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McKinnon I, Iranpour A, Charlton A, Green E, Groom F, Watts O, McKenna D, Hackett S. Models of care in secure services for people with intellectual and developmental disability: Implementing the Walkway to Wellness. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2024; 34:144-162. [PMID: 38279962 DOI: 10.1002/cbm.2328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 01/04/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Changes to policy around inpatient services for people with intellectual and developmental disability (IDD) who offend, have led to a need for services to reconsider their models of care. This has led to calls for more tailored, patient-centred care models, with less reliance solely on offence-related treatment programmes which can be unsuitable for a growing proportion of patients with more complex cognitive and behavioural difficulties. In response, the Walkway to Wellness (W2W) was developed at one National Health Service Trust providing secure services to people with IDD, with the intention of delivering a more collaborative, co-produced and goal-oriented care model that was better understood by staff and patient stakeholders. AIMS To evaluate the implementation of the W2W using Normalisation Process Theory (NPT), an evidence-based theoretical approach is used across a number of health settings. METHODS Staff were invited to complete a short questionnaire, using the NPT informed Normalisation Measure Development questionnaire, at two time points along the implementation process. Patients were invited to complete a simplified questionnaire. Both groups were asked for their views on the W2W and the process of its implementation. RESULTS Although the W2W was more familiar to staff at the second time point, scores on the four NPT constructs showed a trend for it being less embedded in practice, with significant results concerning the ongoing appraisal of the new model. Patient views were mixed; some saw the benefit of more goal-oriented processes, but others considered it an additional chore hindering their own perceived goals. CONCLUSION Early involvement of all stakeholders is required to enhance the understanding of changes to models of care. Live feedback should be used to refine and revise the model to meet the needs of patients, carers and staff members.
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Affiliation(s)
- Iain McKinnon
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Morpeth, UK
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Arman Iranpour
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Morpeth, UK
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Anne Charlton
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Morpeth, UK
| | - Ellen Green
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Morpeth, UK
| | - Faye Groom
- School of Psychology, Newcastle University, Newcastle-upon-Tyne, UK
| | - Oliver Watts
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Morpeth, UK
| | - Dannielle McKenna
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Morpeth, UK
| | - Simon Hackett
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Morpeth, UK
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
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Melvin CL, Barnoux M, Alexander R, Roy A, Devapriam J, Blair R, Tromans S, Shepstone L, Langdon PE. A systematic review of in-patient psychiatric care for people with intellectual disabilities and/or autism: effectiveness, patient safety and experience. BJPsych Open 2022; 8:e187. [PMID: 36268640 PMCID: PMC9634562 DOI: 10.1192/bjo.2022.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND An increasing number of children, adolescents and adults with intellectual disabilities and/or autism are being admitted to general psychiatric wards and cared for by general psychiatrists. AIMS The aim of this systematic review was to consider the likely effectiveness of in-patient treatment for this population, and compare and contrast differing models of in-patient care. METHOD A systematic search was completed to identify papers where authors had reported data about the effectiveness of in-patient admissions with reference to one of three domains: treatment effect (e.g. length of stay, clinical outcome, readmission), patient safety (e.g. restrictive practices) and patient experience (e.g. patient or family satisfaction). Where possible, outcomes associated with admission were considered further within the context of differing models of in-patient care (e.g. specialist in-patient services versus general mental health in-patient services). RESULTS A total of 106 studies were included and there was evidence that improvements in mental health, social functioning, behaviour and forensic risk were associated with in-patient admission. There were two main models of in-patient psychiatric care described within the literature: admission to a specialist intellectual disability or general mental health in-patient service. Patients admitted to specialist intellectual disability in-patient services had greater complexity, but there were additional benefits, including fewer out-of-area discharges and lower seclusion rates. CONCLUSIONS There was evidence that admission to in-patient services was associated with improvements in mental health for this population. There was some evidence indicating better outcomes for those admitted to specialist services.
