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El Mrayyan N, Bökberg C, Eberhard J, Ahlström G. Healthcare utilisation patterns among older people with intellectual disability and with affective and anxiety diagnoses in comparison with the general population. Aging Ment Health 2021; 25:1525-1534. [PMID: 32208744 DOI: 10.1080/13607863.2020.1742657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study investigates specialist healthcare visits of older people with intellectual disability ID having affective and anxiety diagnoses in comparison with the general population, as well as across different levels of ID, behavioural impairment, and living in special housing in Sweden. METHOD The study is a retrospective national-register-based study from 2002-2012 of people with ID 55 years and older (n = 7936) and a control group the same size matched by birth year and sex from the general population at the end of study. The study groups comprised those with affective (n = 918) and anxiety (n = 825) diagnoses who visited specialist healthcare, including data about living in special housing at the end of study in 2012. RESULTS Older people with ID and with affective and anxiety diagnoses have a higher risk of inpatient and unplanned visits to psychiatric and somatic healthcare than the general population. The average length of stay in inpatient psychiatric healthcare was higher in older people with ID and anxiety diagnoses than in the general population. Within the ID group, more inpatient and unplanned visits were made by those with moderate and severe levels of ID, behavioural impairment, and living in special housing. CONCLUSION Older people with ID and affective and anxiety diagnoses are more likely to have inpatient and unplanned visits for specialist healthcare than the general population. Future research should explore the quality of healthcare services delivered by healthcare providers to older people with ID and with affective and anxiety diagnoses.
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Affiliation(s)
- Nadia El Mrayyan
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Christina Bökberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Jonas Eberhard
- Division of Psychiatry, Clinical Psychosis Research Unit, Region Skane and Affiliated to Department of Clinical Sciences, Lund University, Helsingborg, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Ahlström G, Axmon A, Sandberg M, Hultqvist J. Specialist psychiatric health care utilization among older people with intellectual disability - predictors and comparisons with the general population: a national register study. BMC Psychiatry 2020; 20:70. [PMID: 32066421 PMCID: PMC7027029 DOI: 10.1186/s12888-020-02491-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/10/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND People with intellectual disability (ID) face considerable barriers to accessing psychiatric health care, thus there is a risk for health disparity. The aims of the present study were 1) to compare specialist psychiatric health care utilization among older people with ID to that with their age peers in the general population, taking into account demographic factors and co-morbidities associated with specialist psychiatric health care utilization and 2) to determine a model for prediction of specialist psychiatric health care utilization among older people with ID. MATERIAL AND METHODS We identified a national cohort of people with ID (ID cohort), aged 55+ years and alive at the end of 2012 (n = 7936), and a referent cohort from the general population (gPop cohort) one-to-one matched by year of birth and sex. Data on utilization of inpatient and outpatient specialist psychiatric health care, as well as on co-morbidities identified in either psychiatric or somatic specialist health care, were collected from the National Patient Register for the time period 2002-2012. RESULTS After adjusting for sex, age, specialist psychiatric health care utilization the previous year, and co-morbidities, people in the ID cohort still had an increased risk of visits to unplanned inpatient (relative risk [RR] 1.95), unplanned outpatient (RR 1.59), planned inpatient (RR 2.02), and planned outpatient (RR 1.93) specialist psychiatric health care compared with the general population. Within the ID cohort, increasing age was a predictor for less health care, whereas psychiatric health care the previous year predicted increased risk of health care utilization the current year. As expected, mental and behavioral disorders predicted increased risk for psychiatric health care. Furthermore, episodic and paroxysmal disorders increased the risk of planned psychiatric health care. CONCLUSIONS Older people with ID have a high need for psychiatric specialist health care due to a complex pattern of diagnoses. Further research needs to investigate the conditions that can explain the lesser psychiatric care in higher age groups. There is also a need of research on health care utilization among people with ID in the primary health care context. This knowledge is critical for policymakers' plans of resources to meet the needs of these people.
