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The experience of detention under the Mental Health Act (1983)
- Authors:
- McNALLY Carolyn, BEAIL Nigel, KELLETT Stephen
- Journal article citation:
- Advances in Mental Health and Learning Disabilities, 1(4), December 2007, pp.47-53.
- Publisher:
- Emerald
This study explored the experiences of detention under the Mental Health Act (1983) of people with learning disabilities. Seven semi-structured one-to-one interviews were analysed using interpretative phenomenological analysis. Participants had mild learning disabilities and had been detained under the Mental Health Act in England for compulsory assessment and treatment within a two-year period prior to the study. A number of valuable insights emerged, including: the impact of perceived lack of control over self, experiences of vulnerability/powerlessness/victimisation (both prior to and following detention), participant's sense of care versus punishment; the development of 'role' within the mental health system and attribution of blame.
The dose-effect relationship in psychodynamic psychotherapy with people with intellectual disabilities
- Authors:
- BEAIL Nigel, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 20(5), September 2007, pp.448-454.
- Publisher:
- Wiley
Although there is an established body of evidence attesting to the dose–effect relationship in psychotherapy with non-disabled adults, the issue as to whether such a relationship exists for persons with intellectual disabilities has not been previously examined. Dose–effect essentially concerns the amount of psychotherapy required to produce positive results. The current study used a naturalistic design to examine and compare the outcomes of three groups of participants with co-morbid psychological problems undergoing treatments of differing lengths (i.e. ‘doses’) with psychodynamic psychotherapy. Three measures of psychopathology were completed at assessment and at subsequent eight-session intervals until the conclusion of treatment. Each patient received a 3-month follow-up appointment, at which time the measures were again completed. Three treatment duration groups were subsequently constructed and compared via anova: eight sessions (n = 8), 16 sessions (n = 5) and 24 plus sessions (n = 7). Results were supportive of a dose–effect relationship, in that outcomes were generally equivalent regardless of treatment duration. It is concluded that most change appears to occur in the first eight sessions of treatment, with subsequent outcomes trailing off over time. The clinical implications of the study are discussed in the context of the methodological limitations identified.
Naturalistic evaluation of the effectiveness of psychodynamic psychotherapy with adults with intellectual disabilities
- Authors:
- BEAIL Nigel, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 18(3), September 2005, pp.245-251.
- Publisher:
- Wiley
This study used an open trial design with a 3-month follow-up period. Widely available and used psychotherapy outcome measures were adopted, but administered in an assisted completion format at intake, outcome and follow-up. Data were collected on teh completed treatment and follow-up for 20 people. Data were analyzed using repeated measures ANOVA. Effect sizes were also computed. The results show statistically significant reductions in recipients' levels of psychological distress and interpersonal problems and an increase in self-esteem. Effect sizes were modest to large. The study shows that adults with intellectual disabilities can benefit from individual psychotherapy provided in routine clinical practice. The method has obvious limitations because of its uncontrolled, open trial design. However, the study had a recipient group that represents the client population and thus has greater generalisability to clinical practice. This study also provides some suggestions for routine audit and evaluation exercises and more rigorous designs.
Learning disability: experience of diagnosis
- Authors:
- KENYON Elinor, BEAIL Nigel, JACKSON Tom
- Journal article citation:
- British Journal of Learning Disabilities, 42(4), 2014, pp.257-263.
- Publisher:
- Wiley
Studies have focused on the experience of diagnosis from the perspectives of parents of children with learning disabilities, but there has been limited methodologically rigorous investigation into the experience for the person themselves. Eight participants were recruited from a range of different backgrounds. Interviews were analysed using interpretive phenomenological analysis. Three main themes emerged. The first concerned awareness of difference. Participants described becoming aware of an unwanted difference at school. Adolescence appeared as a time when an increased understanding of disability developed. In the second theme of ‘the relationship with nondisabled others’, participants described their opinions on labelling and their perspectives on how others viewed them. The final theme explored coping responses to stigma. (Publisher abstract)
From denial to acceptance of sexually offending behaviour: a psychodynamic approach
- Author:
- BEAIL Nigel
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 7(5), 2013, pp.293-299.
- Publisher:
- Emerald
Purpose: Offenders who have intellectual disabilities like any one else may deny their offence. This paper reports a case study of a man who admitted his offence and them accepted probation with a condition of treatment. However, when he attended treatment he denied the offence. Thus do those providing treatment send them back into the criminal justice system or work with them try and help them accept what they have done and provide appropriate treatment to help them reduce future risk of offending. Design/methodology/approach: In this case study the assimilation model was used to understand the process of change and monitor change through exploratory psychotherapy. The psychotherapeutic model was psychodymnamic. Findings: The client demonstrated gains through the stages of the model toward acceptance of his problematic behaviour and continued to work on this through further psychotherapy. Originality/value: The assimilation model offers a useful approach to monitor change in psychotherapy; but especially when the client does not accept the problem the rest of the world feels they have. (Publisher abstract)
Service user satisfaction with individual psychotherapy for people with intellectual disabilities
- Authors:
- KHAN Mahbub Munir, BEAIL Nigel
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 7(5), 2013, pp.277-283.
