An intensive personalised support approach to treating individuals with psychosis and co-morbid mild intellectual disability

Developing a recovery-oriented intervention for people with severe mental illness and an intellectual disability: design-oriented action research

Introduction

Mild intellectual disability or borderline intellectual functioning (MID/BIF) are common in people with severe mental health problems (SMHP). Despite this, there is a lack of treatments adapted for this group of clients.

Methods

This qualitative study describes the development of a new intervention, guided by the principles of action research, for people with SMHP and MID/BIF and mental health professionals to help them talk about all aspects of the process of recovery. The intervention was developed in four cycles and in close cooperation with mental health professionals, experts by experience, other experts in the field of SMHP or MID/BIF, and clients. During all cycles there was a strong focus on the content of the intervention, exercises, understandable language, and drawings for visual support.

Results

This resulted in the intervention "Routes to Recovery," which covers both complaints and strengths, coping strategies, helpful (social) activities, and how to determine future steps in a recovery plan.

Discussion

Routes to Recovery is a first step in helping professionals and their clients with SMHP and MID/BIF to have a conversation about personal strengths and what the client needs to recover. Future research should investigate the effects of this intervention.

Psychosocial interventions for older people with intellectual disabilities and the role of support staff: A systematic review

Background

The life expectancy of people with intellectual disabilities has increased. The implications of ageing have resulted in changes in their support needs and challenges to support staff. Access to evidence based strategies for support staff providing care to elderly with intellectual disabilities remains scarce. A systematic review was conducted to provide an overview of available psychosocial interventions.

Methods

Four databases were searched and assessed according to the PRISMA guidelines. A narrative, integrative method of analysis was conducted to synthesise quantitative and qualitative data.

Results

The 36 studies included in the review reported on interventions aimed at either identifying and meeting the needs or perceptions of older individuals or at improving their behaviour and skills. Furthermore, the role of support staff in the implementation of interventions was either active, assisting or undefined.

Conclusions

This overview of studies could contribute to the existing body of knowledge and help to optimise psychosocial support for a growing population.

A cost-effectiveness analysis of dialectical behaviour therapy for treating individuals with borderline personality disorder in the community

BACKGROUND/AIMS

This paper investigates the cost-effectiveness of dialectical behaviour therapy (DBT) for treating individuals with borderline personality disorder (BPD) in a community setting in Ireland, in the short term.

METHODS

Resource utilisation and effectiveness data were collected as part of the National DBT Project, Ireland, and are incorporated into a cost-effectiveness analysis. The perspective taken was that of the service provider and payer. Direct health resources were included and effectiveness was measured using the EQ-5D-5L questionnaire. To examine cost-effectiveness, incremental costs are compared with incremental quality-adjusted life years, to estimate an incremental cost-effectiveness ratio. A probabilistic sensitivity analysis was employed to investigate parameter uncertainty. Scenario analyses are employed to investigate cost-effectiveness of DBT with varying assumptions around effectiveness and costs.

RESULTS

The baseline analysis reveals that DBT is more expensive and more effective than routine clinical care (without DBT). The low incremental cost-effectiveness ratio suggests DBT can be considered cost effective in the short term. In each scenario analyses considered, the probability that DBT is cost effective is greater than 50%.

CONCLUSIONS

Mental health care provision, including that of DBT, varies across jurisdictions, necessitating economic evaluations of current practice in community-based services, on a country-by-country basis, to inform resource allocation decisions. In line with previous research, the analysis here indicates DBT can be considered cost effective in the short term. Future data collection on alternative comparators and long-term outcomes associated with DBT is warranted to investigate the longer term cost-effectiveness of DBT.

Borderline personality disorder: resource utilisation costs in Ireland

Objectives

Borderline personality disorder (BPD) is characterised by recurring crises, hospitalisations, self-harm, suicide attempts, addictions, episodes of depression, anxiety and aggression and lost productivity. The objective of this study is to determine the use of direct health care resources by persons with BPD in Ireland and the corresponding costs.

Methods

This prevalence-based micro-costing study was undertaken on a sample of 196 individuals with BPD attending publicly funded mental health services in Ireland. All health care costs were assessed using a resource utilisation questionnaire completed by mental health practitioners. A probabilistic sensitivity analysis, using a Monte Carlo simulation, was performed to examine uncertainty.

Results

Total direct healthcare cost per individual was €10 844 annually (ranging from 5228 to 20 609). Based on a prevalence of 1% and an adult population (18–65 years) of 2.87 million, we derived that there were 28 725 individuals with BPD in Ireland. Total yearly cost of illness was calculated to be up to €311.5 million.

Conclusions

There is a dearth of data on health care resource use and costs of community mental health services in Ireland. The absence of this data is a considerable constraint to research and decision-making in the area of community mental health services. This paper contributes to the limited literature on resource use and costs in community mental health services in Ireland. The absence of productivity loss data (e.g. absenteeism and presenteeism), non-health care costs (e.g. addiction treatment), and indirect costs (e.g. informal care) from study participants is a limitation of this study.