New long-stay patients in a hospital for mental handicap

The relationship between behaviour disturbance and psychiatric diagnosis in male mentally handicapped adults resident in a long-stay unit

Objective: To investigate the relationship between behavioural disturbance and psychiatric diagnosis in male mentally handicapped adults resident in a long stay unit. Method: The case notes of all 144 residents of St. Raphaels were reviewed. Diagnoses were classified according to the International Classification of Diseases Ninth Revision (ICD-9) and grouped into one of four categories Infantile Autism, Functional Psychoses, Personality/Behavioural Disorder and Emotional Disorders. Carers (Senior Nursing Staff) were interviewed using the Adaptive Behaviour Scale Part 2 (ABS Part 2) as a measure of behavioural disturbance in the preceding year for the 144 residents. Results: 56% of residents had significant psychiatric disorder. Those with a psychiatric diagnosis showed increased behavioural disturbance across a wide range of measures (p<0.001) with Hyperactivity, Self Abuse and Violence showing greatest discriminative power. However there was not a relationship between diagnostic category and pattern of scoring on the ABS Part 2. There was a significant relationship between Degree of Mental Handicap and Psychiatric Diagnostic Category (p<0.001). Neither psychiatric morbidity nor behavioural disturbance was associated with epilepsy, age or duration of stay. Conclusions: Mentally handicapped adults in residential care show high rates of psychiatric disturbance. Those with psychiatric diagnoses exhibit a wide range of disturbed behaviours but similar patterns of maladaptive behaviour occur across the spectrum of psychiatric disorders. These findings refer to a male residential population and cannot be generalised to all mentally handicapped.

The medical care of mentally retarded persons in public residential facilities

Large public residential facilities have traditionally been society's primary service resource for persons with serious mental retardation. Despite current emphasis on restricting admissions and community placement of retarded persons, approximately 175,000 people continue to reside in 230 institutions throughout the United States. This population is vulnerable to a variety of chronic medical disorders that diminish successful adaptation to a more normal life-style, especially when health services are marginal. Institutional medical staffs have been largely isolated from their physician peers, and their patients have not had access to medical care equivalent to that available in the community. We describe the recent affiliation of a teaching hospital with a Massachusetts institution. We suggest that such affiliations would assure better medical care for mentally retarded persons while increasing physicians' knowledge of attendant medical and societal problems.

Residential needs in hospital and the community for mentally handicapped people

Using successive analyses of hospitalized mentally handicapped people from a geographically defined Welsh catchment area, this article attempts to evaluate changes in cohorts of such patients. It suggests the likelihood that the level of hospital accommodation predicted in the White Paper "Better Services for the Mentally Handicapped" will be sufficient.

Abuse and neglect as a cause of mental retardation: a study of 140 children admitted to subnormality hospitals in Wiltshire

The survey of 140 children under 16 in two subnormality hospitals showed that 3 per cent of the children had definitely been rendered mentally handicapped as a consequence of violent abuse, and that a possible maximum total of 11 per cent might have been thus rendered mentally handicapped. In 24 per cent of the children, neglect was considered to be a contributory factor in reducing intellectual potential. Impairment of intellect from abuse and neglect, especially in those with 'vulnerable' brains due to pre-existing abnormality, may be much commoner in children than is generally realized.