Psychiatry and intellectual disabilities: navigating complexity and context

2017 ◽  
Vol 12 (4) ◽  
pp. 224-236 ◽  
Author(s):  
Jo Jones ◽  
Kiran Jeenkeri ◽  
Peter Cutajar
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Intellectual Disabilities ◽  
Health Practitioner ◽  
Current Policy ◽  
Content Type ◽  
General Mental Health ◽  
Neurodevelopmental Model ◽  
Wide Range ◽  
Potential Factors

Purpose The paper is a review, for the general adult mental health practitioner, of the issues to consider when managing a mental health presentation of a person with intellectual disability (PWID). The paper aims to discuss these issues. Design/methodology/approach A neurodevelopmental model is outlined to assist practitioners in unravelling the wide range of potential factors relevant to intellectual disabilities (IDs). This includes an emphasis on complexity and interdisciplinary formulation within an individual’s context, and implications of the current policy changes. Findings In practice, managing the mental health of PWID can be challenging within usual mainstream services; there is more to consider than is usual for the general population. Originality/value The paper provides general mental health practitioners with a framework for a greater depth of understanding of the issues involved in the management of people with intellectual disability (ID). This includes discussion of the current policy context in ID, and some of its limitations.

Mind Matters: a psychoeducation programme for individuals with intellectual disabilities and co-morbid diagnoses of mental disorder

2017 ◽  
Vol 8 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Sarah Ashworth ◽  
Krista Jansen ◽  
Lydia Bullock ◽  
Paul Mooney
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Intellectual Disability ◽  
Personality Disorder ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Intellectual Disabilities ◽  
Psychological Intervention ◽  
Content Type ◽  
Group Members

Purpose The purpose of this paper is to describe a feasibility study into the development and pilot of a psychoeducational group for people with intellectual disability and co-morbid mental disorder (including mental illness and personality disorder) within forensic settings. Design/methodology/approach “Mind Matters”, a psychoeducational programme for people with an intellectual disability and co-morbid mental disorders is a group based programme in a medium secure hospital, adapted and developed to be suitable for people with intellectual disability therapist multidisciplinary approach was key to its development. An open group on a 16-bedded ward for individuals with mild to moderate intellectual disability and co-morbid mental illness was delivered over a six-week period. Findings The group was positively received in pilot by participants and members of the clinical teams. Attendance and engagement of participants were key measures of the success of the programme. In addition to the apparent increased social skills and motivation to engage with future psychological intervention. Practical implications The authors believe that this approach benefitted both the group members and staff on ward, reinforcing strategies for maintaining positive mental health. It also stimulated engagement, discussion about mental disorders including mental illness, personality disorder and intellectual disabilities. Originality/value This paper shows how a psychoeducational approach to mental disorder and mental health in individuals with an intellectual disability is possible, beneficial and well received.

Antipsychotic prescribing for patients with intellectual disabilities and challenging behaviours

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Bushra Elhusein ◽  
Yassin Eltorki ◽  
Oraib Abdallah ◽  
Mohamed El Tahir
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Best Practices ◽  
Intellectual Disabilities ◽  
Challenging Behaviour ◽  
Prescribing Practices ◽  
Content Type ◽  
Antipsychotic Prescribing ◽  
Challenging Behaviours ◽  
Audit Standards

