers and facilitators to addressing some of the experiences discussed by carers. Methods: nine professionals working in intellectual disability-specific services participated in four semi-structured interviews and one focus group (n=5) and the data were analysed using a descriptive thematic analysis process. Findings – Three major themes were developed to represent what professionals identified as a number of individual, organisational and practical facilitators and barriers to the provision of support to carers at this time. Professionals recognised the important role they have in developing relationships with carers during the admission. Key to this relationship is effective communication, collaboration, involvement and the need to be consistently open and honest. Research limitations/implications – The small sample size could be said to be a weakness and unrepresentative and practice of other professionals. However, what professionals reported had similarities to the findings from other related research. Importantly, the findings have a practical significance in that they can be used to raise awareness and be used to inform the development of future research and practice. The sample could also be criticised for not having representation from a wider range of professionals from across the multi-disciplinary team. However, a strength of the sample is that it did have representation from three different professional disciplines with different roles and responsibilities. Practical implications – Currently there is very limited research exploring the experiences of professionals in respect of supporting carers during the admission of a relative to a specialist in-patient setting. Professionals demonstrated an understanding of the impact that the additional needs and admission of their relative to an ATU could have on carers. Accordingly, they were able to recognise the important role that they, and other professionals, play in developing relationships as part of providing support to them during this time. Key to these relationships was effective communication and in particular the need to be consistently open and honest. Social implications – The findings from this study illustrate a gap between the rhetoric of policy, legislation and carer strategies, and practice of valuing and respecting the role that carers. Of particular concern is that some of the relationships that carers have had with professionals have threatened rather than positively endorsed and augmented their role and identity. These engagements with professionals therefore have had a profound effect on the way in which they have understood their value as a carer and their own sense of self. Significantly, the actions and behaviours of professionals play a key role in shaping carers views of themselves and their identity. Originality/value – Currently there is no research that has explored the views of professionals in respect of support and relationships with carers at this time. The synthesis of findings from stage one of this study with professionals’ perspectives of resulted in the identification of similarities and differences in experiences as well as facilitators and barriers to support provision. In so doing, it has given clear application of the studies findings to practice. This study therefore provides an original contribution to the understanding of this area of carer experience, from the perspectives of professionals and adds to the wider literature exploring the family carer experience.

Hospital discharge: lost opportunities to promote or maintain older people’s mental health

2016 ◽  
Vol 17 (3) ◽  
pp. 189-197 ◽  
Author(s):  
Tarran Haskey Macmillan
Keyword(s):  
Mental Health ◽  
Older People ◽  
Hospital Discharge ◽  
Large Scale ◽  
Mental Wellbeing ◽  
Discharge Process ◽  
Content Type ◽  
Health And Wellbeing ◽  
Health And Social Care ◽  
The Impact

Purpose The purpose of this paper is to explore the impact of hospital discharge on the wider wellbeing of older people, drawing out implications this can have on mental health. Design/methodology/approach This paper is based on research from the Healthwatch England Special Inquiry into hospital discharge. The paper focuses on the experiences of 1,300 older people, with the majority of the research being undertaken by the local Healthwatch network. The 58 local Healthwatch who submitted evidence on the experiences of older people as part of the inquiry were autonomous in how they were able to carry out the research, with results being analysed through use of a qualitative framework. Findings Older people often felt they were not ready for discharge due to not feeling involved in planning of their discharge, being discharged without the information they need and having difficulties accessing aftercare support. This paper examines the impact these issues can have on the mental health and wellbeing of older people, their carers and specifically patients with dementia both during and after discharge from hospital. Through examination of these issues the discharge process can be viewed from the perspective of the individual, and start to conceptualise where the hospital discharge process could further support older people’s mental health and wellbeing. Research limitations/implications This paper examines these issues in detail through case studies collected regarding older people, and exposes the impact poor discharge can have on physical and mental wellbeing for older patients. The paper presents a number of issues which have implications for policy and practice in both health and social care, and the integration of the two services. Originality/value This is the first Special Inquiry conducted by Healthwatch England in conjunction with the local Healthwatch network and presents a large scale piece of research led by the experiences of older people.

