Oxford Textbook of the Psychiatry of Intellectual Disability, 2020
Depressive disorders are common in people with intellectual disability (ID), and may sometimes po... more Depressive disorders are common in people with intellectual disability (ID), and may sometimes pose difficulties in identification and appropriate treatment, mainly due to associated comorbid conditions and significant impairment in communication. This chapter describes both typical and atypical presentations of depression in people with intellectual disability, along with associated aetiopathological factors that might influence the presentation. Depressive disorders are common in people with intellectual disability, causing individual suffering, additional impairments in adaptive behaviour and functioning, disruption of interpersonal relationships, social exclusion, poor physical health outcomes, and sometimes death. The issue of overshadowing and influence of comorbid conditions leading to lack of identification has also been considered. Management approaches, including that of pharmacological and psychological therapies and their applicability to persons with intellectual disabi...
Knowledge about the assessment of personality disorder (PD) in people with intellectual and devel... more Knowledge about the assessment of personality disorder (PD) in people with intellectual and developmental disabilities (IDD) has improved significantly in the last 15 years. Guidelines have been developed starting with recommendations by Alexander and Cooray (2003) that informant information, observation, and interview should be employed in a convergent assessment. Specific considerations should be given to the features of IDD itself such as delay in perspective taking abilities. While initial research found widely differing prevalence of PD in people with IDD, more recent research following guidelines, has been more consistent. It has also been demonstrated that PD has an orderly relationship with the assessment of general personality and with emotional problems. Recent alterations in the assessment of PD in the general population have been found suitable for people with IDD and it has also been found that generic services for this population are suitable for those with IDD and PD.
The General Medical Council revalidation process1 re-licenses doctors through an absence of clini... more The General Medical Council revalidation process1 re-licenses doctors through an absence of clinical governance concerns and the positive demonstration of continued competence by doctors, who collect, reflect on, and discuss a defined portfolio of supporting information in appraisal. This process is recognised internationally as world class.23 It is much more flexible than periodic high stakes examinations. It recognises the depth, breadth, and diversity of medical careers while identifying unsatisfactory performance due to conduct, capability, or health related issues. Its definition and purposes are clear and subtle enough to provide support for development while also providing a robust re-licensing process.4 Tzortziou Brown and …
BackgroundThe approach taken to support individuals during the coronavirus disease 2019 (COVID-19... more BackgroundThe approach taken to support individuals during the coronavirus disease 2019 (COVID-19) pandemic needs to take into account the requirements of people with intellectual disabilities and/or autism, who represent a major vulnerable group, with higher rates of co-occurring health conditions and a greater risk of dying prematurely. To date, little evidence on COVID-related concerns have been produced and no report has provided structured feedback from the point of view of people with intellectual disabilities and/or autism or of their family/carers.AimsTo provide systemised evidence-based information of the priority concerns for people with intellectual disabilities and/or autism regarding the COVID-19 pandemic.MethodSenior representatives of major UK-based professional and service-user representative organisations with a stake in the care of people with intellectual disabilities and/or autism were contacted to provide a list of concerns across three domains: ‘mental health a...
Journal of Policy and Practice in Intellectual Disabilities, 2020
The current COVID-19 pandemic is a pressing world crisis and people with intellectual disabilitie... more The current COVID-19 pandemic is a pressing world crisis and people with intellectual disabilities (IDs) are vulnerable due to disparity in healthcare provision and physical and mental health multimorbidity. While most people will develop mild symptoms upon contracting severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), some will develop serious complications. The aim of this study is to present guidelines for the care and treatment of people with IDs during the COVID-19 pandemic for both community teams providing care to people with IDs and inpatient psychiatric settings. The guidelines cover specific issues associated with hospital passports, individual COVID-19 care plans, the important role of families and carers, capacity to make decisions, issues associated with social distancing, ceiling of care/treatment escalation plans, mental health and challenging behavior, and caring for someone suspected of contracting or who has contracted SARS-CoV-2 within community or inpatient psychiatric settings. We have proposed that the included conditions recommended by Public Health England to categorize someone as high risk of severe illness due to COVID-19 should also include mental health and challenging behavior. There are specific issues associated with providing care to people with IDs and appropriate action must be taken by care providers to ensure that disparity of healthcare is addressed during the COVID-19 pandemic. We recognize that our guidance is focused upon healthcare delivery in England and invite others to augment our guidance for use in other jurisdictions.