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Affiliation(s)
- G Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
| | - A Axmon
- EPI@LUND (Epidemiology, Population studies, and Infrastructures at Lund University), Lund University, Lund, Sweden
| | - M Sandberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - J Hultqvist
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Lindsey M, Flynn A. A survey of consultants in the psychiatry of learning disability. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.27.9.342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodAll 208 consultant members of the Faculty for the Psychiatry of Learning Disability were contacted and asked to complete a questionnaire to provide qualitative and quantitative information about their work and experiences.ResultsOne hundred and thirty-six consultants responded, giving a 64% response rate. They reported a wide range of clinical, academic and management skills, with 72 having registration in other specialities. Insufficient in-patient provision and problems with discharge were cited by 85% of respondents. There was a wide disparity in the provision of mental health services for children and adolescents with learning disabilities and 12 areas reported no services from any source. Although most respondents showed satisfaction with clinical work and professional relationships, there were many concerns about management, commissioning and planning of services.Clinical ImplicationsConsultant psychiatrists in the field of learning disability are a broadly skilled group of clinicians with a wide range of responsibilities and areas of expertise, but many are working in services that they see as under-resourced and poorly managed, planned and commissioned. Overall levels of satisfaction are good, particularly in relation to clinical work, peer support and study/academic work.
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Nicholas DB, Calhoun A, McLaughlin AM, Shankar J, Kreitzer L, Uzande M. Care Experiences of Adults With a Dual Diagnosis and Their Family Caregivers. Glob Qual Nurs Res 2017; 4:2333393617721646. [PMID: 28804747 PMCID: PMC5533258 DOI: 10.1177/2333393617721646] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 06/12/2017] [Accepted: 06/15/2017] [Indexed: 11/17/2022] Open
Abstract
Individuals diagnosed with developmental disability and mental illness (a “dual diagnosis”) contend with multiple challenges and system-related barriers. Using an interpretive description approach, separate qualitative interviews were conducted with adults with a dual diagnosis (n = 7) and their caregiving parents (n = 8) to examine care-related experiences. Results indicate that individuals with a dual diagnosis and their families experience misunderstanding and stigma. Families provide informal complex care amid insufficient and uncoordinated services but are often excluded from formal care planning. A lack of available funding and services further impedes care. While negative care experiences are reported as prevalent, participants also describe instances of beneficial care. Overall, findings indicate a lack of sufficiently targeted resources, leaving families to absorb system-related care gaps. Recommendations include person- and family-centered care, navigation support, and capacity building. Prevention and emergency and crisis care services, along with housing, vocation, and other supports, are needed. Practice and research development regarding life span needs are recommended.
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Balogh R, McMorris CA, Lunsky Y, Ouellette‐Kuntz H, Bourne L, Colantonio A, Gonçalves‐Bradley DC. Organising healthcare services for persons with an intellectual disability. Cochrane Database Syst Rev 2016; 4:CD007492. [PMID: 27065018 PMCID: PMC8720486 DOI: 10.1002/14651858.cd007492.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND When compared to the general population, persons with an intellectual disability have lower life expectancy, higher morbidity, and more difficulty finding and obtaining healthcare. Organisational interventions are used to reconfigure the structure or delivery of healthcare services. This is the first update of the original review. OBJECTIVES To assess the effects of organisational interventions of healthcare services for the mental and physical health problems of persons with an intellectual disability. SEARCH METHODS For this update we searched CENTRAL, MEDLINE, EMBASE, CINAHL and other databases, from April 2006 to 4 September 2015. We checked reference lists of included studies and consulted experts in the field. SELECTION CRITERIA Randomised controlled trials of organisational interventions of healthcare services aimed at improving care of mental and physical health problems of adult persons with an intellectual disability. DATA COLLECTION AND ANALYSIS We employed standard methodological procedures as outlined in the Cochrane Handbook of Systematic Reviews of Interventions, in addition to specific guidance from the Cochrane Effective Practice and Organisation of Care (EPOC) Group. MAIN RESULTS We identified one new trial from the updated searches.Seven trials (347 participants) met the selection criteria. The interventions varied but had common components: interventions that increased the intensity and frequency of service delivery (4 trials, 200 participants), community-based specialist behaviour therapy (1 trial, 63 participants), and outreach treatment (1 trial, 50 participants). Another trial compared two active arms (traditional counselling and integrated intervention for bereavement, 34 participants).The included studies investigated interventions dealing with the mental health problems of persons with an intellectual disability; none focused on physical health problems. Four studies assessed the effect of organisational interventions on behavioural problems for persons with an intellectual disability, three assessed care giver burden, and three assessed the costs associated with the interventions. None of the included studies reported data on the effect of organisational interventions on adverse events. Most studies were assessed as having low risk of bias.It is uncertain whether interventions that increase the frequency and intensity of delivery or outreach treatment decrease behavioural problems for persons with an intellectual disability (two and one trials respectively, very low certainty evidence). Behavioural problems were slightly decreased by community-based specialist behavioural therapy (one trial, low certainty evidence). Increasing the frequency and intensity of service delivery probably makes little or no difference to care giver burden (MD 0.03, 95% CI -3.48 to 3.54, two trials, moderate certainty evidence). It is uncertain whether outreach treatment makes any difference for care giver burden (one trial, very low certainty evidence). There was very limited evidence regarding costs, with low to very low certainty evidence for the different interventions. AUTHORS' CONCLUSIONS There is very limited evidence on the organisation of healthcare services for persons with an intellectual disability. There are currently no well-designed studies focusing on organising the health services of persons with an intellectual disability and concurrent physical problems. There are very few studies of organisational interventions targeting mental health needs and the results of those that were found need corroboration. There is an urgent need for high-quality health services research to identify optimal health services for persons with an intellectual disability and concurrent physical problem.
