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Purpose: The risk factors related to the mental health issues of adolescents diagnosed with mild to moderate intellectual difficulties (MMID) are not consistently recognised in South Africa. This paper aims to address the scarcity of literature by examining the risk factors linked to the mental health issues of adolescents with MMID. Design/methodology/approach: Four hundred and fourteen participants were sampled from adolescent learners attending three special educational needs schools in Gauteng, South Africa. The selected sample included 275 male and 139 female participants with a median age of 16.5 years. The three schools represented Grade 8 with 177 learners and Grade 9 with 237 learners. Data were collected through a biographical questionnaire and an Adverse Child Experiences Questionnaire. A quantitative approach was used to identify the risk factors impacting the mental health of adolescents with MMID. The findings were used to propose intervention programmes for the support of adolescents diagnosed with MMID. Findings: The findings suggest that risk factors for mental health difficulties issues among adolescents with MMID include family dysfunction, along with experiences of physical, sexual and verbal abuse as well as emotional and physical neglect. The recommendations stemming from the findings advocate empowering teachers, parents and caregivers to provide support for the mental health of learners with MMID. Originality/value: The study makes a valuable contribution to reducing the existing gap in the literature regarding risk factors impacting the mental health of adolescents with MMID in South Africa. The study served as a platform for adolescents diagnosed with MMID to articulate their challenges. This cohort is occasionally marginalised and this research acts as an active contribution to research that focuses on their experiences. Their insights are crucial for enhancing intervention programmes and promoting their overall well-being. [ABSTRACT FROM AUTHOR]

Purpose: People with intellectual disability die prematurely and from avoidable causes. Innovative solutions and proactive strategies have been limited in addressing this disparity. This paper aims to detail the process of developing a risk stratification tool to identify those individuals who are higher risk of premature mortality. Design/methodology/approach: This study used population health management principles to conceptualise a risk stratification tool for avoidable deaths in people with intellectual disability. A review of the literature examined the existing evidence of causes of death in people with intellectual disability. A qualitative methodology using focused groups of specialist clinicians was used to understand the factors that contributed towards avoidable deaths in people with intellectual disability. Delphi groups were used for consensus on the variables for inclusion in the risk stratification tool (Decision Support Tool for Physical Health). Findings: A pilot of the Decision Support Tool for Physical Health within specialist intellectual disability service demonstrated effective utility and acceptability in clinical practice. The tool has also demonstrated good face and construct validity. A further study is currently being completed to examine concurrent and predictive validity of the tool. Originality/value: To the best of the authors' knowledge, this is the only study that has used a systematic approach to designing a risk stratification tool for identifying premature mortality in people with intellectual disability. The Decision Support Tool for Physical Health in clinical practice aims to guide clinical responses and prioritise those identified as at higher risk of avoidable deaths. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to consider informed consent with those who may be legally judged incapable of consent. Frequently individuals with traumatic brain injuries and intellectual disabilities may fall into this category. This paper seeks to consider aspects of guardianship, moral and legal implications and best practices for mental health professionals. Design/methodology/approach: This practice piece reviews literature regarding informed consent, as well as pertinent issues in the professional literature regarding types of guardianship as well as the occurrence of "Lucid intervals." Furthermore, literature from moral philosophy and current legal research was examined to fully provide readers with a grasp of the legal and ethical landscape of this issue. Findings: The paper finds that treating consent as a one-time binary event is lacking in both practicality and nuance. Moral philosophy and issues regarding paternalism are raised, as well as practice approaches to assessment of capability and how to engage in therapy in meaningful ways. Originality/value: This paper provides insight into providing dignity-affirming therapy with a population that is often not considered in the literature of mental health ethics. When it is considered, the suggestions are so vague as to be of limited use. This manuscript provides nuance and practical applications to be a therapist that promotes dignity in those who might have varying levels of capacity to consent. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to understand the lived experience of people with intellectual disability of their anxiety and of being co-design partners in developing a multi-component approach to the management of anxiety. Design/methodology/approach: The development of an anxiety manual and programme was part of a service development which allowed existing and established psychological therapies to be adapted for people with intellectual disability. A qualitative approach was used to better understand the views of people who experienced anxiety on a daily basis. The feedback generated was used to make modifications to the manuals and the anxiety management programme. Findings: The study has demonstrated the value of involving people with intellectual disability in the co-production of an anxiety management programme. Additional findings identified the real-life challenges and experiences of the impact anxiety has on people's lives. Originality/value: To our knowledge, this is the first study to involve people with intellectual disability in developing an anxiety management programme as co-production partners. This paper underlines the value of understanding and involving people as co-production partners in developing clinical interventions. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to discuss the work of Dr Valerie Sinason and her contribution to working with people with an intellectual disability with psychotherapy. Design/methodology/approach: Dr Valerie Sinason is a psychoanalyst, and the author is trained in psychoanalytic psychotherapy. Findings: The author believes there is important value in reading Valerie Sinason's contribution to the literature of psychotherapy with people with intellectual disabilities. Originality/value: It is a review of Sinason's contribution, and the author believes she's very original and important thinker. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the use of videoconferencing when conducting multi-disciplinary team (MDT) and handover meetings within an NHS Adult Learning Disabilities Intensive Support Team (IST). The IST have been conducting MDT and handover meetings "virtually" since the start of the COVID-19 pandemic in March 2020, in line with government guidance. It is pertinent to evaluate the effectiveness of using videoconferencing, as the move to flexible, remote working is detailed within the NHS Long Term Plan. Design/methodology/approach: Participants were members of the IST. A mixed methods approach using an online questionnaire collected participant's views relating to the use of videoconferencing when conducting MDT and handover meetings, in comparison to previous face-to-face meetings. The questionnaire considered five key areas: accessibility, environment and communication, organisation, continuation of care and data protection and confidentiality. Results were collated and analysed. Findings: Improvements were reported relating to accessibility, as the virtual format allowed for easier attendance, provided greater flexibility in attending and inviting key stakeholders. A reduced sense of team connectedness was reported, related to the virtual environment. The majority of participants reported that they wish to continue to have the option to attend meetings virtually in future. Originality/value: There are no previous papers evaluating the use of videoconferencing within ISTs during the COVID-19 pandemic. This study suggests that the use of videoconferencing to conduct MDT and handover meetings is effective within the IST and highlights points for consideration moving forward. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to offer a perspective on depression and self-help from two experts with lived experience of learning disabilites.Design/methodology/approach This paper outlines the authors’ presentation and experiences at the recent Learning Disability Today conference.Findings The paper shares some things we can do to help our mental wellbeing.Originality/value This paper offers the view of two people with learning disabilities lived experience of depression. The paper also offers and insight into some of the strategies they use to manage and encourage positive mental health. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe the development, use and evaluation of a web-based mental capacity assessment tool (MCA WAT) within the Learning Disabilities division of a Mental Health and Learning Disabilities Trust in England. Design/methodology/approach: The MCA WAT was developed to ensure there was contemporaneous recording of each capacity assessment; help staff improve their knowledge, confidence and satisfaction in completing assessments of capacity; and analyse the number and type of capacity assessments completed. Three questionnaires were developed: a 12-item multiple-choice knowledge questionnaire, a nine-item confidence questionnaire and a 10-item satisfaction questionnaire, which reflect the five core principles of the MCA (2005). Eight-five health and social care staff who were trained to use the MCA WAT and had used it at least once had their scores from pre- and post-use of the questionnaires analysed using Wilcoxon signed-ranks tests. Data on the use of the MCA WAT was analysed. Findings: Results showed a significant increase in knowledge, confidence and satisfaction from pre- to post-questionnaires. Concerns remain regarding staff understanding of who is the decision maker and the use of communication aids to enhance capacity. These issues are being addressed through training and updating the information boxes in the MCA WAT. The MCA WAT has been used to complete 3,645 capacity assessments over a five-year time scale, covering a wide range of decisions. Originality/value: This project demonstrates the effectiveness of a contemporaneous method of conducting and recording MCA assessments. [ABSTRACT FROM AUTHOR]