Health, happiness and your future: using a “men’s group” format to work with homeless men in London

2017 ◽  
Vol 13 (4) ◽  
pp. 403-418
Author(s):  
Kate Thompson ◽  
Pippa Brown ◽  
Stephanie Vieira
Keyword(s):  
Mental Health ◽  
Psychosocial Issues ◽  
Horn Of Africa ◽  
Content Type ◽  
Health And Wellbeing ◽  
Care Services ◽  
Homeless Men ◽  
Group Members ◽  
Future Work ◽  
The Impact

Purpose The purpose of this paper is to describe an intervention with a group of homeless men from the Horn of Africa, service users of the Horn of Africa Health and Wellbeing Project in London. The group was conceived by the second author who noted the presence of significant psychosocial issues for her clients, but equally their reluctance to access mainstream mental health or social care services. Design/methodology/approach Designing the group and introducing it to the men involved threw up some challenges which are explored, and the impact of the group on participants is evaluated. Findings Overall both the participants and the facilitators evaluated the group positively and it appeared to have led to lasting change for some of the group members, and this is described. The authors argue that this sort of group may be a more acceptable way to work on psychosocial issues than something more directly focused on mental health intervention. The group protocol is outlined along with suggestions for future work in this area. Originality/value This intervention represents a creative alternative to more mainstream psychological interventions for homeless or exiled men.

Self-injurious behaviour in forensic mental health care: a study into the prevalence and characteristics of incidents of self-injury

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Vivienne de Vogel ◽  
Nienke Verstegen
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Suicide Attempts ◽  
Psychiatric Patients ◽  
Forensic Mental Health ◽  
Content Type ◽  
Self Injury ◽  
Forensic Psychiatric ◽  
The Impact

Purpose Incidents of self-injury by forensic psychiatric patients often have a deleterious impact on all those involved. Moreover, self-injurious behaviour is an important predictor for violence towards others during treatment. The aim of this study is to analyse methods and severity of incidents of self-injury of patients admitted to forensic psychiatry, as well as the diagnoses of self-injuring patients. Design/methodology/approach All incidents of self-injury during treatment in a forensic psychiatric centre recorded between 2008 and 2019 were analysed and the severity was coded with the modified observed aggression scale+ (MOAS+). Findings In this period, 299 incidents of self-injury were recorded, displayed by 106 patients. Most of these incidents (87.6%) were classified as non-suicidal. Methods most often used were skin cutting with glass, broken plates, a razor or knife and swallowing dangerous objects or liquids. Ten patients died by suicide, almost all by suffocation with a rope or belt. The majority of the incidents was coded as severe or extreme with the MOAS+. Female patients were overrepresented and they caused on average three times more incidents than male patients. Practical implications More attention is warranted for self-injurious behaviour during forensic treatment considering the distressing consequences for both patients themselves, supervisors and witnesses. Adequate screening for risk of self-injurious behaviour could help to prevent this behaviour. Further research is needed in different forensic settings into predictors of self-injurious behaviour, more specifically, if there are distinct predictors for aggression to others versus to the self. Originality/value Incidents of self-injury occur with some regularity in forensic mental health care and are usually classified as severe. The impact of suicide (attempts) and incidents of self-injurious behaviour on all those involved can be enormous. More research is needed into the impact on all those involved, motivations, precipitants and functions of self-injurious behaviour and effective treatment of it.

Is co-production working well in recovery colleges? Emergent themes from a systematic narrative review

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Karen Louise Bester ◽  
Anne McGlade ◽  
Eithne Darragh
Keyword(s):  
Mental Health ◽  
Lived Experience ◽  
Social Care ◽  
The Body ◽  
Bibliographic Databases ◽  
Service Users ◽  
Content Type ◽  
Practitioner Attitudes ◽  
Health And Social Care ◽  
The Impact