Oxford Textbook of the Psychiatry of Intellectual Disability, 2020
Accessing treatment for a relative with intellectual and/or developmental disabilities requiring ... more Accessing treatment for a relative with intellectual and/or developmental disabilities requiring assessment or treatment from services can be extremely difficult for families and carers. Adverse past experiences can significantly affect the development of trust and relationships with present services and professionals. Listening and acknowledging families’ past and present concerns, alongside providing transparent information and reassurance about their relatives’ care, provides a foundation for starting positive relationships. Families are valuable in helping clinicians understand their patients fully and this helps the recovery process. Services have a duty to work collaboratively with patients’ families, in order to improve treatment outcomes including quality of life. Occasionally, there may be concerns in relation to the patient being the victim of familial financial, emotional, physical, and/or sexual abuse. In such instances, safeguarding processes must be followed.
Sabyasachi (Sab) Bhaumik, who died of a massive cardiac infarction at the age of 66 years on 8 No... more Sabyasachi (Sab) Bhaumik, who died of a massive cardiac infarction at the age of 66 years on 8 November 2019, was a leading figure nationally and internationally in the psychiatry of people with developmental disabilities. He served as Chair of the Faculty of the Psychiatry of Intellectual Disability at the Royal College of Psychiatrists (RCPsych) between 2006 and 2010, and before that as Chair of the Trent Division. In 2007, he established an international links group that brought together all the activities related to intellectual disability undertaken internationally by RCPsych members. Members of this committee have undertaken numerous educational, research and service development projects in India,
• This study looked at how many people with learning disabilities in a forensic unit were overwei... more • This study looked at how many people with learning disabilities in a forensic unit were overweight or obese, and whether people put on weight in the service. • The study showed that lots of people put on weight while they were in the service. It might be due to people struggling to exercise and the food provided in hospitals. • This research matters to people with learning disabilities because being overweight and obese can lead to other physical issues, such as heart disease and diabetes. Being overweight also affects how confident a person is and can lead to feeling depressed. • We now need to look at ways we can support people with learning disabilities in all settings to stay healthy, enjoy exercise, and lose weight if they want to.
IntroductionAutism spectrum disorders (ASDs) are associated with difficulties in social interacti... more IntroductionAutism spectrum disorders (ASDs) are associated with difficulties in social interaction, communication and restricted, repetitive behaviours. Much is known about their community prevalence among adults, data on adult inpatients within an acute mental health setting is lacking.This pilot study aimed to estimate the prevalence of ASDs among adults admitted to acute mental health wards and to examine the association between ASDs and psychiatric and physical comorbidities within this group.Methods and analysisA multiple-phase approach will be used. Phase I will involve testing of 200 patients and corresponding informants, using the autism quotient (AQ), the informant version of the Social Responsiveness Scale, second edition—Adult, the self and informant versions of the Adult Social Behaviour Questionnaire and the EuroQol-5D-5L. Patients with intellectual disability (ID) will bypass Phase I.Phase II will involve diagnostic testing of a subgroup of 40 patients with the Diagno...
Advances in Mental Health and Intellectual Disabilities, 2019
Purpose The purpose of this paper is to provide a professional consensus position with regard to ... more 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 measur...
