Strange bedfellows: economics, happiness and mental disorder

Using 'candidacy' as a framework for understanding access to mainstream psychological treatment for people with intellectual disabilities and common mental health problems within the English Improving Access to Psychological Therapies service

BACKGROUND

The Improving Access to Psychological Therapies (IAPT) service was established to address common mental health problems among the English population in a timely manner in order to counter the social and economic disadvantage accompanying such difficulties. Using the concept of candidacy, we examined how the legitimacy of claims by people with intellectual disabilities to use this service is facilitated or impeded.

METHOD

We used a sequential mixed methods design. We completed 21 interviews with a range of stakeholders, including people with intellectual disabilities and their carers. Themes from the interviews were used to design an online survey questionnaire that was returned by 452 staff from IAPT and specialist intellectual disability services.

RESULTS

Using the candidacy framework, we noted that eligibility and access to IAPT were achieved through dynamic and iterative processes of negotiation involving people with intellectual disabilities and their supporters on one side and IAPT staff and service structures on the other. Barriers and facilitators were apparent throughout the seven dimensions of candidacy (identification, navigation, permeability of services, appearances, adjudications, offers and resistance and operating conditions) and were linked to discourses relating to the character and purpose of IAPT and specialist intellectual disability services.

CONCLUSIONS

Opportunities exist for some people with intellectual disabilities to assert their candidacy for IAPT input, although there are barriers at individual, professional, organisational and structural levels. More attention needs to be paid to how principles of inclusiveness are operationalised within IAPT teams and to the mental health facilitation role of specialist intellectual disability staff.

Women's mental health nursing: depression, anxiety and stress during pregnancy

Depression affects more women than men, with a preponderance of cases occurring during prime childbearing years (15-44 years of age). Research shows newborns and infants exposed to maternal antepartum depression, anxiety and stress exhibit pronounced neurobiobehavioral dysregularities. The present study investigated the relationship between maternal psychosocial and biochemical profiles during the antepartum period. Participants were recruited from prenatal registration at a large metropolitan hospital in the southeastern USA--the sample consisted of 59 pregnant women (mean age = 22 years). Structured clinical interviews and maternal self-report were utilized to assess maternal psychosocial distress at mid- (26-28 weeks) and late- (32-34 weeks) gestation. Salivary cortisol levels served as an objective stress measure. The resultant high incidences of maternal depression, anxiety and stress provide evidence of the need for nurses to closely monitor psychosocial and biochemical profiles of all women to thwart the negative effects on the developing human foetus. Clinical nursing implications of the requisite consideration of antepartum maternal psychosocial conditions are discussed.