Purpose: The novel coronavirus and associated mitigation efforts have produced barriers to accessing services for adults with intellectual disabilities. This paper aims to evaluate the impact of Covid-19 on access to psychological services. The paper evaluates monthly referral rates and psychological distress scores for service users awaiting therapy. Design/methodology/approach: A quantitative service evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. A single case experimental design was used to examine the impact of events in March 2020 on referral rates. Descriptive statistics and effect size calculations were used to examine the impact of prolonged waiting times on psychological distress scores. Findings: Referral rates were examined comparing a 5-year rolling average monthly referral rate for the 12 months prior to March 2020 with the 12 months following. Findings demonstrate that events starting in March 2020 have had a considerable impact on referral rates and rates have not recovered. Eight service users were contacted to determine the impact of prolonged waiting times with results demonstrating increases in psychological distress of large effect size. Originality/value: This is the only paper the authors are aware of examining the impact of the coronavirus on access to services and psychological distress for adults with intellectual disabilities. It is hoped that these findings will be able to inform both policy and practice as services continue to navigate the pandemic. [ABSTRACT FROM AUTHOR]

Purpose: The novel coronavirus and associated restrictions have resulted in mental health services across the UK having to adapt how they deliver psychological assessments and interventions. The purpose of this paper is to explore the accessibility and prospective acceptability of providing telephone and videoconference-mediated psychological interventions in individuals with intellectual disabilities. Design/methodology/approach: As part of a service evaluation, a mixed-methods questionnaire was developed and completed by clients who had been referred for psychological therapy at an adult intellectual disabilities' community health service in the north of England. All clients were assessed using the Red/Amber/Green (RAG) system by a consultant clinical psychologist for risk and potential suitability for indirect service delivery given their ability and needs. Findings: Overall, 22 clients were invited to take part, of which, only seven (32%) were accepting of telephone or videoconference-mediated psychological therapy. Most of the clients were unable to engage in video-conference therapy and therefore, only suitable for phone therapy. This paper presents the remaining findings and discusses the clinical implications and unique considerations for intellectual disability services drawing on the existing literature. Originality/value: This is the first paper that the authors are aware of, examining videoconference-mediated psychological therapy in this population. It is hoped the data will be used to help inform practice or policy when using such therapeutic approaches in adults with an intellectual disability. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide a synthesis of the literature on the topic of developmental framework and health comorbidities of children and adults with borderline intellectual functioning (BIF) and neurodevelopmental disorders. Design/methodology/approach – A rapid review of the literature and hand searching of relevant papers from 1999 to 2015 was carried out. Totally, 21 papers were identified covering a range of perspectives from neurodevelopmental trajectories to prevalence, treatment and service use. Findings – All papers were utilised and complemented a previous review which, however, had not covered the aspect of treatment approaches for this population. As a group they appear to have distinctly different profiles from people with mild intellectual disability and of peers with average intelligence. Practical implications – The evidence summary indicates an ongoing interest by the international scientific community in the topic of BIF. This group are often lost in the health system and may not receive appropriate care given their unique clinical profile. More should be done to increase clinicians’ awareness of their health needs. Originality/value – The paper adds substantially to a previous review of the topic. An international collaboration may help to increase the profile of this work and lead to further changes in the care these individuals receive across the diagnostic and treatment spectrum. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to assess the quality of systematic reviews on the effectiveness of psychological therapy for adults with intellectual disabilities (ID) and mental health difficulties. Design/methodology/approach: Four electronic databases were used: Cochrane, PsycINFO, PubMed and Scopus. Studies were included if they were a systematic review focused primarily on psychological therapy for adults with ID and mental health difficulties. Systematic reviews focused on anger were also considered for inclusion. These reviews were rated for quality on the Amstar-2, a quality rating tool designed to evaluate systematic reviews. Findings: Twelve relevant systematic reviews were identified, which included seven reviews focused primarily on cognitive behavioural therapy, two on psychodynamic therapy and three on third-wave therapies. The AMSTAR-2 indicated that all 12 reviews were of "critically low" quality. Thus, there are significant problems with the evidence base. Originality/value: To the best of the authors' knowledge, this is the first systematic review of systematic reviews of the effectiveness of psychological therapies for people who have ID. It provides an overview of the quality of the evidence base into one place. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine guided self-help (GSH), and some of the barriers as to why it is not routinely available for people with intellectual disabilities (IDs).Design/methodology/approach This paper offers an overview of GSH and the potential benefits of it as an intervention for people with ID with mild depression and/or anxiety.Findings The current literature reports the successful use and effectiveness of GSH in the general population. However, despite this there is little evidence that it is being used in practice for people with ID.Originality/value This paper offers an overview of GSH and advocates for its increasing use for people with ID to help bring about equality in mental healthcare. [ABSTRACT FROM AUTHOR]