The Journal of Forensic Psychiatry & Psychology, 2018
Deliberate foreign body ingestion is a significant issue in prison and psychiatric settings. It i... more Deliberate foreign body ingestion is a significant issue in prison and psychiatric settings. It is associated with serious physical complications, including bowel obstruction, perforation and haemorrhage. Episodes of deliberate foreign body ingestion were identified retrospectively from 5417 incident records from two inpatient forensic services (one mental health and one intellectual disability) over a one year timeframe, using related search terms. Rates were compared according to gender, diagnosis and level of security. Incidents of deliberate foreign body ingestion were found to occur on average every 2.7 days across the study population, with 133 incidents recorded over a one year period, accounted for by 27 patients. Women and patients in lower levels of security were significantly more likely to engage in deliberate foreign body ingestion. Staff responses to this behaviour were highly variable. Deliberate foreign body ingestion occurs frequently within inpatient forensic services, and can have significantly detrimental physical implications for affected patients. Further research should investigate the psychiatric and intellectual disability profile of such individuals in further detail, as well as exploring patient narratives; both of which will help inform development of treatment strategies.
International Journal of Culture and Mental Health, 2016
ABSTRACT Persons with intellectual disabilities are likely to be misdiagnosed and end up in priso... more ABSTRACT Persons with intellectual disabilities are likely to be misdiagnosed and end up in prisons for petty offences. The rates of criminal behaviours will be influenced by social and cultural factors. What is seen as illegal behaviour in one society may not be so in another. Cultures also play a major and significant role in defining deviant behaviour and defining what is abnormal. Thus relationship between intellectual disability and criminal behaviour deserves better understanding and research. In hospital or care settings as well as in prisons, clinicians must be sensitive to the role intellectual disability may play in contributing to mental ill-health and behavioural problems. Clinicians must have the skills to identify intellectual disability and its consequences. Wherever possible, depending upon local needs, court diversion schemes and pathways be identified and developed through all agencies who may be involved in caring for persons with intellectual disability.
There is limited empirical information on service-level outcome domains and indicators for the la... more There is limited empirical information on service-level outcome domains and indicators for the large number of people with intellectual disabilities being treated in forensic psychiatric hospitals. This study identified and developed the domains that should be used to measure treatment outcomes for this population. A systematic review of the literature highlighted 60 studies which met eligibility criteria; they were synthesised using content analysis. The findings were refined within a consultation and consensus exercises with carers, patients and experts. The final framework encompassed three a priori superordinate domains: (a) effectiveness, (b) patient safety and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviours, reactive and restrictive interventions, quality of life and patient satisfaction. To index recovery, services need ...
Advances in Mental Health and Intellectual Disabilities, 2015
Purpose – The purpose of this paper is to describe key policy and practice issues regarding a sig... more Purpose – The purpose of this paper is to describe key policy and practice issues regarding a significant subgroup of people with intellectual disability – those with offending behaviour being treated in forensic hospitals. Design/methodology/approach – The reasons why psychiatrists continue to be involved in the treatment of people with intellectual disability and mental health or behavioural problems and the factors that may lead to patients needing hospital admission are examined. Using two illustrative examples, three key questions – containment vs treatment, hospital care vs conditional discharge and hospital treatment vs using deprivation of liberty safeguards usage in the community are explored. Findings – Patients with intellectual disability, mental health problems and offending behaviours who are treated within forensic inpatient units tend to have long lengths of stay. The key variable that mediates this length of stay is the risk that they pose to themselves or others. C...
Advances in Mental Health and Intellectual Disabilities, 2015
Purpose – The 11th revision of the International Classification of diseases which sets global sta... more Purpose – The 11th revision of the International Classification of diseases which sets global standards for defining, reporting and managing health conditions is under way. The International Classification of Diseases (ICD) underpinning principle of clinical utility is currently poor for persons with Disorders of Intellectual Development (DID) and mental disorders. This impedes access to healthcare resources; services and social inclusion thereby further aggravating their vulnerability. The purpose of this paper is to present a critical overview and evidence informed recommendations within the context of an international collaborative programme, undertaken by the Faculty of Psychiatry of Intellectual Disability, Royal College of Psychiatrists, UK with support from the World Health Organisation (WHO). Design/methodology/approach – The authors carried out: first, a systematic review (SR) of literature, using PRISMA guidelines regarding the reliability, validity and utility of the ICD-...
