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Purpose: Three deaths at Cawston Park Hospital shed a bright light on Norfolk's services for people with learning disabilities and autism, including those operated by the company that ran the hospital. The purpose of this paper is to review Norfolk County Council's current position from the unique aspect of a senior manager wihtin the system. Design/methodology/approach: This paper reviews the unique perspective of a social worker from within the system. Findings: The process of making change included engagement and action concerning such thorny challenges as the pressures on community services; the undervaluing of care-giving as a career; and the continuing admissions to specialist mental health services at a time when hospital discharges are being expedited. Originality/value: Norfolk's investment in improving its services involves the adoption of a human rights approach; a capital programme to facilitate new developments; nurturing care-giving as a career; and bringing a clearer evidence base to this work programme. [ABSTRACT FROM AUTHOR]

Purpose: Institutional abuse is a worldwide phenomenon with the UK also subject to several high-profile abuse scandals perpetuated on people with learning disabilities and/or mental health conditions living within institutional settings. This study aims to provide a broad perspective of safeguarding practices within institutional care to inform practice and service development in this area. Design/methodology/approach: A narrative overview was undertaken of a range of empirical evidence, discussion papers, enquiry reports, reports from regulatory bodies and professional guidance to explore safeguarding practices within institutional care for individuals with learning disabilities and/or mental health conditions. Findings: A range of literature was identified that exposed and explored abuse in this context. Three key themes were identified: failings within institutional care; safeguarding issues and concerns; and good practice within institutional care. Whilst guidance is available, standards are explicit and protocols facilitate improvement potential in this area, a consistent message was that statutory recommendations for reform have not been effective. Originality/value: This paper provides an important resource for practitioners and service providers involved in institutional care. An accessible overview of both the empirical evidence and grey literature on adult safeguarding within institutional settings is provided, along with a range of standards and resources that specify practice in these settings. [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 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 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 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: 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 People with intellectual disabilities experience poorer health outcomes than the general population, and a significantly increased risk of mental health comorbidity. Their access to healthcare has been consistently shown as inadequate, and their access to mental health support is still largely wanting. Adequate training and education should improve these shortcomings but there is limited evidence available as to the best way to achieve this. The paper aims to discuss these issues.Design/methodology/approach This paper reports on the co-production and co-delivery of a simulation training course to support healthcare professionals to provide care for people with intellectual disabilities, with a particular focus on their mental health needs. This training was designed with actors with intellectual disabilities, who participated as simulated patients in scenarios during the course and subsequently provided feedback on their experience.Findings This paper focusses on the positive experiences of the simulated patients, reporting on and interpreting their direct feedback on their experience of contributing to the development and delivery of the course and being involved as co-educators.Originality/value It is highlighted that the co-production and delivery of this simulation training with people with intellectual disabilities has the potential to realise some of the key principles called upon when attempting to improve how they are treated, by illustrating concrete participation, independence, and access to fulfilling lives. The value and benefits of interprofessional education to achieve these educational aims is further highlighted, particularly for the potential to generate a sense of shared responsibility within mainstream services in caring for people with intellectual disabilities. [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 inform readers about the Law Commission's review of hate crime offences and provide information on key stages. At the time of writing the review is at consultation stage and people are being invited to participate in this process. Design/methodology/approach – The paper is structured in a question and answer format and provides an overview of existing hate crime offences and the stages of the Law Commission's review. Findings – The consultation will consider the effect of the Law Commission's review of hate crime law on people with disabilities. Originality/value – The author is a member of the Law Commission's criminal law team and answers questions on what's involved in the consultation process. The Law Commission wants to make sure that people who could be affected by any changes to the law on hate crime have their say. [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 Mental Capacity Act (MCA) was implemented in 2007 as a piece of legislation to empower and protect adults who require support making decisions. Many older adults in residential care homes will be in this position due to developmental disabilities associated with functional impairments of the mind and brain. This paper aims to evaluate the impact of MCA training within older persons' care homes within an East-Midlands local authority. Design/methodology/approach – Semi structured interviews were conducted with key informants who had strategic responsibility for implementation of MCA training as well as a focus group conducted with managers/deputy managers of care homes within the local authority. Findings – With a primary focus on training, data revealed issues surrounding the delivery and content of training, and the organisational factors relating to both training and the subsequent implementation of the knowledge learned. Research limitations/implications – The key informants for this paper are limited to management perspectives. Interviews and a focus group were conducted with stakeholders who either had direct responsibility for service delivery or managerial oversight for training and development. Practical implications – The paper suggests methods of delivery with the Mental Capacity Act which offer a tailored, engaging and cost effective alternative to conventional "away day" training sessions. Originality/value – The paper challenges and critiques conventional approaches to training the social care workforce. [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 purpose of this paper is to summarise what is known about the health of people with autism spectrum disorder (ASD).Design/methodology/approach - The paper aims to update the unpublished review and scoping paper undertaken by Swift for the Foundation for People with Learning Disabilities; provide a conceptual framework for understanding the key determinants of the poorer health outcomes experienced by people with ASD; undertake a brief option appraisal of existing sources of data that may be of value in addressing the mortality and morbidity of people with ASD; and establish future research possibilities.Findings - The limited literature suggests higher rates of mortality and morbidity among people with ASD.Originality/value - A simple conceptual framework for understanding the key determinants of poorer health of people with ASD is proposed. Options for studying the mortality and morbidity in ASD using existing data sources are also appraised and recommendations are made for future research in the area. [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]