Purpose: The novel coronavirus and associated mitigation efforts have caused significant increases in stress for adults with intellectual disabilities. Such increases in life stress predict an increased risk of relapse following psychological therapy. This contributes to the high global disease burden of common mental health difficulties. Therefore, this paper aims to explore service user experiences of maintaining gains following therapy within the context of the Covid-19 pandemic. Design/methodology/approach: A mixed-methods evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. Descriptive statistics and effect size calculations were used to examine therapeutic outcomes pre-therapy, post-therapy, and at follow-up. These findings informed a framework analysis of eight semi-structured interviews. Findings: Overall, outcome results improved post-therapy and regressed at follow-up. The framework analysis revealed facilitators to maintenance include a recollection of specific aspects of therapy and the regular utilisation of strategies and resources. Conversely, barriers to maintenance include a recollection focussed on personal outcome, a reliance on social support and an inability to remember therapy. Originality/value: This is the only study to the authors' knowledge examining service user experiences of maintaining gains following therapy within the context of Covid-19. It is hoped that these findings will inform further research and be useful for services in preparing service users for discharge as the Covid-19 pandemic continues and moves towards the post-pandemic phase. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide a critical overview of some main implications of the neurodevelopmental perspective for the field of the mental health in intellectual disability and autism spectrum disorders. Design/methodology/approach – A discussion surrounding the importance of integrating different approaches in the neurodevelopmental perspective, drawing on sources from the paper proposals to the 10th International Congress of the European Association in Mental Health and Intellectual Disability (EAMHID), and the literature. Findings – At present, the neurodevelopmental perspective seems to be the most appropriate and valued conceptual framework to support multi-level, interdisciplinary approaches in understanding the aetiologies of mental health problems as well as when and how to intervene. It inherently exemplifies a dimensional approach, which can capture variations between individuals, their developmental time course, brain-behaviours associations and functional significance better than categorical approaches, and diagnostic measures. Originality/value – This editorial outlines a special issue that offers a comprehensive and varied collection of papers from the contributions to the 10th International Congress of the EAMHID. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is threefold: to document the relationship between intellectual disability (ID) and psychopathology; to raise awareness of the ongoing lag in professional training for psychologists in the area of mental health treatment for people with intellectual disabilities; and, to provide recommendations for advancing professional education and, ultimately, adequate mental health treatment availability for people with intellectual disabilities. Design/methodology/approach - The paper reviews the literature on prevalence of mental health problems in people with intellectual disabilities. At the same time, the paper reviews the training of psychologists relative to the burgeoning growth in awareness of the mental health needs of people with intellectual disabilities. Findings - The paper concludes that ID is a significant risk factor for psychopathology. In addition, the paper concludes that the education of psychologists regarding the mental health needs of people with intellectual disabilities is insufficient. The authors document the need for incorporating research and treatment advances related to intellectual disabilities and mental health into to the professional training of psychologists. The paper also describe the potential this training holds for improving both the lives of people with intellectual disabilities and the overall competence of psychologists. Practical implications - This paper provides a literature-based rationale for the need to include education in the mental health needs of people with intellectual disabilities into the general training of mental health professionals. In addition, it provides specific recommendations for how such training can be incorporated into graduate psychology programs. Originality/value - This paper provides mental health professionals with a review of the growth in understanding of the enormous, unmet mental health needs of people intellectual disabilities, and of the critical role of ID in development of mental health problems. Moreover, this paper builds the case for an important revision in the training of psychologists to include competence in understanding and treating mental health problems across the full spectrum of intellectual functioning. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present and discuss mental health services for people with intellectual disability (ID) in Norway.Design/methodology/approach A literature review and a survey were conducted to map services for people with ID and mental health problems in Norway.Findings The results were sparse and confirmed what is already known among clinicians working with these patients. The Norwegian services are fragmented and there are geographical differences.Research limitations/implications There are no special services for children with ID developing mental illness. For offenders with ID, a national unit assesses and follows up, also when the person is sentenced to compulsory care and services are provided in their home municipality.Practical implications More data about both the patients and the services are needed in order to improve mental health services for people with ID in Norway.Originality/value This paper describes mental health services for people with ID in Norway. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to establish the value of clinical genetic diagnostics in the lives of people with an intellectual disability (ID), their families, and their primary and professional caregivers. It has been shown that psychologists are more likely to make use of the opportunities offered by clinical genetic diagnostics if they have seen the psychological benefits in their own practice. Moreover, this paper aims to promote the practice of informing people with ID, their families, and other caregivers regarding the current technological advances in genetic diagnostics, thereby allowing these patients to decide for themselves whether to utilise these opportunities.Design/methodology/approach The authors report four case studies in which the psychosocial value to each patient is pivotal.Findings In these four cases, it is clear the medical model can augment the social model by providing an interpretation of its meaningfulness in the lives of the people concerned.Research limitations/implications Case studies alone can have limited scientific significance. This approach examining the significance of clinical genetic diagnosis should be studied further in larger groups.Practical implications It is hoped that psychologists and other professional caregivers will become enthused about the value of clinical genetic diagnostics and will choose to discuss the option of referral for clinical genetic diagnostics with their patients more often.Social implications People with an ID who are seeking mental health care, and their caregivers, should be given the opportunity to take part in the decision regarding whether to use clinical genetic diagnostics, which may even have a destigmatising effect.Originality/value Quality of life may improve for people with an ID seeking mental healthcare and for their caregivers as well by opening up discussion regarding the opportunities presented by clinical genetic diagnostics. The fact that people are able to make their own choices based on their own considerations can have a destigmatising effect. [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: This paper aims to present the process of reviewing, adapting and evaluating, the second edition of the I Can Feel Good programme (Ashworth et al., 2018) and adapted DBT programme facilitated at a low-security psychiatric hospital for men with intellectual disability. Through the presentation of programme development, evaluation and revision, a more thorough and transparent understanding of the process involved can be disseminated. Design/methodology/approach: The programme lasted approximately 14 months and covered all four modules. N = 5, all-male, ages ranged between 23 and 57 years old. All detained under the MHA (1983) with a primary diagnosis of Mild ID with comorbid psychiatric diagnoses including mental illness, autism spectrum disorders and personality disorder. To evaluate routine effectiveness a pre-post comparison within groups design was used. A standardised GAS approach provided a template to score the degree to which identified goals were achieved over the intervention for participants. Findings: Wilcoxon signed-rank tests were used due to data not meeting parametric assumptions regarding normal distribution. Except for the mindfulness module, all modules saw pre to post programme psychometric results in the desired direction, evidencing skills acquisition. Coping in crisis and managing feelings modules outcomes neared statistical significance, with the module of people skills demonstrating statistical significance (p < 0.05). Originality/value: Upon examination of the results, it appears as though the second edition pilot programme, displayed initially promising results. The clinical and statistical aspects of the programme are explored, in the hope that clinicians may consider the programme's application and utility within various clinical contexts, in addition to gaining insight into the process of programme development and refinement. [ABSTRACT FROM AUTHOR]