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Affiliation(s)
| | | | - Regi Alexander
- Broadland Clinic and Community Forensic Learning Disability Team, Hertfordshire Partnership University NHS Foundation Trust, UK; and School of Life and Medical Sciences, University of Hertfordshire, UK
| | - Ashok Roy
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK; Centre for Mental Health and Wellbeing Research, University of Warwick, UK; and Brooklands Hospital, Coventry and Warwickshire Partnership NHS Trust, UK
| | - John Devapriam
- Trust Headquarters, Herefordshire and Worcestershire Health and Care NHS Trust, UK
| | - Robert Blair
- School of Computing Sciences, University of East Anglia, UK
| | - Samuel Tromans
- Adult Learning Disabilities Service, Leicestershire Partnership NHS Trust, UK; and Department of Health Sciences, University of Leicester, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, UK
| | - Peter E Langdon
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK; Centre for Mental Health and Wellbeing Research, University of Warwick, UK; Brooklands Hospital, Coventry and Warwickshire Partnership NHS Trust, UK; and Research and Development, Herefordshire and Worcestershire Health and Care NHS Trust, UK
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McCarthy J, Chaplin E, Hayes S, Søndenaa E, Chester V, Morrissey C, Allely CS, Forrester A. Defendants with intellectual disability and autism spectrum conditions: the perspective of clinicians working across three jurisdictions. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2022; 29:698-717. [PMID: 36148388 PMCID: PMC9487969 DOI: 10.1080/13218719.2021.1976297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The treatment of vulnerable defendants by criminal justice systems or correctional systems varies within and between countries. The purpose of this paper is to examine three legal jurisdictions - New South Wales in Australia; Norway; England and Wales - to understand the extent of variation in practice within the court systems for defendants with intellectual disabilities (ID) and/or autism spectrum conditions (ASC). Two of the jurisdictions had a process for screening in place, either in police custody or at court, but this was not universally implemented across each jurisdiction. All three jurisdictions had a process for supporting vulnerable defendants through the legal system. Across the three jurisdictions, there was variation in disposal options from a mandatory care setting to hospital treatment to a custodial sentence for serious offences. This variation requires further international exploration to ensure the rights of defendants with ID or ASC are understood and safeguarded.
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Affiliation(s)
- Jane McCarthy
- Institute of Psychiatry, Psychology & Neuroscience King’s College London, London, UK
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Eddie Chaplin
- Institute of Health and Social Care, London South Bank University, London, UK
- Correspondence: Eddie Chaplin, Institute of Health and Social Care, London South Bank University, 103 Borough Road, LondonSE1 0AA, UK.
| | - Susan Hayes
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Erik Søndenaa
- Faculty of Medicine, Institute of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Forensic Department, St.Olavs Hospital, Trondheim, Norway
| | - Verity Chester
- Hertfordshire Partnership University NHS Foundation Trust, Little Plumstead Hospital, Hospital Road, Norwich, UK
| | - Catrin Morrissey
- Lincolnshire Partnership NHS Foundation Trust and University of Nottingham, Nottingham, UK
| | - Clare S. Allely
- School of Health and Society, Salford University, Salford, UK and affiliate member of the Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andrew Forrester
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
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Hackett SS, Zubala A, Aafjes-van Doorm K, Chadwick T, Harrison TL, Bourne J, Freeston M, Jahoda A, Taylor JL, Ariti C, McNamara R, Pennington L, McColl E, Kaner E. A randomised controlled feasibility study of interpersonal art psychotherapy for the treatment of aggression in people with intellectual disabilities in secure care. Pilot Feasibility Stud 2020; 6:180. [PMID: 33292629 PMCID: PMC7677838 DOI: 10.1186/s40814-020-00703-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/15/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Rates of aggression in inpatient secure care are higher than in other psychiatric inpatient settings. People with intellectual disabilities in secure care require adapted psychological treatments. Interpersonal art psychotherapy incorporates the use of creative art making approaches by participants, thus reducing sole reliance upon verbal interactions during psychotherapy for people who may have communication difficulties. During interpersonal art psychotherapy, participants are individually supported by their therapist to consider how they conduct relationships. This includes the influence and impact of interpersonal issues resulting in repeated patterns of conflict. The key feasibility objectives were to assess recruitment and retention rates, follow-up rates and trial procedures such as randomisation, allocation and identifying any practical or ethical problems. In addition, a preliminary 'signal' for the intervention was considered and an indicative sample size calculation completed. The acceptability of a potential third trial arm attentional control condition, mindful colouring-in, was assessed using four single-case design studies and a UK trial capacity survey was conducted. METHODS Adult patients with intellectual disabilities in secure care were recruited and randomised to either interpersonal art psychotherapy or delayed treatment in this multi-site study. Outcomes were assessed using weekly observations via the Modified Overt Aggression Scale and a range of self-report measures. Within study reporting processes, qualitative interviews and a survey were completed to inform trial feasibility. RESULTS Recruitment procedures were successful. The target of recruiting 20 participants to the trial from multiple sites was achieved within 8 months of the study opening. All participants recruited to the treatment arm completed interpersonal art psychotherapy. Between-group differences of interpersonal art psychotherapy versus the delayed treatment control showed a 'signal' effect-size of .65 for total scores and .93 in the verbal aggression sub-scale. There were no amendments to the published protocol. The assessment of key feasibility objectives were met and the trial procedures were acceptable to all involved in the research. CONCLUSION This study suggested that a randomised controlled trial of interpersonal art psychotherapy is acceptable and feasible. TRIAL REGISTRATION ISRCTN14326119 (Retrospectively Registered).