Introduction Secure hospital services for people with intellectual disability were established fo... more Introduction Secure hospital services for people with intellectual disability were established for patients whose presentation rendered their management unsafe in the community. These services offer an integrated, multi-disciplinary model of support within an environment that ...
Aims and Method With an absence of appropriate residential services, people with learning disabil... more Aims and Method With an absence of appropriate residential services, people with learning disabilities are often placed outside their local areas and there is regularly no dialogue between the relevant health authorities prior to a placement being made. This survey from Leicestershire explored this issue by focusing on the catchment area covered by one consultant psychiatrist. Practice standards were formulated and compliance with these was examined. Results A total of 29 patients were identified as ‘out-of-area’ placements. They had high psychiatric morbidity, exhibited significant degrees of aggression and needed a high level of professional input. The suggested practice standards were met by less than 10%. Clinical Implications In parts of the country where a large number of ‘specialist’ residential homes have opened, there has been an unplanned increase in the workload of local learning disability/ mental health services. This can compromise patient care and there is an urgent n...
Background There has been a policy shift away from hospital to community in the services of all t... more Background There has been a policy shift away from hospital to community in the services of all those with psychiatric disorders, including those with intellectual disability, in the last fifty years. This has been accompanied recently by the growth of assertive outreach services, but these have not been evaluated in intellectual disability services. Method In a randomised controlled trial we compared assertive outreach with 'standard' community care, using global assessment of function (GAF) as the primary outcome measure, and burden and quality of life as secondary measures. Results We recruited thirty patients, considerably less than expected; no significant differences were found between the primary and secondary outcomes in the two groups. The differences were so small that a Type II error was unlikely. Conclusions Reasons for this lack of specific efficacy of the assertive approach are discussed and it is suggested that there is a blurring of the differences between standard and assertive approaches in practice.
Oxford Textbook of the Psychiatry of Intellectual Disability, 2020
Depressive disorders are common in people with intellectual disability (ID), and may sometimes po... more Depressive disorders are common in people with intellectual disability (ID), and may sometimes pose difficulties in identification and appropriate treatment, mainly due to associated comorbid conditions and significant impairment in communication. This chapter describes both typical and atypical presentations of depression in people with intellectual disability, along with associated aetiopathological factors that might influence the presentation. Depressive disorders are common in people with intellectual disability, causing individual suffering, additional impairments in adaptive behaviour and functioning, disruption of interpersonal relationships, social exclusion, poor physical health outcomes, and sometimes death. The issue of overshadowing and influence of comorbid conditions leading to lack of identification has also been considered. Management approaches, including that of pharmacological and psychological therapies and their applicability to persons with intellectual disabi...
Knowledge about the assessment of personality disorder (PD) in people with intellectual and devel... more Knowledge about the assessment of personality disorder (PD) in people with intellectual and developmental disabilities (IDD) has improved significantly in the last 15 years. Guidelines have been developed starting with recommendations by Alexander and Cooray (2003) that informant information, observation, and interview should be employed in a convergent assessment. Specific considerations should be given to the features of IDD itself such as delay in perspective taking abilities. While initial research found widely differing prevalence of PD in people with IDD, more recent research following guidelines, has been more consistent. It has also been demonstrated that PD has an orderly relationship with the assessment of general personality and with emotional problems. Recent alterations in the assessment of PD in the general population have been found suitable for people with IDD and it has also been found that generic services for this population are suitable for those with IDD and PD.