Purpose Building the resilience of children with intellectual disabilities (ChID) can help reduce the personal, social and economic costs associated with mental ill health among such children. The purpose of this paper is to review the research evidence on resilience in ChID and to suggest areas for further research.Design/methodology/approach Journal articles published in the last 20 years were searched in on-line databases to find potential papers for this review. The inclusion criteria were to search for published journal articles covering the theme of resilience in ChID and their families. All identified titles and abstracts were screened which resulted in 50 articles. These were scrutinised more thoroughly and 34 remaining articles were selected for review.Findings Resilience is a dynamic process involving interactions between various risk and protective processes both internal and external to the individual that act to mediate the influences of adverse life events. Five key themes were identified within the literature which helped to form a picture of the current understanding of resilience among ChID and their careers. These were increased risk factors associated with ID, the role of personal attributes on resilience, family and resilience, schooling and resilience, and cultural factors which enhance resilience.Originality/value Despite the consistency with which poor outcomes for ChID have been reported there is little investigation of the specific causes, contributory factors and processes that might improve them. This paper contributes to greater understanding of resilience factors for children and young people with ID and provides areas for further research. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to outline a two-year project designed to reduce health inequalities and improve health outcomes of people with intellectual disabilities using health services in South London by raising awareness and increasing health staff confidence and capability.Design/methodology/approach The project was conducted in two stages. In stage 1, a mapping exercise was undertaken to establish existing intellectual disabilities education and training availability. In stage 2, a network of stakeholders was formed and education and training materials were developed and delivered.Findings A formal evaluation of the project is underway and this paper seeks to share information about the project. That said prima facie data appear to indicate that health staff who attended education and training events learned new knowledge and skills that they could implement in their practice, increasing confidence and capability.Research limitations/implications Health staff who attended the events appeared to have an interest in intellectual disabilities and wanted to increase their knowledge and skills base. This means that there is a significant group of health staff that the project was unable to reach or who may not know that they need to know about intellectual disabilities. The results of the project have not yet been formally analysed.Practical implications Work-based education and training events can have a positive impact on health staff capability and confidence, however, it would appear that only those who already have an interest in the field or recognise its value to their own practice attend such events. To truly capture all health staff intellectual disabilities needs to be visibly included in all health curricula.Originality/value This project has not focussed on one profession or one aspect of healthcare and has embraced the values of inter professional and inter agency learning; this has enabled health staff to learn from each other and think in a “joined up” way replicating the realities of providing healthcare to people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Purpose - Given the increased prevalence of mental health problems amongst people with intellectual disabilities, it seems pertinent to consider how the recovery approach could potentially benefit practice within mental health services for people with intellectual disabilities. This paper seeks to explore the similarities between recovery principles and existing approaches in services for people with intellectual disabilities; it also aims to reflect on the potential barriers to the explicit uptake of the "recovery" approach in this context. Design/methodology/approach - The presence and implementation of "recovery" approaches within mental health services for people with intellectual disabilities are reviewed. This is achieved through an examination of existing practices that could be described as recovery oriented, along with reflections on how these relate to the recovery approach. Questions are raised regarding whether practices can be regarded as "recovery oriented", without first consulting service users. Findings - Further consideration is needed about the extent to which mental health services for people with intellectual disabilities are recovery oriented and how recovery would be defined amongst people with intellectual disabilities. Research limitations/implications - It is suggested that further research using qualitative methodology is conducted, to enable the voice of service users to be heard. Originality/value - The paper is one of the first to explore the relevance of the recovery approach to people with intellectual disabilities. Given the increasing emphasis on recovery approaches within mainstream services, it seems vital to give consideration to the potential for its meaningful application to people with intellectual disabilities and mental health problems. [ABSTRACT FROM AUTHOR]

Purpose - The terms capacity and competence are often used interchangeably, but are actually distinct. This aim of this paper is to clarify the application of these terms, and to illustrate some of the practical benefits of distinguishing them.Design/methodology/approach - The concepts of capacity and competence are discussed in relation to restrictions that are placed on choice and action, respectively, when these qualities are judged to be absent. The paper explores the distinction between these two concepts in relation to their legal status, assessment, and scope.Findings - Mental capacity refers to the ability to make decisions, while competence refers to the ability to perform the actions needed to put decisions into effect. Questions of capacity are governed by legislation (in the UK: the Mental Capacity Act (MCA); the Adults with Incapacity (Scotland) Act and the Sexual Offences Act); they apply only to people who can be demonstrated to have a "mental disorder", and trigger best-interests decision making and other legal provisions if capacity is assessed as absent. Questions of competence involve a range of formal and informal assessment procedures, and can apply to anyone; they arise where others possess legal powers to control a person's actions.Originality/value - In addition to clarifying the conceptual confusion that exists in this area, the paper also considers some areas of practice where the MCA can be invoked to promote competence, in addition to capacity. [ABSTRACT FROM AUTHOR]

Monitoring care quality is integral to modern health service delivery. This paper describes how a specialist mental health assessment and treatment inpatient service for people with intellectual disabilities put in place a process to improve and reprovide the service, following an audit, in partnership with local stakeholders. In describing the process the paper highlights the need for transparent and honest working relationships with stakeholders, along with the role of audit and monitoring of quality to determine the 'health' and effectiveness of services. This included evaluating the continuing need for service and maintaining an agenda driven by needs rather than beds, based on best practice. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics related to neuropsychiatric and neurodevelopmental conditions, and their impacts on the mental health needs of people with intellectual disabilities.

