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Background: Hospital closure programmes in England have generally sought to attain a fulfilling life for people with an intellectual disability by locating them in domestic-style housing in urban settings. Few have been placed in intentional or "village" communities. Yet comparative studies of different housing types have found that intentional communities have better or similar outcomes for their residents than dispersed housing or residential clusters on former hospital sites. A possible explanation is the distinctive pattern of social relationships that exist in many intentional communities and the impact this has on the lives of their residents. This paper reports the results of research that explores the perceptions of people with an ID living in an intentional community and the meaning of their community to them. Methods: The research used an ethnographic approach to interview a sample of 15 residents in a large intentional community (Botton Village), which is part of the Camphill Movement. Interviews used Makaton, pictures and symbols where required. Results: Respondents included 10 men and 5 women aged between 38 and 78 years. Length of residence in Botton Village ranged from 5 to 50 years. All lived with the families of co-workers and valued these relationships. All but one (who had retired) worked in a diverse range of employment in the village. Almost all were positive about their work. Respondents reported that they took part in both individual and communal leisure activities and all but two had a network of friends. Opportunities for friendship were enhanced by proximity to other people with an ID and a sense of personal security in the village. As in many villages and communities in society in general, these advantages were balanced by some loss of privacy. Conclusions: Results confirm those from earlier studies of intentional communities and suggest that positive outcomes derive from the absence of the overt subordination of residents to staff, the facilitation of friendship with other people with an ID, high levels of meaningful employment and a sense of community. These factors contrast with the experience of living in small homes funded on a contractual basis by public authorities, in which cost pressures reduce wage levels for staff resulting in difficulties in retaining suitable staff and a consequent high staff turnover.

Background: Supporting men and boys with an intellectual disability (ID) to meet their penile hygiene needs is perhaps one of the least acknowledged but most confronting issues facing care staff. The delivery of intimate hygiene can be a challenging topic particularly as it has been drawn into the emerging sexuality discourse and the ongoing abuse narrative. Compounding this challenge is the lack of guidance in intimate care for support staff. In addition, whereas the male with an ID outnumber the female, female care staff greatly outnumber male staff. Whether this situation affects outcomes for men and boys with an ID is unknown but it is an issue which should be examined. Method: This paper reports data from two separate studies, one quantitative the other qualitative, which sought to explore penile hygiene as a male health issue. Results: Results show the practice of care staff to be inconsistent, the views and values of care staff to be divergent. Some patterns and contextual differences were identified depending upon the gender of care staff. An emerging dialogue described some of the positive contributions that male staff make to men and boys with an ID. Conclusions: The penile health needs of men and boys with an ID are being compromised by a lack of guidance, training, knowledge and limited gender-sensitive care.

Aims: To describe the characteristics of homeless children and families seen by the mental health outreach service [MHOS], to evaluate the impact of this service on the short term psychosocial [...]

A survey of all admissions of patients under the age of 65 during the first 6 years of a District General Psychiatric Department without mental-hospital support is reported. Three high-uptake groups of in-patients were defined; the long-stay (12 months or more), the medium-stay (6-12 months), and the revolving-door group (more than three admissions in any period of 12 months). Identifying characteristics which distinguish between these groups were examined. During a 7-year period there was no accumulation of long-stay patients, and a striking lack of schizophrenic patients who remained in hospital for more than 6 months or who had more than three admissions in any twelve-month period. This was not accounted for by drift of the high-uptake groups out of contact with the service, but may be related both to the style of service provision and to the socially cohesive nature of the area under study. Local variation should be given due importance when community services are being developed. [ABSTRACT FROM AUTHOR]

A review of the article "Supported housing for people with Down's syndrome" by S. Cumella and S. Heslam is presented.

A letter to the editor is presented as a response to an article on the treatment of two patients with extrapyramidal symptoms with calcium in the May 1988 issue of the periodical.

The aim of this study was to investigate offenders' living patterns, quality of life, types of aftercare received and psychological well-being, following their diversion from one court diversion scheme in England. Sixty-five offenders were followed up after six months, 22 of whom were also followed up after one year. Their transient living patterns throughout these two periods were described. Their quality of life was found to be poor in that most did not have an occupation, nor did they receive education, and the life experiences during both periods were lower than that of standardized urban samples. There were no significant changes in their poor life experiences over the two periods. Over 55% of the 22 offenders still contacted their GPs regularly but there was a significant drop in those consulting hospital doctors. Only a small number of offenders had contact with the social services in these two periods and no significant differences were found between them. Their GHQ total scores went above cutoff point and the level of psychiatric conditions was similar in both periods.