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Affiliation(s)
- Robert Balogh
- University of Ontario Institute of TechnologyFaculty of Health Sciences2000 Simcoe Street NorthOshawaONCanadaL1H 7K4
| | - Carly A McMorris
- Cumming School of Medicine, University of CalgaryDepartment of Pediatrics3820 24th AveCalgaryABCanadaT3B 2X9
| | - Yona Lunsky
- Centre for Addiction and Mental Health, University of TorontoDepartment of PsychiatryTorontoONCanada
| | | | | | - Angela Colantonio
- University of TorontoRehabilitation Sciences Institute500 University Avenue, Suite 160TorontoONCanadaM5G 1V7
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Campbell M, Robertson A, Jahoda A. Psychological therapies for people with intellectual disabilities: comments on a matrix of evidence for interventions in challenging behaviour. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:172-188. [PMID: 23106865 DOI: 10.1111/j.1365-2788.2012.01646.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/15/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Psychological therapies with a proven efficacy in the general population are being adapted for use with people who have intellectual disabilities in community settings. METHODS A systematic review of peer-reviewed literature published between 1980 and 2010 was carried out, to identify the evidence base for effective psychological interventions in challenging behaviour. Relevant databases were searched using applied key terms. Evidence was graded, according to the quality of the research. A best-evidence Matrix was produced to improve guidance for service providers and practitioners in the range, volume and quality of psychological interventions. RESULTS There is a limited amount of efficacy research that meets the most stringent standards of empirical evidence. CONCLUSIONS It is important to broaden the evidence base and consider the context of psychological interventions, alongside the values underpinning care and treatment.
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Affiliation(s)
- M Campbell
- School of Psychology & Neuroscience, University of St. Andrews, St. Andrews, Fife, UK
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Kelly M, Humphrey C. Implementation of the care programme approach across health and social services for dual diagnosis clients. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2013; 17:314-328. [PMID: 24132192 DOI: 10.1177/1744629513508383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Care for clients with mental health problems and concurrent intellectual disability (dual diagnosis) is currently expected to be provided through the care programme approach (CPA), an approach to provide care to people with mental health problems in secondary mental health services. When CPA was originally introduced into UK mental health services in the 1990s, its implementation was slow and problematic, being hampered in part by problems occurring at a strategic level as health and social service organizations attempted to integrate complex systems. This article reports on a study of a more recent attempt to implement CPA for dual diagnosis clients in one mental health foundation trust, aiming to gauge progress and identify factors at the strategic level that were helping or hindering progress this time round. METHODS The study took place in a mental health National Health Service (NHS) Foundation Trust in a large English city, which was implementing a joint mental health and intellectual disability CPA policy across five of its constituent boroughs. Semi-structured interviews with key informants at Trust and borough levels focused on the Trust's overall strategy for implementing CPA and on how it was being put into practice at the front line. Documentary analysis and the administration of the Partnership Assessment Tool were also undertaken. Data were analysed using a framework approach. RESULTS Progress in implementing CPA varied but overall was extremely limited in all the boroughs. The study identified six key contextual challenges that significantly hindered the implementation progress. These included organizational complexity; arrangements for governance and accountability; competing priorities; financial constraints; high staff turnover and complex information and IT systems. The only element of policy linked to CPA that had been widely taken up was the Greenlight Framework and Audit Toolkit (GLTK). The fact that the toolkit had targets and penalties associated with its implementation appeared to have given it priority. CONCLUSION None of the contextual challenges identified in this study were specifically related to CPA as a policy or to the needs and circumstances of dual diagnosis clients. Nevertheless, they inhibited the types of organizational change and partnership working that implementing CPA for a client group of this kind required. Unless these more generic factors are acknowledged and addressed when introducing policies such as CPA, the chances of effective implementation will inevitably be compromised.
