A hospital-based psychiatric unit for mentally handicapped adults

Learning disability psychiatry – the future of services

Distinctions between mental illness and learning disability have existed since the last century (Pinel, 1801; Ireland, 1877). The conditions have been accepted as coexisting in the same individual since the beginning of this century (Kraepelin, 1902). More recent papers have investigated the frequency of their coexistence and concluded that most psychiatric disorders are more common in those with learning disability than the general population (Turner, 1989).

Psychiatric Services for Mentally Handicapped Adults and Young People

Psychiatric disorder is a common complication of mental handicap. Whilst there are few detailed studies of psychiatric morbidity in mentally handicapped people, recent epidemiological surveys indicate that approximately 50% of mentally handicapped people in hospital and in contact with services in the community have suffered from psychiatric symptoms or behavioural problems sufficient to require specialist advice. All forms of psychiatric disorder are seen although the pattern differs somewhat from that in the general population and there is a high frequency of behaviour disorders.

Calculating the medical time required in the psychiatry of mental handicap

A method for estimating the psychiatric manpower needs of a district has been described in the Bulletin (Watson, 1986), and while the data presented in that article were for general psychiatry the approach to this issue can be modified for specialist services.

Assessment and treatment units for people with intellectual disabilities and challenging behaviour in England: an exploratory survey

BACKGROUND

Evaluative studies have shown that special units for people with intellectual disabilities (ID) who have challenging behaviour have advantages and disadvantages. There has been no survey of their number or characteristics for nearly 20 years.

METHODS

A questionnaire was sent to all National Health Service trusts that had ID inpatient beds, and all private or voluntary healthcare establishments providing services for people with mental health problems or ID. This asked for information about the unit, its residents and the views of the unit manager.

RESULTS

Forty-four agencies confirmed that they provided assessment and treatment units, of which 38 returned questionnaires. These units served 333 people, of whom 75% had mild or moderate ID. A quarter had been there for more than 2 years. Forty per cent of residents had a discharge plan, and 20% had this and the type of placement considered ideal for them in their home area. The main strengths of the units were identified as the knowledge and experience of the staff and having sufficient staff; the main problems as inappropriate admissions, bed-blocking and the relationship with other services; difficulties with recruiting and retaining staff; the location and environment of the unit; and the mix of residents.

CONCLUSIONS

There has been an increasing rate of provision of special units, which now predominantly serve people with moderate or mild ID. This model of service provision is becoming more widespread, but the potential problems identified 20 years ago are still present. Areas are identified for further research.

Mental health services for people with mental retardation: a framework for the future

The mental health needs of mentally retarded people cannot be met satisfactorily with generic mental health services. Specialized services are required. A number of different service models have evolved which require evaluation. They include subregional units, community-based services with a small admission facility, integrated services and specialist teams. Staff working in specialist mental health services must be appropriately trained.

Towards a system of outcome indicators for mental health care

A system of outcome indicators for mental health care is urgently needed in order to ensure that clinicians, district health authorities, and directors of public health can monitor and evaluate mental health care. Theoretical aspects of health care indicators and the various classes of outcome measures available can be used to draw up a preliminary system of indicators of health care input, process and outcome for the major categories of mental illness, including schizophrenia, affective psychosis, neurosis, dementia, mental handicap, child psychiatry, forensic psychiatry, alcohol and drugs. Such a system is not intended to be definitive or exhaustive but rather to form a basis for development by clinicians, researchers and planners for their own requirements.

Psychiatric disorder in the middle-aged and elderly mentally handicapped

In a study of 357 long-stay hospital residents aged 40 years and over, 30% had significant psychiatric disorder, while a retrospective survey of 215 new admissions over a seven-year period to a psychiatric unit for the mentally handicapped revealed that 20% of patients were aged 40 years and over. Both similarities and differences were found in the overall pattern of disorders between the two groups and a non-handicapped population in a comparable age-range.