Purpose: Children and young people with comorbid intellectual disabilities (ID) and autism spectrum disorders (ASD) are more likely to exhibit comorbid mental health disorders (MHD) and other significant behaviours (SB) in addition to the core symptoms of ASD. The purpose of this paper is to identify the prevalence of comorbid MHD and behaviours in children and young people with ID and ASD in Egypt. Design/methodology/approach: The Reiss scale for children's dual diagnosis was administered by parents and teachers of 222 Egyptian children and young people with mild/moderate ID and ASD to screen for MHD and SB. The mean age of children and young people was 12.3 years (SD = 3.64), with 75.6 per cent male. Findings: The results revealed that 62.2 per cent of children and young people with ID and ASD had high rates of comorbid MHD and behaviour disorders were shown in 64.4 per cent of the participated children and young people. The results identified anger, anxiety and psychosis being the most frequently diagnosed disorders while crying spells and pica were the most SB. No differences were found between the male and female with ID and ASD in the current study. Research limitations/implications: Mental health assessment of children and young people with ID and ASD will help to highlight the needs of these vulnerable children and develop the appropriate services. Originality/value: The findings highlight the prevalence of MHD in children and young people with ID and ASD in Egypt. This has implications on the assessment of comorbid disorders and services needed for children with ID and ASD in Egypt. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [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 explore significant events in psychotherapy with clients with intellectual disabilities (IDs).Design/methodology/approach Four therapy dyads, each consisting of one client and one therapist, were recruited. Following the brief structured recall procedure (Elliott and Shapiro, 1988), semi-structured interviews focused on helpful events in psychotherapy, using video of particular sessions as a stimulus to help prompt recall of that session.Findings Using interpretative phenomenological analysis, five super-ordinate themes were identified: “The Uniqueness of the Therapeutic Relationship”; “Using adaptations to Express Emotions”; “Client Behaviour/Therapist Behaviour”; “Hope and Paternalism”; and “Meaning-Making”. The results provide additional evidence that significant therapy events occur for clients with IDs. Furthermore, the research enabled insights to be gained about the process of therapy for this client group and for exploration of therapeutic factors that may be involved in facilitating a significant therapy event.Research limitations/implications This study highlights the need for therapists to work in such a way as to facilitate significant events in therapy. Whilst this study was a necessary first step, owing to the non-existence of research in this area, the sample size and qualitative design may limit any wider generalisation of the findings.Originality/value Significant events have not previously been explored in psychotherapy with clients with IDs. This research could therefore make an important contribution to our understanding of the process of psychotherapy for this client group. [ABSTRACT FROM AUTHOR]

Purpose – Adults with intellectual disabilities are the most psychotropically medicated population of all. Non-medically trained care staff with whom these individuals spend the majority of their time are generally poorly trained in issues surrounding psychotropic medication. Much of the research related to the experiences of staff working in intellectual disability services has focused on medically trained professionals, and clients, and has been of a quantitative nature. Very little attention has been paid to care staff, their experiences, and through a qualitative approach. The purpose of this paper is to address this issue. Design/methodology/approach – The current study employed a semi-structured interview methodology to explore the experiences of, and impact on, care staff in relation to psychotropic medication usage in adults with intellectual disabilities living in long-term residential care. Eight full-time, experienced care staff were interviewed and data were analysed using interpretative phenomenological analysis (Smith et al., 2009). Findings – The paper demonstrates an array of concerns for staff, such as the negative impact upon client quality-of-life, the ethical implications of the medications' regime, and the relationship perceived by care staff with the organisation management; and a significant lack of training. The limited field of previous research demographically comparable to the present paper was analysed for findings. Originality/value – The paper helps expand the current literature on experiences of care staff for people with intellectual disabilities from their own perspective, explores the emotional impact of the organisation's treatment of clients, and offers a range of recommendations in terms of theory, clinical practice and research. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe the mental healthcare system for people with intellectual disabilities (ID) in Switzerland. It covers the current provision of mental healthcare services as well as educational and research aspects, and summarises both the historical development and the current data on demography, health economics, legislation and national policy.Design/methodology/approach The authors performed an extensive literature research and evaluated the (very sparse) literature, conducted some interviews with recognised experts and carried out extensive internet-based research on the topic.Findings There are numerous, well-funded, well-staffed and well-equipped facilities for people with ID. These facilities have highly trained special education teachers and social education workers. Legislation, the insurance system as well as the policies and strategies on a national level are basically in line with people’s with ID needs. On the other hand, there are too few specialist physicians and psychologists, not enough training centres and too few specialist psychiatric services, both inpatient and outpatient. Medical and psychological research in this field is also insufficient.Practical implications In Switzerland, the development of treatment facilities typically does not start with a decision by a central authority to implement a policy in a top-down process. Usually, these organisations develop on the basis of some local initiatives and spread throughout the country. The process is likely to be similar in the case of services for people with mental health and intellectual disabilities (MHID), and the situation can be expected to be much better throughout the country within a few years. Furthermore, specific training programmes are expected to be created for physicians and psychologists of various disciplines, to promote an interdisciplinary approach.Originality/value This review fills a gap in that there are very few published reviews on the provision of MHID services in Switzerland. [ABSTRACT FROM AUTHOR]