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Affiliation(s)
- Simon S. Hackett
- Newcastle University, Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ania Zubala
- University of the Highlands and Islands, Inverness, UK
| | | | - Thomas Chadwick
- Newcastle University, Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Toni Leigh Harrison
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jane Bourne
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mark Freeston
- Newcastle University, Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | | | - John L. Taylor
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Northumbria University, Newcastle upon Tyne, UK
| | - Cono Ariti
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Lindsay Pennington
- Newcastle University, Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Elaine McColl
- Newcastle University, Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Newcastle University, Faculty of Medical Sciences, Newcastle upon Tyne, UK
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Kaufman KR. BJPsych Open fifth anniversary editorial: history, accomplishments, trajectory and passion. BJPsych Open 2020; 6:e52. [PMID: 32475364 PMCID: PMC7345524 DOI: 10.1192/bjo.2020.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BJPsych Open has come of age. This editorial celebrates the journal's fifth anniversary by reviewing the history of BJPsych Open, what we have accomplished, where we strive to go (our planned trajectory) and the passion of being an Editor-in-Chief.
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Affiliation(s)
- Kenneth R Kaufman
- Departments of Psychiatry, Neurology and Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Jersey, USA; and Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Devapriam J, Fosker H, Chester V, Gangadharan S, Hiremath A, Alexander RT. Characteristics and outcomes of patients with intellectual disability admitted to a specialist inpatient rehabilitation service. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2020; 24:21-34. [PMID: 29444613 DOI: 10.1177/1744629518756698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Rehabilitation services for people with mental illnesses have been extensively researched. However, services with similar aims and specifications for patients with intellectual disabilities (IDs) have had little focus. This study describes the characteristics and outcomes of 21 patients admitted to a specialist ID rehabilitation service over an 8-year time frame. Rather that solely accepting 'step-down' referrals, some patients were referred from community settings. During the study, 20 patients were discharged, 80% to lower levels of service restriction, while 14.3% to higher levels. The study suggested that rehabilitation services have an important role within the wider service model for people with ID. Within the service studied, patients were referred from both higher and lower levels of restriction, suggesting the rehabilitation service 'bridged the gap' between inpatient and community settings, supporting the aim of caring for patients in the least restrictive setting for their needs.
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Affiliation(s)
- J Devapriam
- Leicestershire Partnership NHS Trust, UK; Care Quality Commission, UK
| | - H Fosker
- Leicestershire Partnership NHS Trust, UK
| | | | | | - A Hiremath
- Leicestershire Partnership NHS Trust, UK
| | - R T Alexander
- St Johns House, UK; Leicestershire Partnership NHS Trust, UK
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Fish R, Morgan H. "Moving on" through the locked ward system for women with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:932-941. [PMID: 30950144 PMCID: PMC6850027 DOI: 10.1111/jar.12586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 11/26/2022]
Abstract
Background The move to community support for all people with intellectual disabilities is an aspiration with international significance. In this article, we draw on rich accounts from women with intellectual disabilities detained under the Mental Health Act (E&W) 1983 and staff at an National Health Service secure setting in England to explore how “moving on” is defined and perceived. Methods The study reports on an ethnographic study using the field‐notes and the 26 semi‐structured interviews with detained women and staff on three wards. Results We first explore staff conceptions of moving on, which include behavioural change and utilizing coping strategies. Then, we discuss the areas of analysis that women discussed: taking back responsibility, success in arranged relationships, acceptance of regime and resistance to progression. Conclusion The concepts of moving on were not determined by the women but by the service. We recommend further research which explores women's own rehabilitation requirements.