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Alexander RT, Piachaud J, Singh I. Two Districts, Two Models: In-Patient Care in the Psychiatry of Learning Disability. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/096979501799155585] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Rose N, Kent S, Rose J. Health professionals' attitudes and emotions towards working with adults with intellectual disability (ID) and mental ill health. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:854-864. [PMID: 21917050 DOI: 10.1111/j.1365-2788.2011.01476.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Mainstream mental health services are providing more care for individuals with an intellectual disability (ID); this has implications for staff and service users. Attitudes of staff towards people with ID in mental health services may be negative and negative staff attitudes may have a detrimental impact on service provision. DESIGN A cross-sectional design was used. METHODS A questionnaire designed to investigate the attitudes and emotions of staff towards delivering mental health care to adults with ID was completed by 84 staff from mainstream and specialist ID services. RESULTS Staff in both services experienced more positive emotions when working with clients whom they are currently employed to work with. When the frequency of contact with adults with ID, the number of individuals worked with and the amount of formal ID training received were considered, there was no significant difference between the attitudes of staff in both services. Positive correlations were found between attitude scores and positive emotional experiences in both services. CONCLUSIONS The research suggests that numerous factors, including the role of emotional experience and a number of environmental aspects, need to be considered in the context of providing mental health services to adults with ID to ensure the highest quality. Research limitations and clinical implications of the study are also considered.
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Affiliation(s)
- N Rose
- Psychological Heath Service, Black Country Partnership NHS Foundation Trust, Stourbridge, UK.
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Taua C, Hepworth J, Neville C. Nurses' role in caring for people with a comorbidity of mental illness and intellectual disability: a literature review. Int J Ment Health Nurs 2012; 21:163-74. [PMID: 22034918 DOI: 10.1111/j.1447-0349.2011.00779.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This article examines literature on the role of the nurse caring for people with a dual disability (DD) of intellectual disability and mental illness. A search of the literature between 2000 and 2010 resulted in a total of 21 articles that met the inclusion criteria. Seven key categories of the role of the nurse were identified: (i) advocacy/health promotion (including working with family); (ii) assessment/case management; (iii) behavioural interventions; (iv) communication; (v) leadership and the nurse's role within the multidisciplinary team; (vi) functions regarding medication administration; and (vii) safety/risk management. There is a paucity of research about the role of nurses working with people with DD, although a number of opinion-based articles exist. This article identifies a need for the role of the nurse working in DD to be more clearly articulated and for the development of evidence to guide best practice.
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Affiliation(s)
- Chris Taua
- School of Nursing and Midwifery, The University of Queensland, Brisbane, Queensland, Australia.
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Townsend CE. Developing a Comprehensive Research Agenda for People With Intellectual Disability to Inform Policy Development and Reform. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2011. [DOI: 10.1111/j.1741-1130.2011.00297.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rose J. Staff stress and people who have mental health needs living in new models of service. ACTA ACUST UNITED AC 2009. [DOI: 10.1108/17530180200900016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Longo S, Scior K. In-patient psychiatric care for individuals with intellectual disabilities: the service users' and carers' perspectives. J Ment Health 2009. [DOI: 10.1080/09638230410001669318] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Balogh R, Ouellette-Kuntz H, Bourne L, Lunsky Y, Colantonio A. Organising health care services for persons with an intellectual disability. Cochrane Database Syst Rev 2008:CD007492. [PMID: 18843752 DOI: 10.1002/14651858.cd007492] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND When compared to the general population, persons with an intellectual disability have lower life expectancy, higher morbidity, higher rates of unmet health needs, and more difficulty finding and getting health care. Organisational interventions are used to reconfigure the structure or delivery of health care services and may prove useful to decrease the noted disparities. OBJECTIVES To assess the effects of organisational interventions for the mental and physical health problems of persons with an intellectual disability. SEARCH STRATEGY We searched the Cochrane Effective Practice and Organisation of Care Group specialised register (no year restriction), MEDLINE, EMBASE, CINAHL, other databases from January 1990 to April 2006 reference lists of included studies, and we consulted experts in the field. SELECTION CRITERIA Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series of organisational interventions aimed at improving care of mental and physical health problems of adult persons with an intellectual disability. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed study quality. Missing data were requested from authors of included studies. MAIN RESULTS Eight studies met the selection criteria: six were randomised controlled trials, one was a controlled before and after study, and one was an interrupted time series. In general the studies were of acceptable methodological quality. The included studies investigated interventions dealing with the mental health problems of persons with an intellectual disability, none focused on physical health problems. Three of the studies identified effective organisational interventions and five showed no evidence of effect. Only two studies were similar enough to analyse using a meta-analysis. In the pooled analyses 25 participants received assertive community treatment and 25 received standard community treatment. Results from measures of function, caregiver burden and quality of life were non-significant. AUTHORS' CONCLUSIONS There are currently no well designed studies focusing on organising the health services of persons with an intellectual disability and concurrent physical problems. There are very few studies of organisational interventions targeting mental health needs and the results of those that were found need corroboration. There is an urgent need for high quality health services research to identify optimal health services for persons with an intellectual disability and concurrent physical problem.