Purpose: Mental health courts (MHCs) may enable better support for people with intellectual disabilities (ID) within the criminal justice system (CJS) but little evaluative empirical evidence is available regarding their operation. The purpose of this paper is to explore professional perceptions of the challenges of including people with ID in a targeted services court (TSC) designed for people with mental health issues and ID. Design/methodology/approach: Information was gathered, via interviews and focus groups, from 46 professionals working with people with mental health issues and ID within the TSC. Data were analysed by using thematic network analysis. Findings: Findings highlight the neglect and lack of inclusion of people with ID within the TSC processes, with challenges in identifying people with ID, stakeholder awareness, inconsistent adapting of practices for people with ID and information transfer underpinned by the involvement of numerous organisations with differing agendas. Research limitations/implications: Although valued, development of a TSC, including people with ID, was a challenging endeavour and may reflect societal and institutional neglect of people with ID, recommendations are provided. Originality/value: This study adds to the few investigations that have considered the process of including people with ID in a TSC from the perspective of those working in the CJS. [ABSTRACT FROM AUTHOR]

Purpose -- Cognitive behaviour therapy (CBT) is currently one of the recommended treatments for depression for the general population and guidance recommends that people with a learning disability should have access to the same treatments as people without a learning disability. The purpose of this paper is to identify, outline and evaluate current research on the effectiveness of CBT for depression for people with a learning disability. The clinical, service and research implications are considered. Design/methodology/approach -- A systematic search was conducted and five relevant articles were identified for critical review. Findings -- There is a limited but promising evidence base for the use of CBT for depression with people with learning disabilities. Research limitations/implications -- The current review identified a number of methodological issues and future research should attempt to overcome these (e.g. small sample sizes and lack of controls). In particular, research should focus on determining the relative contribution of cognitive and behavioural techniques in producing a change in depressive symptoms. Practical implications -- Services (including those provided as part of Improving Access to Psychological Therapies) should be offering CBT-based interventions for people with learning disabilities who are experiencing depression. Originality/value -- This paper provides a comprehensive and up to date review of the current literature regarding the use of CBT for depression for people with a learning disability. This will be of value to clinicians working with people with a learning disability as well as those commissioning services. [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 The purpose of this paper is to provide information for non-specialists on identifying the characteristics, assessment and support needs of people with intellectual disabilities (ID) accessing mainstream services.Design/methodology/approach A review of relevant policy and research literature is supplemented with observations from the authors’ own experience of working in mental health services for people with ID.Findings With change in provision of services the likelihood of mainstream staff encountering someone with ID will increase. However, information on whether a person has ID or their level of ID is not always available to professionals in acute mental health services meeting an individual for the first time. Reliance on observational and interview-based assessments can leave people with ID vulnerable to a range of over- and under-diagnosis issues. This is as a result of difficulties with communication and emotional introspection, psychosocial masking, suggestibility, confabulation and acquiescence. For people with poor communication, carers will be the primary source of information and their contribution has to be taken into account.Practical implications Knowing or suspecting an individual has ID allows staff to take into account the various assessment, diagnosis and formulation issues that complicate a valid and reliable understanding of their mental health needs. Awareness about an individual’s ID also allows professionals to be vigilant to their own biases, where issues of diagnostic overshadowing or cognitive disintegration may be important considerations. However, understanding some of the practical and conceptual issues should ensure a cautious and critical approach to diagnosing, formulating and addressing this population’s mental health needs.Originality/value This synthesis of a review of the literature and observations from the authors’ experience of working in mental health services for people with ID provides an informed and practical briefing for those encountering people with ID accessing mainstream services. [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 – 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 – 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 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 -- This article aims to outline simple measures which, by making better use of existing legislation and provision, could change the day-to-day experience of individuals with learning disabilities currently in long stay hospitals, whilst phased local provision is being sourced for them. The proposals will also promote the safety and dignity of the minority of patients who ultimately cannot be settled successfully within their own community Further, these measures may help ensure that any individual undergoing assessment and treatment at such a unit, for whatever period, and for whatever reason, will receive care in an environment where abuse cannot go unnoticed or unchecked. Design/methodology/approach -- The paper provides a review of the potential to use current legislation and provision to better effect, highlighted by case studies. Findings - Commissioners contracting with providers could include measures to promote the safety and protection of adults with learning disabilities from abuse at little or no cost to the commissioning authority. Originality/value -- This is an original piece of work - developed from a short opinion/comment piece (750 words) originally prepared for the benefit of mental health lawyers in the Law Society Gazette. It is primarily of value, however, to social workers, care providers, adult safeguarding teams, advocacy services and commissioners of services. [ABSTRACT FROM AUTHOR]