The General Medical Council revalidation process1 re-licenses doctors through an absence of clini... more The General Medical Council revalidation process1 re-licenses doctors through an absence of clinical governance concerns and the positive demonstration of continued competence by doctors, who collect, reflect on, and discuss a defined portfolio of supporting information in appraisal. This process is recognised internationally as world class.23 It is much more flexible than periodic high stakes examinations. It recognises the depth, breadth, and diversity of medical careers while identifying unsatisfactory performance due to conduct, capability, or health related issues. Its definition and purposes are clear and subtle enough to provide support for development while also providing a robust re-licensing process.4 Tzortziou Brown and …
BackgroundThe approach taken to support individuals during the coronavirus disease 2019 (COVID-19... more BackgroundThe approach taken to support individuals during the coronavirus disease 2019 (COVID-19) pandemic needs to take into account the requirements of people with intellectual disabilities and/or autism, who represent a major vulnerable group, with higher rates of co-occurring health conditions and a greater risk of dying prematurely. To date, little evidence on COVID-related concerns have been produced and no report has provided structured feedback from the point of view of people with intellectual disabilities and/or autism or of their family/carers.AimsTo provide systemised evidence-based information of the priority concerns for people with intellectual disabilities and/or autism regarding the COVID-19 pandemic.MethodSenior representatives of major UK-based professional and service-user representative organisations with a stake in the care of people with intellectual disabilities and/or autism were contacted to provide a list of concerns across three domains: ‘mental health a...
Journal of Policy and Practice in Intellectual Disabilities, 2020
The current COVID-19 pandemic is a pressing world crisis and people with intellectual disabilitie... more The current COVID-19 pandemic is a pressing world crisis and people with intellectual disabilities (IDs) are vulnerable due to disparity in healthcare provision and physical and mental health multimorbidity. While most people will develop mild symptoms upon contracting severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), some will develop serious complications. The aim of this study is to present guidelines for the care and treatment of people with IDs during the COVID-19 pandemic for both community teams providing care to people with IDs and inpatient psychiatric settings. The guidelines cover specific issues associated with hospital passports, individual COVID-19 care plans, the important role of families and carers, capacity to make decisions, issues associated with social distancing, ceiling of care/treatment escalation plans, mental health and challenging behavior, and caring for someone suspected of contracting or who has contracted SARS-CoV-2 within community or inpatient psychiatric settings. We have proposed that the included conditions recommended by Public Health England to categorize someone as high risk of severe illness due to COVID-19 should also include mental health and challenging behavior. There are specific issues associated with providing care to people with IDs and appropriate action must be taken by care providers to ensure that disparity of healthcare is addressed during the COVID-19 pandemic. We recognize that our guidance is focused upon healthcare delivery in England and invite others to augment our guidance for use in other jurisdictions.
Oxford Textbook of the Psychiatry of Intellectual Disability, 2020
Accessing treatment for a relative with intellectual and/or developmental disabilities requiring ... more Accessing treatment for a relative with intellectual and/or developmental disabilities requiring assessment or treatment from services can be extremely difficult for families and carers. Adverse past experiences can significantly affect the development of trust and relationships with present services and professionals. Listening and acknowledging families’ past and present concerns, alongside providing transparent information and reassurance about their relatives’ care, provides a foundation for starting positive relationships. Families are valuable in helping clinicians understand their patients fully and this helps the recovery process. Services have a duty to work collaboratively with patients’ families, in order to improve treatment outcomes including quality of life. Occasionally, there may be concerns in relation to the patient being the victim of familial financial, emotional, physical, and/or sexual abuse. In such instances, safeguarding processes must be followed.
Sabyasachi (Sab) Bhaumik, who died of a massive cardiac infarction at the age of 66 years on 8 No... more Sabyasachi (Sab) Bhaumik, who died of a massive cardiac infarction at the age of 66 years on 8 November 2019, was a leading figure nationally and internationally in the psychiatry of people with developmental disabilities. He served as Chair of the Faculty of the Psychiatry of Intellectual Disability at the Royal College of Psychiatrists (RCPsych) between 2006 and 2010, and before that as Chair of the Trent Division. In 2007, he established an international links group that brought together all the activities related to intellectual disability undertaken internationally by RCPsych members. Members of this committee have undertaken numerous educational, research and service development projects in India,
• This study looked at how many people with learning disabilities in a forensic unit were overwei... more • This study looked at how many people with learning disabilities in a forensic unit were overweight or obese, and whether people put on weight in the service. • The study showed that lots of people put on weight while they were in the service. It might be due to people struggling to exercise and the food provided in hospitals. • This research matters to people with learning disabilities because being overweight and obese can lead to other physical issues, such as heart disease and diabetes. Being overweight also affects how confident a person is and can lead to feeling depressed. • We now need to look at ways we can support people with learning disabilities in all settings to stay healthy, enjoy exercise, and lose weight if they want to.
