Search

Purpose The purpose of this paper is to outline the historical background and policy context of mental health services for people with intellectual disability (ID) in Ireland. It then considers recent implementation and lessons from the Irish experience.Design/methodology/approach The policy background and research literature relevant to the development of mental health services for people with ID in Ireland was reviewed and discussed.Findings Mental health services in Ireland remain in a state of change, moving towards the implementation of specialist multi-disciplinary teams in the community, alongside previous models of care and service.Research limitations/implications This paper summarises recent advances and research regarding mental health services for people with ID in Ireland.Practical implications The paper illustrates the process of delivering changes to mental health services with practical implications for mental health services internationally.Originality/value This is the first paper in many years to summarise the development of mental health services for people with ID in Ireland. There has been considerable recent change and it is therefore important to provide a useful reference for the current status of services. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to determine the relation between quality of life (QoL), mental illness, challenging behaviour and institutionalisation in an adult population with intellectual disabilities (ID).Design/methodology/approach The study assessed the QoL and its conditioning factors in 142 subjects with different degrees of ID. The GENCAT and Quality of Life in Late Stage Dementia scale were used to evaluate QoL, the Psychiatric Assessment Schedule for Adults with Developmental Disability and Diagnostic Assessment for the Severely Handicapped-II scale to assess mental illness and the Inventory for Client and aetiology Planning scale to assess challenging behaviour.Findings Individuals who live in residential care homes were found to have significantly impaired QoL (<0.001). Individuals with challenging behaviour presented significantly lower QoL, regardless of ID aethiology and degree, while psychiatric disorders did not seem to have a direct influence on individual QoL.Originality/value This paper provides new insight into the importance of challenging behaviour and psychiatric disorders in the QoL of individuals with ID. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide a routine evaluation of clinical effectiveness of an adapted DBT informed skills programme (“I Can Feel Good”; Ingamells and Morrissey, 2014), run on both male and female intellectual disability wards of a medium security psychiatric hospital.Design/methodology/approach A pre–post evaluation study of routine clinical practice was undertaken utilising staff report scales collected as the primary source of evaluation.Findings Findings show a positive shift regarding each module for both gender groups. Due to observed baseline differences between gender groups, data were separated and analysed separately. Non-parametric statistical analysis demonstrates statistically significant improvement across three modules for the male sample (managing feelings, coping in crisis and people skills) and two modules for the female sample (managing feelings and people skills).Originality/value There appears to be subtle outcome differences regarding this programme for both gender groups across modules. Potential reasons for this are discussed, along with clinical reflections regarding gender differences and adaptations. Reflections upon future revisions including the integration of the new DBT skills (Linehan, 2014) are made in light of these findings. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to describe key policy and practice issues regarding a significant subgroup of people with intellectual disability --- those with offending behaviour being treated in forensic hospitals. Design/methodology/approach -- The reasons why psychiatrists continue to be involved in the treatment of people with intellectual disability and mental health or behavioural problems and the factors that may lead to patients needing hospital admission are examined. Using two illustrative examples, three key questions -- containment vs treatment, hospital care vs conditional discharge and hospital treatment vs using deprivation of liberty safeguards usage in the community are explored. Findings -- Patients with intellectual disability, mental health problems and offending behaviours who are treated within forensic inpatient units tend to have long lengths of stay. The key variable that mediates this length of stay is the risk that they pose to themselves or others. Clinicians work within the framework of mental health law and have to be mindful that pragmatic solutions to hasten discharge into the community may not fall within the law. Originality/value -- This paper makes practical suggestions for the future on how to best integrate hospital and community care for people with intellectual disability, mental health and offending behaviours. [ABSTRACT FROM AUTHOR]

Purpose - 22q11.2 deletion syndrome (22q11.2DS) is a rare genetic syndrome involving high risk of psychiatric disorders with average intellectual functioning in the lower borderline range. Due to the cognitive and social problems many adolescents with 22q11.2DS experience, adaptions may be needed to teach these adolescents cognitive behavioral therapy (CBT) skills. The purpose of this paper is to assess psychosocial functioning in adolescents with 22q11.2DS and to adapt CBT with this group. Design/methodology/approach - Totally twelve adolescents (M age=14.5 years, SD=1.4, range 12-17 years; 25 percent boys) with 22q11.2DS were recruited from a competence center for rare disorders. Their parents completed the Child Behavior Checklist and the Kiddie SADS screening interview. The adolescents participated in 7×45-minute CBT group sessions, comprising emotional awareness, cognitive restructuring tasks, and problem-solving skills. Findings - Adolescents had poor parent-reported social and school functioning at onset. The most frequent disorders indicated by screening interviews were attention deficit hyperactivity disorder (92 percent), anxiety (58 percent), depression (50 percent), autism spectrum disorders (50 percent), and potential post traumatic stress disorder (50 percent). Practical implications - The main adaptions made to CBT groups were shorter sessions, frequent breaks, and repetition of main points, limited use of written materials and items that could distract participants (e.g. balloons, papers), extensive and explicit use of turn taking, and two adult group facilitators per group. Originality/value - Offers practical advice on teaching CBT skills to adolescents with 22q11.2DS, which may also be applicable to other adolescents with lower borderline intellectual functioning or intellectual disabilities. [ABSTRACT FROM AUTHOR]