Previous research indicates that children in homeless families have a high risk of physical and mental illness. This study reports the initial stage of a longitudinal research programme to measure the prevalence of psychiatric disorders among parents and children in homeless families. A sample of parents in 113 homeless families were interviewed within 2 weeks of admission to seven homeless centres in the City of Birmingham, and compared with a sample of 29 low-income families who were not homeless. Both sets of interviews used the Child Behaviour Checklist (CBCL), the Communication Domain of the Vineland Adaptive Behaviour Scales (VABS), the General Health Questionnaire (GHQ), the Interview Schedule for Social Interaction (ISSI), and height and weight percentiles. A sub-sample of children was also interviewed. The results indicate that 85% of families became homeless because of domestic or neighbourhood violence, that in 54% of families in homelessness coincided with the separation of the partners, and that 49% of mothers had current psychiatric morbidity. Children in homeless families had delayed communication and higher mean scores for mental health problems than the comparison sample. Homeless children were also more likely to have had histories of abuse, and less likely to have attended school or nursery school since becoming homeless. Homeless families had high rates of contact with primary healthcare and social services, but few had been in contact with specialist child and adolescent mental health services. These results indicate a need for a co-ordinated action by housing, social services, education, health services, and the police to prevent families from becoming homeless by protecting victims of domestic and neighbourhood violence from further violence and intimidation. Hence the need to rapidly re-house into permanent accommodation those who do become homeless, to maintain education for their children, and to ensure that such families have access to effective social support and healthcare.

This paper describes some recent research on forensic diversion services and the application of such services in Birmingham, UK. Key components include the diversion scheme in court, diversion at point of arrest, and the remand prison liaison scheme. Various community facilities, such as a specialized bail hostel and landlady schemes to which offenders are possibly referred, are also briefly described. We advocate the need for further research in order to examine the effectiveness of the services in Birmingham.

Objective: To investigate the psychosocial characteristics of homeless children and their parents., Method: Homeless families were assessed within 2 weeks of admission to seven hostels and were compared with a group of housed families matched for socioeconomic status. Measures included a semistructured interview, the General Health Questionnaire (GHQ), the interview Schedule for Social Interaction, the Child Behavior Checklist (CBCL), the Communication domain of the Vineland Adaptive Behavior Scales, and height and weight percentiles. The sample consisted of 113 homeless families (249 children aged 2 through 16 years) and 29 comparison families (83 children)., Results: Homeless families primarily consisted of single mothers and an average of two children, who had become homeless because of domestic violence (56%) or violence from neighbors (29%). Homeless mothers reported high rates of previous abuse (45%) and current psychiatric morbidity (49% caseness on the GHQ) and poor social support networks compared with housed controls. Homeless children were more likely to have histories of abuse, living in care, and being on the at-risk child protection register and less likely to have attended school or a preschool/day-care center since admission to the hostel. They also had delayed communication and higher CBCL scores. Maternal GHQ scores best predicted CBCL caseness., Conclusions: Homeless mothers and children have high rates of psychosocial morbidity, which are related to multiple risk factors and chronic adversities. Their complex needs should be best met by specialized and coordinated health, social, and educational services.

The aim of the present study was to assess the health care needs for people with learning difficulties who display challenging behaviour in a newly established health district. Ninety-eight clients were studied, using Disability Assessment Schedule (DAS), Aberrant Behaviour Checklist (ABC) and The Psychopathology Inventory for Mentally Retarded Adults (PIMRA). The results showed that a large proportion of them were mobile, continent and able to feed themselves. Almost half had no problems in communication but less than half were sociable. On the whole, they did not have adequate skills. A large proportion of them did not present severe challenging behaviour and did not suffer from psychiatric illnesses, apart from inappropriate adjustment disorder. Correlation coefficients showed that there were relationships between challenging behaviours and some of clients' disabilities and inappropriate adjustment disorder.

The purpose of this study was to estimate the prevalence of challenging behaviour among subjects with learning disabilities in an English health district. Subjects' disabilities included incontinence, lack of communication skills, and need of assistance with domestic activities, feeding, washing, and dressing. Some also had physical impairments. The most common behaviours were hyperactivity and irritability and the most common psychiatric disorders included severe anxiety, affective disorder, and adjustment disorder.

There are clear parallels between the problems of industrial firms in eastern Europe and those faced by NHS managers in meeting the challenge posed by the internal market. Stuart Cumella looks at the ever-changing rules of the game.

A survey of all admissions of patients under the age of 65 years during the first 6 years of a General Hospital Psychiatric Department identified 16 'long-stay' patients (a year or more of continuous inpatient care) and 8 'medium-stay' patients (at least 6 months inpatient care in any period of a year). The most common diagnoses were organic brain disorders among long-stay patients, and affective disorders among medium-stay patients. There was no consistent accumulation of long-stay patients: those with functional disorders were usually discharged to hostel accommodation, while those with organic brain disorders died or were transferred to inpatient care in other hospitals.