- Publisher:
- Emerald
Purpose: Psychological therapies are increasingly being made available to adults with intellectual disabilities. However, little is known about service user satisfaction with this type of intervention. The aim was to ascertain quantitative and qualitative data on user satisfaction with the psychological therapy they had received. Design/methodology/approach: In total, 20 recipients of psychological therapy completed the Satisfaction with Therapy and Therapist Scale – Revised (STTS-R; Oei and Shuttleword, 1999) and the Experience of Service Questionnaire (Commission for Health Improvement, 2002). The scales were adapted for language and administered in an assisted completion format by an independent researcher after a course of psychological therapy had been completed. Descriptive statistics were used to analyse the quantitative data and thematic analysis was used to analyse the qualitative data. Findings: Generally, recipients were highly satisfied with their therapist and the therapy they received. Originality/value: The results confirm previous findings from two small-scale qualitative studies. Service user satisfaction is a key quality outcome measure and can be collated in routine practice for people with intellectual disabilities. The collation of qualitative responses in addition to quantitative measures is important to enable the expression of dissatisfaction and greater detail in order to inform service improvement. (Publisher abstract)
Prisoners' voices: experiences of the criminal justice system by prisoners with learning disabilities
- Author:
- BEAIL Nigel
- Journal article citation:
- Tizard Learning Disability Review, 15(3), July 2010, pp.42-45.
- Publisher:
- Emerald
This paper comments on the article in this issue by Jenny Talbot which describes research on prisoners with learning difficulties and disorders. It discusses the very wide inclusion criteria used in Talbot’s article, which includes people who have a diagnosis of a learning disability and those who have other learning difficulties and disorders. Thus the paper includes people who have average intellectual functioning but with other conditions such as Asperger’s syndrome or learning disorders such as dyslexia. This paper describes how the prisoners with learning disabilities are struggling to cope, and concludes that the UK prisons are not recognising or meeting their needs. Of particular concern is that the participants went through the criminal justice system from being a suspect, through the Court and into prison without their disabilities being identified or supported. Thus the criminal justice agencies are failing in their legal duty to promote disability equality and to eliminate discrimination.
Risk assessment: actuarial prediction and clinical judgement of offending incidents and behaviour for intellectual disability services
- Authors:
- LINDSAY William R., BEAIL Nigel
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 17(4), December 2004, pp.229-234.
- Publisher:
- Wiley
Research on prediction of violent and sexual offending behaviour has developed considerably in the mainstream criminological literature. Work on actuarial instruments, dynamic variables, clinical judgement and structured clinical judgement is reviewed. A number of studies comparing actuarial instruments in terms of their predictive validity are reviewed. Relative effectiveness and applicability to intellectual disability is considered. A framework for dynamic variables is outlined and the importance of dynamic variables for inclusion in risk prediction is established. Strengths and limitations of clinical judgement are reported and the importance of reliability is noted. Finally, structured clinical judgement is reviewed in terms of the way in which it combines the other three groups of variables. The information regarding different methods of risk assessment is integrated with research and opinion. Risk prediction will always be a judgement and as such there will always be errors in judgement. As clinicians, researchers and policy makers it is our duty to employ the latest research information to make predictions that are as accurate as possible. However, we must also help to promote a culture that can be tolerant of inevitable errors.
Recidivism following psychodynamic psychotherapy amongst offenders with intellectual disabilities
- Author:
- BEAIL Nigel
- Journal article citation:
- British Journal of Forensic Practice, 3(1), April 2001, pp.33-37.
- Publisher:
- Emerald
Reports on a study of recidivism rates following psychotherapy amongst male offenders with intellectual disabilities. The recipients were 18 men who had been diverted to the clinical psychology service for adults with intellectual disabilities from the criminal justice system. Thirteen participated in treatment and five refused it during assessment. Participants were followed up for 4 years after treatment. Of the 13 who completed treatment two re-offended. All five of the men who refused treatments re-offended. In view of the preliminary nature of these findings they are discussed in relation to methodological issues and future research.
Exploring maintaining gains following therapy during the coronavirus pandemic with adults with an intellectual disability
- Authors:
- PURRINGTON Jack, NYE Arthur, BEAIL Nigel
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 15(6), 2021, pp.253-268.
- Publisher:
- Emerald
Purpose: The novel coronavirus and associated mitigation efforts have caused significant increases in stress for adults with intellectual disabilities. Such increases in life stress predict an increased risk of relapse following psychological therapy. This contributes to the high global disease burden of common mental health difficulties. Therefore, this paper aims to explore service user experiences of maintaining gains following therapy within the context of the Covid-19 pandemic. Design/methodology/approach: A mixed-methods evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. Descriptive statistics and effect size calculations were used to examine therapeutic outcomes pre-therapy, post-therapy, and at follow-up. These findings informed a framework analysis of eight semi-structured interviews. Findings: Overall, outcome results improved post-therapy and regressed at follow-up. The framework analysis revealed facilitators to maintenance include a recollection of specific aspects of therapy and the regular utilisation of strategies and resources. Conversely, barriers to maintenance include a recollection focussed on personal outcome, a reliance on social support and an inability to remember therapy. Originality/value: This is the only study to the authors’ knowledge examining service user experiences of maintaining gains following therapy within the context of Covid-19. It is hoped that these findings will inform further research and be useful for services in preparing service users for discharge as the Covid-19 pandemic continues and moves towards the post-pandemic phase. (Edited publisher abstract)