Purpose Review of antipsychotic prescribing practices, rationale and follow-up using an internationally standardized audit can be an effective tool to encourage and monitor best practices. The purpose of this study is to audit the current prescribing pattern for people with intellectual disabilities and challenging behaviours in Qatar. Design/methodology/approach This study was based on the challenging behaviour management guidelines recommended by the Royal College of Psychiatrists. All current electronic medical records in the Mental Health Service-Hamad Medical Corporation were examined to identify patients with intellectual disabilities who received antipsychotics for challenging behaviour. Demographic variables, such as age, sex and nationality, were collected. In addition, details of psychiatric diagnoses, prescribed psychotropic medications and diagnoses of epilepsy were also collected. For patients who were prescribed antipsychotic medication, the clinical rationale for such medication was collected along with evidence of side effect monitoring to allow performance against the audit standards to be measured. Findings This is the first audit on prescribing practices in people with intellectual disability and challenging behaviour in the state of Qatar. The results of this study regarding the pattern of prescribing practices for patients with intellectual disability and challenging behaviour reflect the limitation in knowledge and experience among non-specialist practitioners within mental health service. The result may be helpful to support the development of specialist service provision to improve the care for such vulnerable group. The result may also help other medical centres and clinicians by providing an improved understanding of possible deviations from the best medical practices. Originality/value This is the first audit on prescribing practices in people with intellectual disability and challenging behaviour in the state of Qatar. The study is also noteworthy as, to the best of the authors’ knowledge, it is one of only a few studies on antipsychotic prescribing for patients with intellectual disability and challenging behaviour in the Middle East; therefore, it will be useful in raising awareness and promoting the best practices in the Middle East region. This study is also among the first few studies that were designed based on the four audit standards by the Royal College of Psychiatrists in this area.

scholarly journals Working together: making the case for integrated forensic services for people with intellectual disabilities

2015 ◽  
Vol 6 (3/4) ◽  
pp. 204-210 ◽  
Author(s):  
Kenneth MacMahon ◽  
Ricky McClements
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Intellectual Disabilities ◽  
Integrated Model ◽  
Content Type ◽  
Fully Integrated ◽  
Forensic Service ◽  
Working Together ◽  
People With Intellectual Disabilities ◽  
Integrated Service

Purpose – There is a general consensus that healthcare for people with intellectual disabilities should be provided by multi-disciplinary teams. Within a forensic setting, recommendations are often made for separate or “parallel” forensic teams, operating independently of generic mental health or intellectual disability teams. An alternative to this model is an “integrated” service, where specialist forensic clinicians work within the general intellectual disability service, to provide support for clients with forensic needs. For clients with intellectual disabilities and forensic needs, there may be advantages to providing access to a wider multi-disciplinary team, through the application of an integrated model. The purpose of this paper is to illustrate the working of an integrated forensic service within a learning disability team, to identify positive aspects of this model, and how potential shortcomings may be overcome. Design/methodology/approach – Literature review, description of service outline with case example. Findings – Although some studies have compared parallel and integrated forensic models within mental health services, there are no evaluations that compare models of forensic services for individuals with intellectual disabilities. However, specific advantages of an integrated model may include availability of multi-disciplinary clinicians, development of forensic skills across wider groups of clinicians, reduction in stigma and avoidance of delay in transfer of care between services. In addition, in areas with smaller populations, parallel services may not be feasible due to low case numbers. Originality/value – There has been no formal evaluation of parallel vs integrated forensic services within an intellectual disability setting. However, the authors describe a fully integrated service and suggest means by which the potential shortcomings of an integrated model may be overcome.

How can mental health clinicians, working in intellectual disability services, meet the spiritual needs of their service users?

2015 ◽  
Vol 9 (1) ◽  
pp. 9-18 ◽  
Author(s):  
Benjamin Loynes ◽  
Jean O'Hara
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Literature Review ◽  
Intellectual Disabilities ◽  
General Health ◽  
Disability Services ◽  
Spiritual Needs ◽  
Service Users ◽  
Mental Health Clinicians ◽  
Content Type

Purpose – The purpose of this paper is to identify approaches that mental health clinicians, working in intellectual disability services, can adopt to ensure the spiritual needs of their service users are met. Design/methodology/approach – A narrative literature review examining original research, expert opinion pieces and book chapters was undertaken. To broaden the perspective of the paper, publications from different academic areas were reviewed including intellectual disabilities, mental health, neurodevelopmental disorders, general health and spirituality literature. Findings – The main principles of spiritual assessment tools from the general health literature can be applied to this group. However, the literature would suggest that certain approaches are of particular importance in intellectual disabilities mental health including advocating for service users to attend the religious services they wish to and working collaboratively with families and carers when addressing spiritual issues. Research limitations/implications – The question of how to meet the spiritual needs of people with autism and severe intellectual disability is a neglected research area. Research examining the spiritual needs of service users with intellectual disabilities, on mental health inpatient units, is also needed as well as a review of whether spiritual needs are being met in current person-centred care plans. Originality/value – No published literature review was identified that specifically addressed the question of how mental health clinicians should approach the spiritual needs of their service users.