Purpose “Co-production” is a process in health and social care wherein service users and practitioners work in partnership. Recovery colleges (RCs) are educational establishments offering mental health education; a cornerstone feature is that courses are designed and delivered in parity by both mental health practitioners and “peers” – people with lived experience of mental illness. This paper aims to consider, through the identification of key themes, whether co-production within RCs is operating successfully. Design/methodology/approach The paper is a systematic review of qualitative literature. Relevant concept groups were systematically searched using three bibliographic databases: Medline, Social Care Online and Scopus. Articles were quality appraised and then synthesised through inductive thematic analysis and emergent trends identified. Findings Synthesis identified three key themes relating to the impact of co-production in RCs: practitioner attitudes, power dynamics between practitioners and service users, and RCs’ relationships with their host organisations. As a result of RC engagement, traditional practitioner/patient hierarchies were found to be eroding. Practitioners felt they were more person-centred. RCs can model good co-productive practices to their host organisations. The review concluded, with some caveats, that RC co-production was of high fidelity. Originality/value RC research is growing, but the body of evidence remains relatively small. Most of what exists examine the impact of RCs on individuals’ overall recovery and mental health; there is a limited empirical investigation into whether their flagship feature of parity between peers and practitioners is genuine.

Inequalities in women’s medium or low secure mental health settings: a scoping review

2021 ◽  
Vol 23 (3) ◽  
pp. 254-271
Author(s):  
Aile Trumm ◽  
Kristina Brenisin ◽  
Kieran Breen
Keyword(s):  
Mental Health ◽  
Sexual Orientation ◽  
Gender Identity ◽  
High Quality Research ◽  
Dysfunctional Family ◽  
Health Service Provision ◽  
Content Type ◽  
Mental Health Settings ◽  
Health Need ◽  
The Impact

Purpose The more disadvantaged members of society generally experience poorer outcomes following the development of mental ill-health. The purpose of this paper is to scope the literature and synthesise findings on the inequalities and mental health within secure mental health settings. Design/methodology/approach Six electronic databases were searched to identify relevant studies. These were included if they examined the association between inequalities and mental health in women’s secure mental health settings. Findings Of the 608 studies reviewed, 14 met the inclusion criteria. In these papers, violence and/or abuse were described as the most prevalent inequalities. The second most frequent group of inequalities identified were socio-economic. Only three published studies researched the impact of ethnicities. Physical health, alcohol abuse and a dysfunctional family upbringing were only mentioned in one of the studies. Gender identity, transitioning and sexual orientation was not considered in any papers. These are areas, which require further investigation to determine their specific impact in this setting. Research limitations/implications This review highlights the dearth of high-quality research-based evidence underpinning an understanding of the impact of inequalities on women in secure mental health settings. The existing studies suggest that inequalities have a very particular impact and that intersectionality plays a key role. Further research is required to further understand how inequalities impact the lives of women in secure mental health settings. Practical implications The inequalities that women experience in relation to mental health need to be further researched in the context of intersectionality. There are also research gaps in terms of gender identity, sexual orientation and socio-economic background. Further primary research using a more complex methodological paradigm is required to explore these factors and their impact on mental health service provision. Social implications The role of inequalities should be considered as part of an overall care package, including the experiences of adverse childhood experiences and this should contribute towards the development of a trauma-based care approach. Originality/value To the best of the authors’ knowledge, this is the first study to scope literature about inequalities experienced in women’s secure psychiatric settings considering intersectionality.

A systematic review of Karen refugee health

2016 ◽  
Vol 12 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Sarah J. Hoffman ◽  
Cheryl L. Robertson
Keyword(s):  
Mental Health ◽  
Forced Migration ◽  
The Body ◽  
Health Needs ◽  
Health Providers ◽  
Physical And Mental Health ◽  
Content Type ◽  
And Migration ◽  
Karen Refugees ◽  
The Impact

Purpose – The purpose of this paper is to provide a comprehensive perspective of the documented physical and mental health issues Karen refugees from Burma face as a result of war and refugee trauma, and migration. The review will address the question: What is the impact of trauma and migration on the physical and mental health of Karen refugees? Design/methodology/approach – A total of 18 articles were systematically selected for inclusion in the final review. The focal content for included articles includes qualitative and quantitative research representative of the health and migration experiences of Karen refugees. Findings – The findings of this review demonstrate significance for health providers from a public health standpoint as programs and services are targeted to meet the specific health needs of the Karen community. It also highlights the contribution of the Karen forced migration experience to the complexity of individual and community health needs, particularly as a result of the protracted conflict. Originality/value – This critical appraisal of the body of literature describing the health experiences of Karen refugees from Burma, with a particular focus on outcomes relevant to resettlement, demonstrates value as programs are developed with an integrated refugee perspective.

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