Purpose In The Netherlands, curative mental health care and supportive care for people with an intellectual disability (ID) are organised in separate domains. Prevalence of mental health problems is known to be high among people with borderline intellectual functioning (BIF) or mild intellectual disabilities (MID). By contrast, according to recent findings, prevalence of BIF and MID is high among patients in mental health care (17.5–58 per cent). In The Netherlands, a new quality standard of care (QSOC) on mental health care for people with BIF or MID is developed. It is designed to supplement existing guidelines on mental health care so that they can be used appropriately in people with BIF or MID and meant for use in both mental health care organisations (MHCO) as in organisations for ID care. To a large extent, the QSOC should describe the existing practice. This paper aims to discuss these issues.Design/methodology/approach To assess the existing practice in current mental health care for people with BIF or MID in The Netherlands, the authors examined the views and accessibility of MHCO on the mental health care for patients with and IQ<85. In addition, the authors reviewed published criteria for in- and exclusion of all 39 top clinical mental health care departments for criteria on BIF or (mild) ID.Findings The authors found there is a clear awareness of the high prevalence of BIF and MID among large Dutch MHCO. Dutch MHCO estimate the prevalence of BIF and MID among their patients to be around 30 per cent. Nonetheless, most MCHO surveyed (76 per cent) indicated they do not routinely estimate or measure IQ among their patients and 53 per cent of MHCO indicated not having knowledge and expertise on the dual diagnoses of mental health problems and BIF or MID. Fitting in with the new QSOC most of the MHCO (59 per cent) agreed on the statement in the survey that professionals should be able to treat patients with BIF or ID and all but one of the MHCO stated to have some form of collaboration with an institute for ID care.Originality/value The authors concluded there is a clear awareness of the high prevalence of BIF and MID among large Dutch MHCO. The new QSOC on mental health care for people with BIF or MID can help improve accessibility and quality of mental health care for these patients. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore service users’ experiences of a mindfulness group intervention.Design/methodology/approach In total, 15 participants with a diagnosis of a mild or moderate intellectual disability and concurrent mental health difficulties were interviewed using semi-structured interviews about their experiences of attending the mindfulness group.Findings Thematic analysis was used to interpret the data. The three super ordinate themes that emerged were positive aspects of mindfulness, positive aspects of attending the group and negative aspects of attending the group. There were seven subthemes. The results highlighted that participants found the mindfulness group to be beneficial, partly due to specific aspects of the mindfulness intervention and partly due to the group process. The negative aspects of the group were harder to elicit, and were less specifically related to mindfulness.Originality/value Mindfulness-based interventions have emerged as a promising approach for individuals with intellectual disabilities with mental health difficulties. There is currently a lack of research exploring service users with intellectual disabilities about their experiences of mindfulness interventions. [ABSTRACT FROM AUTHOR]

Purpose - This paper seeks to review the adaptation and application of mindfulness-based psychotherapeutic practices for individuals with intellectual disability, the population most at risk for mental health and behavioral challenges.Design/methodology/approach - Provided is an overview of the adaptation and utilization of these practices in the treatment of anxiety and mood disorders, and maladaptive behavior in individuals with intellectual disabilities. It also explores current research related to mindfulness-based stress management for parents and caregivers of individuals with intellectual disability.Findings - Current research and practice supports that mindfulness-based psychotherapeutic practices are clinically effective in the treatment of anxiety, mood, stress, aggression, and self-injury in individuals with intellectual disabilities, and enhanced coping and stress management in their parents and caregivers.Practical implications - The effective, experiential, and skills-based practices of mindfulness-based psychotherapy make it easily adaptable and applicable for use with individuals with intellectual disabilities who have varying mental health and behavioral challenges.Originality/value - Very little has been published on the adaptation and application of mindfulness-based psychotherapeutic practices for individuals with intellectual disabilities. Given the mental health and behavioral challenges faced by this population, there is a great need for individuals with intellectual disabilities to have effective and practical treatment such as mindfulness-based psychotherapy. Further research and utilization of these practices with this population is needed. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present outcomes of mixed practices including use of ideas from narrative therapy (NT) in a case of mild intellectual disability (ID) and personality disorder. The formulation, therapy adaptation and outcomes are presented.Design/methodology/approach The study is a single case report describing patient presentation, assessments, psychological formulation and the mixed interventions approaches used, including ideas from NT. Adaptations to meet the needs of patients with ID were described, and therapy outcome measured using Health of the Nation Outcome scale and Psychiatric Assessment Schedule for Adults with Developmental Disorders was presented.Findings The ideas used from NT suggest this is potentially a useful approach in practice for people with intellectual disabilities and personality disorder. However, adaptation is needed for it to be used successfully in practice as a therapeutic intervention.Research limitations/implications A single case study has its limitations, and further work on using ideas from NT, its adaptation and use in this population will be needed.Originality/value There is no previous case of use of NT among patients with ID and personality disorder. [ABSTRACT FROM AUTHOR]

Purpose – The aim of this paper is to consider risk from the perspective of people with learning disabilities. Design/methodology/approach – The paper explores the thoughts and experiences of two people with learning disabilities around two different areas of potential risk and their participation in a mental health promotion group which has helped. Findings – People with learning disabilities encounter many risks in their lives but with the right support these risks can be managed. Originality/value – The paper adds valuable insight into the life of people with learning disabilities and the risks they face. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented wherein the authors discuss various reports published within the issue on topics including exposure of abusive practices in services for people with intellectual disabilities, the risks associated with and causes of challenging behaviour, and the evidence based to better understand complex relationship between mental health and challenging behaviour.