scholarly journals HRM practices that support the employment and social inclusion of workers with an intellectual disability

2017 ◽  
Vol 46 (8) ◽  
pp. 1475-1492 ◽  
Author(s):  
Hannah Meacham ◽  
Jillian Cavanagh ◽  
Amie Shaw ◽  
Timothy Bartram
Keyword(s):  
Intellectual Disability ◽  
Intellectual Disabilities ◽  
Social Inclusion ◽  
Well Being ◽  
Case Study Methodology ◽  
Content Type ◽  
Hrm Practices ◽  
Employment Participation ◽  
Recruitment And Selection ◽  
Hr Managers

Purpose The purpose of this paper is to examine how HRM practices enhance and/or impede the employment, participation, and well-being of workers with intellectual disabilities in three hotels located in Australia. Design/methodology/approach The research employs a case study methodology, including interviews with three HR managers, three department managers, 17 workers with intellectual disabilities, and focus groups of 16 supervisors and 24 work colleagues. Findings The research found that the opportunities to participate in work are driven primarily by developing a social climate that enables social cohesion through the altruistic motives of managers/supervisors and reciprocal relationships. Originality/value The findings lend support for the importance of both formal and informal HR practices, such as inclusive recruitment and selection, mentoring, and training and development, as well as individualised day-to-day support provided by supervisors and colleagues, to improve the participation and well-being of workers with an intellectual disability.

scholarly journals Are we training psychiatrists to develop skills in intellectual disability psychiatry? Current European context and future directions

2020 ◽  
Vol 63 (1) ◽  
Author(s):  
Marisa Casanova Dias ◽  
Bhathika Perera ◽  
Florian Riese ◽  
Livia De Picker ◽  
Mariana Pinto da Costa ◽  
...  
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Mental Health Services ◽  
Health Services ◽  
Intellectual Disabilities ◽  
Psychiatric Disorders ◽  
Psychiatric Training ◽  
Future Directions ◽  
Education And Health ◽  
People With Intellectual Disabilities

Abstract The majority of people with intellectual disabilities (ID) and psychiatric disorders access mainstream mental health services across Europe. However, only 56% of countries provide postgraduate psychiatric training in ID according to a survey across 42 European countries. We explore the challenges of ID training and make recommendations for education and health policymakers.

“When other people try to understand”: exploring the experiences of people with intellectual disabilities, who also have mental health problems

2020 ◽  
Vol 14 (3) ◽  
pp. 91-101
Author(s):  
Sasha Martine Mattock ◽  
Kieron Beard ◽  
Amy Baddeley
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Focus Group ◽  
Health Services ◽  
Intellectual Disabilities ◽  
Mental Health Problems ◽  
Health Problems ◽  
Content Type ◽  
The People ◽  
People With Intellectual Disabilities

Purpose Recent guidelines from the National Institute of Health and Care Excellence highlight that service users (SUs) with intellectual disabilities and co-occurring mental health problems rarely get the opportunity to share their experiences of mental health services. Over the past 20 years, policy documents have stated that these individuals (SUs) must be included in decisions about their care. Research suggests that often this is not the case. Therefore, this paper aims to create a space for SUs to share their experiences of mental health services, and what they found helpful. Design/methodology/approach A focus group was held with five SUs, two psychologists and two researchers. The audio recording of the discussion was transcribed and analysed using thematic analysis. Findings Three main themes were identified, namely, “relationships with others”, “inclusion and communication” and “challenges”. This focus group highlighted that although some SUs felt supported, they reported having little control in their lives and wanted to be listened to. Research limitations/implications Including a SU in the planning and facilitation of the focus group would have made this research more inclusive. Practical implications The implications of this research suggest that by listening to and involving SUs and developing more person-centred services, recovery rates may increase as the services provided would be more targeted. Originality/value Very little research has previously been conducted to explore SUs’ experiences. This paper highlights the value of being heard and the knowledge that is often lost if the authors do not take the time to listen to the people for whom a service is designed.