Purpose – Annoying and bothersome behaviours among persons with developmental disabilities (DD) is a relatively frequent phenomenon. However, not all behaviour that is difficult to accept in its surroundings should be seen as abnormal or problem behaviour (PB). Some of these behaviours may be an expression of a person’s psychosocial needs and may be considered as adaptive and normal. The paper aims to discuss these issues. Design/methodology/approach – Authors attempt to discuss relevant issues in persons with DD which have an impact on their behaviour, intending in this way to define criteria for a reliable differentiation between normal and abnormal behaviour and psychiatric disorders. Findings – Differentiating between normal and abnormal may be a difficult task for a professional treating persons with DD because of the lack of adequate criteria for such differentiation. The problem becomes even more complex when one attempts to differentiate between PB and psychiatric disorder. By approaching the subject from a developmental perspective and by determining the level of the person’s emotional development, insight in subjective person’s experiences was achieved. On the ground of a “good practice” the authors made schemata outlining criteria for differentiation between these constructs. Originality/value – The application of these schemata in the practice made it easier to establish appropriate diagnoses and was favourable for the planning of adequate treatment and support of persons with DD and mental health problems. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe the views and experiences of Improving Access to Psychological Therapies (IAPT) practitioners in providing therapy to patients who have an intellectual disability in order to support IAPT services in increasing their capability in this area. Design/methodology/approach – An online survey was conducted of IAPT practitioners in four IAPT services in the north of England. The survey collected respondents demographic information and their experience, confidence and attitudes to working with people with intellectual disabilities. Qualitative responses regarding respondents attitudes, views of barriers, problems, successes and possible solutions to the delivery of therapy to people with intellectual disabilities within IAPT services were collected. The survey results were interpreted by thematic and statistical analysis. Findings – The majority of respondents report having worked with people with intellectual disabilities and identify the need to adapt therapy, but also believe that such therapy should be offered within mainstream services. Thematic analysis identifies the needs for support in training, therapy adaptation and adjustment to pathways. However, the majority of respondents could identify positive outcomes and experiences. Research limitations/implications – This data supports the further development of pathways and offers some broad frameworks for the focus of training and development work for people with intellectual disabilities within IAPT. Social implications – This project has identified a positive attitude and willingness to consider adaptation of therapy for people with intellectual disabilities in practitioners working within IAPT services. Originality/value – Until now the views and experiences of IAPT practitioners in working with this patient group were relatively unknown. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to examine the trend of admissions and inpatient characteristics in a NHS intellectual disability hospital from 1975 to 2013, in particular looking at the effect following the Winterbourne View scandal. Design/methodology/approach -- A retrospective review of all admissions over a three-year period (January 2011-January 2013) was completed. This information was compared with admissions to the same hospital in three-year period over the last four decades (1975-1977, 1985-1987, 1995-1997, and 2003-2006). Number of admissions, gender, age, source of admission, length of stay, reasons for admission, type of admission, and diagnosis of psychiatric illnesses were included. Findings -- There were 87 admissions (including 29 from out of area) in the study period of 2011-2013. The number of admissions had varied over the years but male admissions were consistently higher than female. A majority of people stayed over six months. For the first time in five decades, there were more formal inpatients than informal ones. The diagnosis of Autism Spectrum Disorder (ASD) and of Attention Deficit Hyperactivity Disorder had increased. Originality/value -- This study has examined admission trends over five decades. It has highlighted that the Mental Health Act legislation is being used more frequently and that co-morbid mental disorders, such as ASD are commonly associated with those admitted to hospital. A well planned-out community health care system, as well as adequate social provision are keys to maintain people with intellectual disability in the community. Furthermore, a better understanding of the symptomology of challenging behaviours, and appropriate use of mental health legislation are crucial in providing a high-quality service that has clear treatment goals and values. Some of these issues have contributed to the failure of the recent initiative to reduce the size of the inpatient intellectual disability following Winterbourne View scandal. [ABSTRACT FROM AUTHOR]