Training and service provision for people with intellectual disability and mental illness: the views of psychiatrists

Psychiatry training in autism spectrum disorder and intellectual disability: Ongoing gaps and emerging opportunities

LAY ABSTRACT

Children, adolescents, and adults with autism spectrum disorder and intellectual disability experience high rates of co-occurring psychiatric conditions throughout their lifetime. However, there is a shortage of psychiatrists to treat these populations. We evaluated how much education psychiatrists-in-training receive on how to care for individuals with autism spectrum disorder/intellectual disability. We found that in many psychiatry programs, residents receive limited training experiences in autism spectrum disorder/intellectual disability involving lectures and patient contact and that psychiatry program directors would benefit from more resources to strengthen education in autism spectrum disorder/intellectual disability.

Healthcare workers' experiences of caring for patients diagnosed with intellectual disability co-occurrent with psychiatric disorders

WHAT IS KNOWN ON THE SUBJECT?: Intellectual disability (ID) involves problems with general mental abilities and affects intellectual functioning and adaptive functioning. People diagnosed with ID present higher levels of functional disability, which means they usually have difficulty or the inability to independently perform basic activities of daily living. Little to no attention has been paid to the issues of the mental health of people diagnosed with ID. Specifically, healthcare workers' experiences of caring for patients with IDPD have been neglected. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The findings increase our understanding and partially address the knowledge gap regarding the situations and circumstances faced by healthcare workers in caring for patients diagnosed with intellectual disability co-occurrent with psychiatric disorders (IDPD). In cases of insufficient staffing, healthcare workers may be forced to ignore the individualized needs of patients so as to facilitate management. Healthcare workers may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. They adapt by adjusting their expectations of their patients. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in-service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them. The government department responsible for the management of ID patient care institutions should be able to regularly monitor the overall staffing and quality of care in these institutions. ABSTRACT: Introduction When intellectual disability co-occurs diagnosed with psychiatric disorders (IDPD), the impact of the burden of illness on the affected individuals, their caregivers, their family and friends, and the services that provide for them is particularly high. The issues of the mental health of people diagnosed with ID have received little, if any, attention. One specific area of neglect is healthcare workers' experiences of caring for patients diagnosed with IDPD. Aim The aim of this study was to understand healthcare workers' experiences of caring for patients diagnosed with IDPD. Methods A qualitative descriptive research approach and semi-structured interviews were used in this study. We interviewed 15 participants who had experience in caring for patients diagnosed with a dual diagnosis of IDPD. Findings Four themes were found, as follows: (1) Negative impacts of insufficient staffing on the quality of care, (2) Constantly worrying about harmful incidents, (3) Discovering effective ways to provide individual patient care and (4) Adjusting expectations and attitudes towards patients. Participants' experiences revealed that they perceived the importance and effectiveness of providing individualized care for IDPD patients. However, when staffing is insufficient, they may be forced to ignore the individualized needs of patients so as to facilitate management. They may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. In addition, they adapt by adjusting their expectations of the patients. Discussion The findings from this research help to fill the knowledge gap in our understanding of healthcare workers' experiences of and their perspectives on caring for patients diagnosed with IDPD. Implications for Practice Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in-service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them. The government department overseeing the management of institutions providing ID patient care should be empowered to conduct regular monitoring of the overall staffing and quality of care in such institutions.