IntroductionAutism spectrum disorders (ASDs) are associated with difficulties in social interacti... more IntroductionAutism spectrum disorders (ASDs) are associated with difficulties in social interaction, communication and restricted, repetitive behaviours. Much is known about their community prevalence among adults, data on adult inpatients within an acute mental health setting is lacking.This pilot study aimed to estimate the prevalence of ASDs among adults admitted to acute mental health wards and to examine the association between ASDs and psychiatric and physical comorbidities within this group.Methods and analysisA multiple-phase approach will be used. Phase I will involve testing of 200 patients and corresponding informants, using the autism quotient (AQ), the informant version of the Social Responsiveness Scale, second edition—Adult, the self and informant versions of the Adult Social Behaviour Questionnaire and the EuroQol-5D-5L. Patients with intellectual disability (ID) will bypass Phase I.Phase II will involve diagnostic testing of a subgroup of 40 patients with the Diagno...
Advances in Mental Health and Intellectual Disabilities, 2019
Purpose The purpose of this paper is to provide a professional consensus position with regard to ... more 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 measur...
The Journal of Forensic Psychiatry & Psychology, 2018
Deliberate foreign body ingestion is a significant issue in prison and psychiatric settings. It i... more Deliberate foreign body ingestion is a significant issue in prison and psychiatric settings. It is associated with serious physical complications, including bowel obstruction, perforation and haemorrhage. Episodes of deliberate foreign body ingestion were identified retrospectively from 5417 incident records from two inpatient forensic services (one mental health and one intellectual disability) over a one year timeframe, using related search terms. Rates were compared according to gender, diagnosis and level of security. Incidents of deliberate foreign body ingestion were found to occur on average every 2.7 days across the study population, with 133 incidents recorded over a one year period, accounted for by 27 patients. Women and patients in lower levels of security were significantly more likely to engage in deliberate foreign body ingestion. Staff responses to this behaviour were highly variable. Deliberate foreign body ingestion occurs frequently within inpatient forensic services, and can have significantly detrimental physical implications for affected patients. Further research should investigate the psychiatric and intellectual disability profile of such individuals in further detail, as well as exploring patient narratives; both of which will help inform development of treatment strategies.
International Journal of Culture and Mental Health, 2016
ABSTRACT Persons with intellectual disabilities are likely to be misdiagnosed and end up in priso... more ABSTRACT Persons with intellectual disabilities are likely to be misdiagnosed and end up in prisons for petty offences. The rates of criminal behaviours will be influenced by social and cultural factors. What is seen as illegal behaviour in one society may not be so in another. Cultures also play a major and significant role in defining deviant behaviour and defining what is abnormal. Thus relationship between intellectual disability and criminal behaviour deserves better understanding and research. In hospital or care settings as well as in prisons, clinicians must be sensitive to the role intellectual disability may play in contributing to mental ill-health and behavioural problems. Clinicians must have the skills to identify intellectual disability and its consequences. Wherever possible, depending upon local needs, court diversion schemes and pathways be identified and developed through all agencies who may be involved in caring for persons with intellectual disability.