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

Purpose – The use of accessible, portable, mental health crisis information in people with intellectual disabilities has not been previously reported. The purpose of this paper is to explore whether crisis information could be modified to be made accessible and meaningful for people with intellectual disabilities. Design/methodology/approach – Personalized information to help in a mental health crisis was recorded on folded A4 sized sheets that could be carried in a conveniently sized wallet. Findings – Three quarters of the participants carried their crisis information wallets on a daily basis for six months before evaluation. They and their carers expressed positive feedback about them carrying the crisis information. No one carrying the information actually experienced a mental health crisis in the six months follow up period so their usefulness in such crises could not be evaluated. However, they were unexpectedly used in other non-mental health settings and reported to have been helpful. Originality/value – The sample size in this was small but the findings suggested that the carrying of crisis information might be a helpful measure for some people with intellectual disabilities. A further, larger scale trial is warranted. [ABSTRACT FROM AUTHOR]

Purpose – In spite of the greater prevalence of mental ill-health in people with intellectual disabilities, there has been little work specifically aimed at how this group recognise threats to their mental health and the strategies used to minimise them. This study aims to look at the first stage of development of a guided self-help (GSH) pack called the Self Assessment and INTervention pack (SAINT). Design/methodology/approach – Delphi methods and focus groups were employed to gather opinions from two expert groups: professionals or clinical experts (ranged N=15-33); and service users (n=9), to inform the contents of the SAINT. The Delphi was conducted by e-mail. Results from each round were shared between the two groups to develop a consensus. Findings – Retention rates for clinical experts were 45.45 per cent, during the Delphi and 100 per cent for the service user experts in the focus groups. Both groups were able to reach a consensus of the items that would make up the SAINT. Delphi methods combined with focus groups were able generate the contents of the SAINT and demonstrated versatility in this dual approach by being able to gain a consensus from both groups. Research limitations/implications – There is no consensus as to how many people are ideal for a Delphi. Although the final number in round 3 was low, it can be argued that those remaining had most interest in the subject. Practical implications – The aim is to produce and pilot the SAINT, a GSH package for people with intellectual disabilities, following reliability and validity testing. Social implications – Currently GSH is widely used for mild depression in Primary Care and other disorders such as mild anxiety, obsessive compulsive disorder, and other related conditions. However, there are no specific GSH packages for people with intellectual disabilities. Currently the GSH tools that are available are not designed for people with cognitive impairments and do not reflect the lifestyles of many people with intellectual disabilities. Originality/value – This paper should be of value to anyone with an interest in supporting people with intellectual disabilities to recognise and manage specific symptoms or feelings that threaten the person's mental well being. [ABSTRACT FROM AUTHOR]

Purpose - This pilot study aimed to investigate whether adults with mild/moderate intellectual disabilities could accurately self-report their attachment style. It explored whether there is a relationship between attachment style and challenging behaviour and/or mental health problems. Additionally, the paper examines the distribution of attachment styles in people with intellectual disabilities, based on the hypothesis that it might be different to that of the general population.Design/methodology/approach - Adults with intellectual disabilities (n = 60) and people who supported them (n = 39) completed questionnaires based on Hazan and Shaver's attachment categories and mental health diagnoses. Supporters also provided information about challenging behaviour.Findings - People with mild/moderate intellectual disabilities show the same range of attachment styles as the general population. Links between challenging behaviour and insecure attachment were found, and there was an association between depression and insecure-avoidant attachment.Originality/value - Applications of attachment theory in individual therapy and at a policy level are explored in light of the findings, as well as directions for future research. There appears to be a relationship between insecure attachment and depression in people with intellectual disabilities. This has implications for the psychological treatment of people with intellectual disabilities and interventions should be developed that focus on attachment relationships. Attachment behaviour may not be linked to challenging behaviour as directly as has been previously suggested, certainly for people with mild moderate intellectual disabilities. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to be the first known case report of a patient with mild intellectual disabilities who has a novel partial trisomy of the long arm of Chromosome 6 (6q25.3 → q26).Design/methodology/approach - The patient's history and diagnosis are discussed. Findings - This case highlights the importance of cytogenetic studies in the systematic evaluation of people with intellectual disabilities and co-morbid psychiatric conditions.Originality/value - Performing detailed chromosome analysis by array comparative hybridisation on patients with unexplained intellectual disabilities and mental health problems may enable an underlying diagnosis to be identified. [ABSTRACT FROM AUTHOR]