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Affiliation(s)
- Robert Balogh
- Graduate Department of Rehabilitation Science, University of Toronto, 160-500 University Ave, Toronto, Ontario, Canada, M5G 1V7.
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Rose N, O'Brien A, Rose J. Investigating staff knowledge and attitudes towards working with adults with learning disabilities and mental health difficulties. ACTA ACUST UNITED AC 2007. [DOI: 10.1108/17530180200700031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Costello H, Bouras N, Davis H. The Role of Training in Improving Community Care Staff Awareness of Mental Health Problems in People with Intellectual Disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2007. [DOI: 10.1111/j.1468-3148.2006.00320.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Glaser W, Florio D. Beyond specialist programmes: a study of the needs of offenders with intellectual disability requiring psychiatric attention. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2004; 48:591-602. [PMID: 15312060 DOI: 10.1111/j.1365-2788.2004.00628.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Despite the increased prevalence of psychiatric disorder amongst offenders with an intellectual disability (ID), there is very little known about the characteristics and needs of those with dual disability. METHOD A study of admissions to a new community forensic dual disability clinic during the first 10 months of its operation. RESULTS Typically, the offenders are male, are older than other offenders, exhibit long-standing and continuing serious behavioural disturbance (independent of their psychiatric diagnosis or level of involvement with the criminal justice system) and require supported or custodial accommodation, despite only mild or borderline levels of ID. Although only one-third have a diagnosable major nonparaphilic psychiatric disorder, three-quarters have had prior or current contact with psychiatric services and two-thirds suffer chronic medical illness. CONCLUSIONS These offenders suffer psychosocial disadvantages far more extensive than those implied by the "psychiatric" or "disability" label. The multiple services provided to this group have been ad hoc, poorly co-ordinated and sometimes dangerously inappropriate. A service provision model is required which must be integrative and consistent. We suggest the use of multiskilled key workers, who maintain close contact with individual clients. Their role will be to implement management plans from the various specialist agencies who become involved with this group and provide long-term follow-up of their recommendations.
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Affiliation(s)
- W Glaser
- Victorian Institute of Forensic Mental Health, 34 Queens Road, Cnr Hanna Street, Melbourne, Victoria 3004, Australia.
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Kerker BD, Owens PL, Zigler E, Horwitz SM. Mental health disorders among individuals with mental retardation: challenges to accurate prevalence estimates. Public Health Rep 2004; 119:409-17. [PMID: 15219798 PMCID: PMC1497647 DOI: 10.1016/j.phr.2004.05.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES The objectives of this literature review were to assess current challenges to estimating the prevalence of mental health disorders among individuals with mental retardation (MR) and to develop recommendations to improve such estimates for this population. METHODS The authors identified 200 peer-reviewed articles, book chapters, government documents, or reports from national and international organizations on the mental health status of people with MR. Based on the study's inclusion criteria, 52 articles were included in the review. RESULTS Available data reveal inconsistent estimates of the prevalence of mental health disorders among those with MR, but suggest that some mental health conditions are more common among these individuals than in the general population. Two main challenges to identifying accurate prevalence estimates were found: (1) health care providers have difficulty diagnosing mental health conditions among individuals with MR; and (2) methodological limitations of previous research inhibit confidence in study results. CONCLUSIONS Accurate prevalence estimates are necessary to ensure the availability of appropriate treatment services. To this end, health care providers should receive more training regarding the mental health treatment of individuals with MR. Further, government officials should discuss mechanisms of collecting nationally representative data, and the research community should utilize consistent methods with representative samples when studying mental health conditions in this population.
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Affiliation(s)
- Bonnie D Kerker
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA.