There is limited empirical information on service-level outcome domains and indicators for the la... more There is limited empirical information on service-level outcome domains and indicators for the large number of people with intellectual disabilities being treated in forensic psychiatric hospitals. This study identified and developed the domains that should be used to measure treatment outcomes for this population. A systematic review of the literature highlighted 60 studies which met eligibility criteria; they were synthesised using content analysis. The findings were refined within a consultation and consensus exercises with carers, patients and experts. The final framework encompassed three a priori superordinate domains: (a) effectiveness, (b) patient safety and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviours, reactive and restrictive interventions, quality of life and patient satisfaction. To index recovery, services need ...
Advances in Mental Health and Intellectual Disabilities, 2015
Purpose – The purpose of this paper is to describe key policy and practice issues regarding a sig... more Purpose – The purpose of this paper is to describe key policy and practice issues regarding a significant subgroup of people with intellectual disability – those with offending behaviour being treated in forensic hospitals. Design/methodology/approach – The reasons why psychiatrists continue to be involved in the treatment of people with intellectual disability and mental health or behavioural problems and the factors that may lead to patients needing hospital admission are examined. Using two illustrative examples, three key questions – containment vs treatment, hospital care vs conditional discharge and hospital treatment vs using deprivation of liberty safeguards usage in the community are explored. Findings – Patients with intellectual disability, mental health problems and offending behaviours who are treated within forensic inpatient units tend to have long lengths of stay. The key variable that mediates this length of stay is the risk that they pose to themselves or others. C...
Advances in Mental Health and Intellectual Disabilities, 2015
Purpose – The 11th revision of the International Classification of diseases which sets global sta... more Purpose – The 11th revision of the International Classification of diseases which sets global standards for defining, reporting and managing health conditions is under way. The International Classification of Diseases (ICD) underpinning principle of clinical utility is currently poor for persons with Disorders of Intellectual Development (DID) and mental disorders. This impedes access to healthcare resources; services and social inclusion thereby further aggravating their vulnerability. The purpose of this paper is to present a critical overview and evidence informed recommendations within the context of an international collaborative programme, undertaken by the Faculty of Psychiatry of Intellectual Disability, Royal College of Psychiatrists, UK with support from the World Health Organisation (WHO). Design/methodology/approach – The authors carried out: first, a systematic review (SR) of literature, using PRISMA guidelines regarding the reliability, validity and utility of the ICD-...
Introduction Secure hospital services for people with intellectual disability were established fo... more Introduction Secure hospital services for people with intellectual disability were established for patients whose presentation rendered their management unsafe in the community. These services offer an integrated, multi-disciplinary model of support within an environment that ...
Aims and Method With an absence of appropriate residential services, people with learning disabil... more Aims and Method With an absence of appropriate residential services, people with learning disabilities are often placed outside their local areas and there is regularly no dialogue between the relevant health authorities prior to a placement being made. This survey from Leicestershire explored this issue by focusing on the catchment area covered by one consultant psychiatrist. Practice standards were formulated and compliance with these was examined. Results A total of 29 patients were identified as ‘out-of-area’ placements. They had high psychiatric morbidity, exhibited significant degrees of aggression and needed a high level of professional input. The suggested practice standards were met by less than 10%. Clinical Implications In parts of the country where a large number of ‘specialist’ residential homes have opened, there has been an unplanned increase in the workload of local learning disability/ mental health services. This can compromise patient care and there is an urgent n...
Background There has been a policy shift away from hospital to community in the services of all t... more Background There has been a policy shift away from hospital to community in the services of all those with psychiatric disorders, including those with intellectual disability, in the last fifty years. This has been accompanied recently by the growth of assertive outreach services, but these have not been evaluated in intellectual disability services. Method In a randomised controlled trial we compared assertive outreach with 'standard' community care, using global assessment of function (GAF) as the primary outcome measure, and burden and quality of life as secondary measures. Results We recruited thirty patients, considerably less than expected; no significant differences were found between the primary and secondary outcomes in the two groups. The differences were so small that a Type II error was unlikely. Conclusions Reasons for this lack of specific efficacy of the assertive approach are discussed and it is suggested that there is a blurring of the differences between standard and assertive approaches in practice.
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Papers by Regi Alexander