PTSD in adults with intellectual disabilities: stabilisation during inpatient stay

2014 ◽  
Vol 8 (4) ◽  
pp. 237-247 ◽  
Author(s):  
Trine Lise Bakken ◽  
Vibeke Gjersoe ◽  
Espen Matre ◽  
Tone Kristiansen ◽  
Arvid Ro ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
Intellectual Disabilities ◽  
Case Reports ◽  
Psychiatric Inpatient ◽  
Training Programme ◽  
Post Traumatic Stress ◽  
Core Element ◽  
Content Type ◽  
Severe Intellectual Disability ◽  
Severe Intellectual Disabilities

Purpose – The purpose of this paper is to describe and discuss interventions of stabilisation of emotions and behaviour in adults with post-traumatic stress disorder (PTSD). This topic is understudied in persons with intellectual disability. Design/methodology/approach – The aim of this study was to investigate interventions of stabilisation in persons with more severe intellectual disability; i.e. persons with moderate or severe intellectual disabilities. Five patients in a specialised psychiatric inpatient unit for patients with intellectual disabilities were included. Information about treatment of the patients was collected through case files, observations, and interviews. The authors of this paper followed a training programme for trauma therapists in addition to the inpatient treatment of the five patients. Findings – Six main areas of stabilisation of emotions and behaviour were identified: validation, anxiety relief, treatment of depressed mood, increased mastering of daily activities, protection against anxiety triggers, and facilitated staff communication. Protection from anxiety triggers seems to be a core element of milieu therapy interventions. Interventions for neurotypical PTSD patients, such as exposure therapy may be contraindicated for patients with more severe intellectual disabilities. Originality/value – Research on interventions of stabilisation towards adults with more severe intellectual disabilities is still in its infancy. The case reports may help milieu therapists to facilitate interventions towards patients with moderate or severe intellectual disabilities.

scholarly journals Effectiveness of interventions for adults with mild to moderate intellectual disabilities and mental health problems: systematic review and meta-analysis

2016 ◽  
Vol 209 (6) ◽  
pp. 469-474 ◽  
Author(s):  
Nadine Koslowski ◽  
Kristina Klein ◽  
Katrin Arnold ◽  
Markus Kösters ◽  
Matthias Schützwohl ◽  
...  
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Intellectual Disabilities ◽  
Mental Health Problems ◽  
Meta Analysis ◽  
Health Problems ◽  
System Level ◽  
Controlled Trials ◽  
Moderate Intellectual Disability

BackgroundThere is a lack of available evidence in relation to the effectiveness of interventions for adults with mild to moderate intellectual disability and mental health problems.AimsTo evaluate the efficacy of interventions for adults with mild to moderate intellectual disabilities and co-occurring mental health problems.MethodAn electronic literature search of the databases Medline, EMBASE, PsycINFO and EBM Reviews aimed at identifying randomised controlled trials (RCTs) and controlled trials testing any type of intervention (psychotherapy, biological or system level) for people with mild to moderate intellectual disabilities (IQ score 35–69) targeting comorbid mental health problems. Additionally a meta-analysis was conducted.ResultsTwelve studies met the inclusion criteria. No significant effect was found for the predefined outcome domains behavioural problems, depression, anxiety, quality of life and functioning. The effect size for depression (d = 0.49) was moderate but non-significant. Quality of studies was moderate and heterogeneity was high.ConclusionsThere is no compelling evidence supporting interventions aiming at improving mental health problems in people with mild to moderate intellectual disability. The number of available trials is too low for definite conclusions. Some interventions are promising and should be evaluated further in larger and more rigorous trials.

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