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Abstract
Services for people with learning disabilities have been transformed since the late 1960s by the move from institutional to community care. (Learning disabilities is the term currently used in the UK in preference to mental retardation, developmental disabilities and mental handicap.) Important changes include the progress towards integration, participation, inclusion and choice for people with learning disabilities, which have occurred in the context of the broader civil and human rights movements. It is time to examine the services delivered to people with learning disabilities and comorbid psychiatric disorders (mental illness, personality disorders, behavioural problems with aggression) and the evidence for their effectiveness.
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Chaplin R. General psychiatric services for adults with intellectual disability and mental illness. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2004; 48:1-10. [PMID: 14675225 DOI: 10.1111/j.1365-2788.2004.00580.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Adults with intellectual disability (ID) and mental illness may use general or specialist psychiatric services. This review aims to assess if there is evidence for a difference in outcome between them. METHODS A literature review was conducted using a variety of electronic databases and hand-search strategies to identify all studies evaluating the outcome of people with ID and mental illness using general psychiatric services. RESULTS There is no conclusive evidence to favour the use of general or specialist psychiatric services. People with ID stay less time on general psychiatric than specialist inpatient units. People with severe ID appear not to be well served in general services. Older studies of inpatient samples suggest a worse outcome for people with ID. Novel specialist services generally improve upon pre-existing general services. Assertive outreach in general services may preferentially benefit those with ID. Recent studies suggest similar lengths of stay in general psychiatric beds for people with and without ID. CONCLUSIONS Although 27 studies were located, only two were randomized controlled trials. The evidence is poor quality therefore further evaluation of services employing a variety of designs need to be employed to give more robust evidence as to which services are preferred.
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Affiliation(s)
- R Chaplin
- Littlemore Hospital, Oxford, OX4 4XN, UK.
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Bouras N, Cowley A, Holt G, Newton JT, Sturmey P. Referral trends of people with intellectual disabilities and psychiatric disorders. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2003; 47:439-446. [PMID: 12919194 DOI: 10.1046/j.1365-2788.2003.00514.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND The Specialist Mental Health Service for people with an intellectual disability (ID) and psychiatric disorder (referred to throughout this paper as 'the Service') has been in operation in south-east London for the last 18 years, during which time two local, long-stay institutions have closed. AIMS To measure the number of referrals to the Service from 1983 to 2001 and identify trends. METHODS Data were recorded on 752 new referrals using the assessment and information rating profile. Diagnoses according to the International Classification of Diseases (10th edition) were made by two psychiatrists. Referrals for a one off consultation or assessment, or with an IQ>70 were excluded from analysis. RESULTS Over time more non-white clients and more clients with mild ID were referred. More referrals were made in later years, and a greater proportion came from primary care. Later referrals were also more likely to have a psychiatric diagnosis than those in earlier years. CONCLUSION Significant trends in referrals were identified, which may be explained by various external factors.
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Affiliation(s)
- N Bouras
- Estia Centre, York Clinic-Guys Hospital, London, UK.
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Maes B, Broekman TG, Dosen A, Nauts J. Caregiving burden of families looking after persons with intellectual disability and behavioural or psychiatric problems. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2003; 47:447-455. [PMID: 12919195 DOI: 10.1046/j.1365-2788.2003.00513.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND During the last decade, there has been a growing interest in outpatient support services for persons with intellectual disability (ID) and psychiatric and/or behavioural problems and their families. In this study, we explore the family burden that is associated with children or adults with ID and behavioural or psychiatric problems living at home. METHOD The research group consisted of 66 clients of In Casa, a project of outpatient treatment. Their average age is 18.97 years and their average IQ 55.37. The Reiss Screen for Maladaptive Behaviour (adults) or Reiss Scales for Children's Dual Diagnosis (children) and the Nijmegen Family Situation Questionnaire have been administered. RESULTS About 62% of the children and 86% of the adults living at home and referred to In Casa have severe psychiatric or behavioural problems as measured by the Reiss scales. The dual diagnosis has a more negative impact on the family situation than the condition of ID only. CONCLUSION Parents consider the psychiatric or behavioural problems of their child to be an extra burden and feel it more difficult to raise and manage such a child. This impels them to change the situation and to call on the help of external services. Some methodological questions and the implications of the findings in terms of support needs are discussed.
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Affiliation(s)
- B Maes
- Department of Special Education, University of Leuven, Vesaliusstraat 2, Leuven, Belgium.
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