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Affiliation(s)
- Rebecca Fish
- Centre for Disability Research, Lancaster University, Bailrigg, UK
| | - Hannah Morgan
- Centre for Disability Research, Lancaster University, Bailrigg, UK
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Chester V, Völlm B, Tromans S, Kapugama C, Alexander RT. Long-stay patients with and without intellectual disability in forensic psychiatric settings: comparison of characteristics and needs. BJPsych Open 2018; 4:226-234. [PMID: 29988967 PMCID: PMC6034466 DOI: 10.1192/bjo.2018.24] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 04/04/2018] [Accepted: 04/30/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In recent years, concerns have been raised that too many patients stay for too long in forensic psychiatric services and that this is a particular problem in those with an intellectual disability. AIMS To compare the characteristics, needs, and care pathways of long-stay patients with and without intellectual disability within forensic psychiatric hospital settings in England. METHOD File reviews and questionnaires were completed for all long-stay patients in high secure and a representative sample of those in medium secure settings in England. Between-group analyses comparing patients with and without intellectual disability are reported. RESULTS Of the 401 long-stay patients, the intellectual disability and non-intellectual disability groups were strikingly similar on many sociodemographic, clinical and forensic variables. The intellectual disability group had significantly lower lengths of stay, fewer criminal sections, restriction orders and prison transfers, and higher levels of behavioural incidents and risk assessment scores. CONCLUSIONS In spite of similar offence histories and higher risk levels, those with intellectual disability appear to be diverted away from the criminal justice system and have shorter lengths of stay. This has implications about the applicability of the Transforming Care programme to this group.
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Affiliation(s)
- Verity Chester
- Research & Projects Associate, Priory Group, St John's House, Diss and PhD candidate, University of East Anglia, UK
| | - Birgit Völlm
- Professor in Forensic Psychiatry, Institute of Mental Health, University of Nottingham, UK
| | - Samuel Tromans
- Speciality Registrar, Leicestershire Partnership NHS Trust, Leicester & Academic Clinical Lecturer, Department of Health Sciences, University of Leicester, UK
| | - Chaya Kapugama
- Speciality Registrar, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Regi T. Alexander
- Consultant Psychiatrist, Hertfordshire Partnership University NHS Foundation Trust and Honorary Senior Lecturer, Department of Health Sciences, University of Leicester, UK
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Williams EM, Thrift S, Rose J. The subjective experiences of women with intellectual disabilities and offending behaviour: exploring their experiences of 'home'. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2018; 64:132-143. [PMID: 34141300 PMCID: PMC8115536 DOI: 10.1080/20473869.2017.1413153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Services supporting individuals with intellectual disabilities are changing in the UK with a drive towards community care and reducing inpatient provision. More needs to be known about the experiences and opinions of individuals living in inpatient settings. Women with intellectual disabilities and offending behavior are a particularly complex, under-represented group affected by these organizational changes. This research aims to consult women with intellectual disabilities, living in a secure hospital, to explore their housing experiences and hopes for future home and care environments. METHOD Seven participant's experiences, and the meaning they assign to these experiences, were explored through semi-structured interviews. Their narratives were analyzed utilizing Interpretive Phenomenological Analysis. RESULTS Four superordinate themes emerged from the analysis (i) hospital as helpful (ii) hospital as undesirable (iii) a sense of belonging (iv) 'I want to be as independent as I can.' The subtheme 'importance of people' emerged throughout with illustrations of why people are important relating to each superordinate theme. CONCLUSIONS The women interviewed experienced living in hospital as both helpful and undesirable. They wanted to live as independently as possible in the community. However, they identified several helpful aspects of hospital including receiving specialist support for their complex needs. They desired independence, freedom to choose, personal space, familiarity, and support from individuals who understand their needs. Whilst it is recognized that hospitals cannot be homes for people, they do have a function in providing helpful specialist support to some individuals with intellectual disabilities who have committed serious crimes and/or cannot safely be supported in the community.
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Affiliation(s)
| | - Su Thrift
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - John Rose
- School of Psychology, The University of Birmingham, Birmingham, UK
- Academic Unit, St Andrews Hospital, Nothampton, UK
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