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. [ABSTRACT FROM AUTHOR]

Purpose – Research into the views of people with dual intellectual and mental health difficulties is sparse. The purpose of this paper is to gain a greater understanding of how individuals with mild intellectual disabilities living in the community understand their psychotic symptoms and experiences. Design/methodology/approach – Five participants with intellectual disabilities and psychotic symptoms living in the community were interviewed. The interview schedule explored key areas: understanding and experiences of having an intellectual disability and a psychotic disorder, and of services provided. The data were analysed using Interpretative Phenomenological Analysis. Findings – The analysis elicited three main themes: self-concept: “How I understand and see myself”, incorporates what participants understood about their labels, their experiences, and how these labels fitted in with their self-concept; Impact: “How having mental health problems and learning difficulties affect my life”, encompasses communication barriers, lack of control, and stigma and vulnerability. The third main theme was coping: “How I cope with my mental health and learning difficulties”. Research limitations/implications – The findings suggest that the participants, rather than identifying with specific psychiatric labels perceive themselves as having individual and specific needs. The analysis highlights areas that can be developed to help with coping; ensuring people are respected and heard, empowerment through the development of positive social roles, and psycho-education. These results are a step towards developing understanding of this group of service users. Originality/value – There has been no previous research into the perspective of this service user group in the community. The study makes recommendations for future person-centred interventions. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to report effectiveness of disability psychotherapy with a male adult with a mild intellectual disability presenting with complex emotional and behavioural problems. Design/methodology/approach – An individual case study was used with repeated analytic, quantitative and qualitative measures. This reported progress from individual weekly disability psychotherapy of psychodynamic orientation within an emotional disability framework. Findings – Disability psychotherapy led to a reduction in emotional and behavioural problems, reduction in emotional disability and facilitated protective psychological growth. In total, 88 sessions resulted in cessation of problem behaviours when other approaches did not. Given this therapy is likely to be reserved for the most complex and severe of cases, this study suggests more sessions of psychotherapy are needed than inferred from previous studies of effectiveness (Beail et al., 2007). This is to promote a sense of self which facilitates psychological well-being. Research limitations/implications – Limitations of a single case study include generalisability, controlling other factors in real life settings and subjectivity from inclusion of analytical measures. Further studies and follow-up would determine longevity of benefits. Nevertheless disability psychotherapy can be effective and should be available in a culturally appropriate service to meet the diverse needs of people with intellectual disabilities. Originality/value – This case study adds to the limited body of evidence on effectiveness of psychotherapy for people with intellectual disabilities. It is novel to report formal outcomes from an emotional disability model (Frankish, 2013a) and the use of analytic and attachment outcome measures. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to investigate the experiences of psychologists in considering the barriers to people with intellectual disabilities being able to access mainstream mental health services. Design/methodology/approach – The information relating to participant experiences was gathered by conducting two focus groups: one with psychologists working in the adult mental health service and the second with psychologists working in the learning disability service. A thematic analysis was used to determine the main themes from each of the focus groups. Findings – The overarching themes for the psychologists in the adult mental health service related to: service restrictions; confidence in their ability/skills; and resistance to change. The overarching themes for the psychologists in the learning disability service reflected: future thinking; protection; pessimism; and clarification around mental health and learning disability. Originality/value – The discussion includes consideration of the dynamic positions of the two services and recommendations for an integrated system of working. [ABSTRACT FROM AUTHOR]

Purpose - The use of violence risk assessment measures within intellectual disabilities (ID) services is now the norm and a growing target for research. The purpose of this paper is to examine the clinical utility of the historical and clinical factors of the HCR-20 in predicting violence. Design/methodology/approach - The study took place within a national low secure service for adults with ID examining all completed admissions over a six-year period, (N=22). Clinical records covering the first three months of admission were examined along with historical reports and incident data recorded at three, six, nine and 12 months admission using the Modified Overt Aggression Scale (MOAS). Findings - Significant positive relationship between Historical score and total number of incidents was established. Patients with challenging behaviour less likely to have a previous history of violence, and more likely to be older at first violent incident than patients without challenging behaviour. Incidents involving patients with autism were less severe and those with no additional psychiatric diagnosis were significantly more likely to have substance misuse problems than those with a diagnosis. Originality/value - The study found the Historical section was predictive of violent incidents and whilst the study is too small to draw any firm conclusions, the significant positive relationship between the Historical Score and number of incidents for those without additional diagnosis needs to be investigated further as well as the potential positive clinical impact of using the HCR-20 in routine clinical practice. [ABSTRACT FROM AUTHOR]

Purpose – Suicide is one of the top three leading causes of death amongst those aged between 15 and 44 years; and tenth leading cause of death in the wider population. The base rates of suicide, suicide attempts and suicide-related behaviours are comparably low in the general population with between 17 and 68 per cent of individuals who successfully commit suicide having made a previous attempt to take their own life. As recently as the 1980's it was still a widely held belief that individuals with intellectual disability (ID) did not have the cognitive capacity to experience mental health problems and this acted as a “buffer” against suicidal behaviour. The paper aims to discuss these issues. Design/methodology/approach – The literature review covered the time period 1993-2013 and returned 117 studies, 77 of which related to individuals with ID, 37 of which related to adults. Following screening titles and abstracts 28 articles were removed. A total of nine studies were found to be eligible for inclusion in the review. A further two studies examining suicide in adolescents (up to adulthood) with ID were also considered. From the eligible studies the following information was considered: study design, sample size, strengths, limitations and the risk factors associated with an increased risk of suicide. Findings – The suicide risk factors identified during the review were found to be in keeping with the general population and included a diagnosis of clinical depression, history of self-harm, unemployment, loneliness, unemployment, an increased need for support from others, early onset mental illness and being treatment resistive. Originality/value – Suicide in individuals with ID is a topic that has not received a great deal of attention from professionals and clinicians alike. People with ID have higher rates of mental health problems and therefore it could be argued that they are more likely to be at risk. This study aims to look at risk factors specific to people with ID for clinicians to consider in their daily practice. [ABSTRACT FROM AUTHOR]