The closure of long-stay National Health Service (NHS) hospitals has seen the placement of people with learning disabilities who offend or have offending-type behaviours placed 'out of area' many miles from local services. This move of people out of area has made it difficult in many localities to develop local services and to monitor the quality of care for this group. This paper describes the start of an exercise to examine potential local care pathways for those who present with offending behaviours and to look at differences between the out of area group, and another receiving treatment locally. Within the two groups we found no significant differences regarding rates of psychiatric disorder, quality of life or levels of unmet need. The main difference was that the out of area group was largely characterised by a range of aggressive and challenging behaviour, necessitating the additional structure and securities provided by out of area placements. [ABSTRACT FROM AUTHOR]

Cognitive behavioural therapy (CBT) is being used increasingly with people with learning disabilities. The evidence base to support these developments comes from uncontrolled trials of CBT in a variety of psychological disorders and eight to nine controlled trials of CBT for anger (plus a single controlled study in depression). This paper reviews the evidence for the effectiveness of group-based anger management and the acquisition of anger coping skills, and the effectiveness of individual anger treatment, with some discussion of the status of CBT for other indications and the difficulties of conducting outcome research in this area. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to describe patients presented in an interprofessional, virtual education program focused on the mental health of adults with intellectual and developmental disabilities (IDD), as well as present interprofessional recommendations for care. Design/methodology/approach: In this retrospective chart review, descriptive statistics were used to describe patients. Content analysis was used to analyze interprofessional recommendations. The authors used the H.E.L.P. (health, environment, lived experience and psychiatric disorder) framework to conceptualize and analyze the interprofessional recommendations. Findings: Themes related to the needs of adults with IDD are presented according to the H.E.L.P. framework. Taking a team-based approach to care, as well as ensuring care provider knowledge of health and social histories, may help better tailor care. Originality/value: This project draws on knowledge presented in a national interprofessional and intersectoral educational initiative, the first in Canada to focus on this population. [ABSTRACT FROM AUTHOR]

Purpose: This literature review aims to ascertain the outcomes and perspectives of community-based compassion-focused therapy (CFT) for adults with intellectual disabilities. Design/methodology/approach: A comprehensive search of five databases was conducted systematically, with one additional study identified manually, yielding eight relevant studies. Methodological quality was appraised using two tools to account for heterogeneity in study designs. Findings: Two studies conducted a CFT-derived task while six studies conducted full CFT interventions, of which two delivered group interventions. Qualitative findings were favourable towards CFT, though some quantitative outcomes were inconsistent across the literature and with qualitative results. It is concluded that CFT is perceived as valuable and appears to produce positive outcomes for adults with intellectual disabilities. However, larger, randomised control trials are required to establish CFT as an efficacious, evidence-based intervention. Originality/value: This review provides insight into the outcomes and perspectives of CFT for individuals with an intellectual disability which has not been explicitly explored prior. Therefore, a holistic and specific examination of community-based CFT for individuals with intellectual disabilities is introduced to the literature. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore the experiences of people with intellectual disabilities in Singapore receiving inpatient mental health treatment. To date, there has not been any research that examines the views and experiences of this population in Singapore. The research examines how the participants view their mental health problems and their experiences of the services they received. Design/methodology/approach: A qualitative design was chosen to address the research question. Six adult men with intellectual disabilities were recruited from the tertiary hospital and interviewed. The transcripts of these interviews were analysed using interpretative phenomenological analysis. Findings: Four super-ordinate themes were identified; awareness of mental health problems; yearn for a life outside the ward; interacting with other people and finding purpose. Originality/value: The participants reported that they struggled with being segregated from their families and communities following an inpatient admission. They were able to report on the emotional difficulties that they experienced and hoped to find employment after their discharge from the hospital. They talked about reconstructing their self-identity and forming friendships to cope with their hospital stay. This research is one of its kind carried out in a non-western society and the findings are discussed in the light of how mental health professionals can best support people with intellectual disabilities during their inpatient treatment. [ABSTRACT FROM AUTHOR]

This paper describes the thoughts of three people with learning disabilities about mental health and what can help people stay mentally well. [ABSTRACT FROM AUTHOR]