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Health service inpatient units for people with intellectual disabilities and challenging behaviour or mental health problems
- Authors:
- MANSELL Jim, RITCHIE Fiona, DYER Ricinda
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 23(6), November 2010, pp.552-559.
- Publisher:
- Wiley
This paper presents findings from a survey was carried out of NHS and independent sector (IH) health settings providing specialist inpatient services for people with intellectual disabilities. Data were collected on setting and patient characteristics, staffing and management and care processes and outcomes. Results revealed that services were very unevenly distributed across England. There were differences between NHS and IH settings. IH assessment and treatment units were bigger, had higher occupancy and lower staff ratio. In all three types of unit, IH units had fewer visits to patients, used more seclusion, physical restraint and had more locked areas. They had more complaints in more services from users and from relatives. In low secure units, they had more adult protection referrals. The authors concluded that the number of people who have finished treatment emphasises the importance of developing housing in the community with sufficiently skilled support. The number of patients in low secure services raises the question whether this type of service is recreating the intellectual disability institutions which government policy intends to close.
Health service units for people with intellectual disabilities and challenging behaviour or mental health problems in England
- Authors:
- MANSELL Jim, RICHIE Fiona, DYER Ricinda
- Journal article citation:
- Tizard Learning Disability Review, 15(4), October 2010, pp.45-50.
- Publisher:
- Emerald
Following allegations of abuse in NHS residential units for people with intellectual disabilities, the Healthcare Commission carried out a national audit for specialist health services for people with intellectual disabilities. The audit comprised a national survey of health service in-patient units for people with intellectual disabilities, followed by visits to selected services. The survey included setting and patient characteristics, staffing and management arrangements, and care processes and outcomes. This paper summarises the published results, describing the characteristics of the services studied and comparing the different types of service (assessment and treatment units, low secure and medium secure units). It also compares National Health Service and independent sector units. The results raise a number of important issues. These include: in nearly two thirds of units some patients did not have an accessible care plan; independent sector units were bigger and had higher occupancy and lower staff ratios; a quarter of patients in assessment and treatment units had finished treatment but had no plans to move in the next month; and the large number of patients in low secure services with no clear specification of what the service is meant to do.
Deinstitutionalisation and community living: position statement of the Comparative Policy and Practice Special Interest Research Group of the International Association for the Scientific Study of Intellectual Disabilities
- Authors:
- MANSELL Jim, BEADLE-BROWN Julie
- Journal article citation:
- Journal of Intellectual Disability Research, 54(2), February 2010, pp.104-112.
- Publisher:
- Wiley
The process of “deinstitutionalisation”; that is the abandonment of large residential institutions and their replacement by small scale services allowing people to live in the community, is well advanced in Scandinavia, the US, Canada, the UK and Australasia. Although here the debate is largely resolved, questions remain about whether newer kinds of supported accommodation replicate institutional features and themselves need reform. In other countries the debate has never really begun because those with intellectual disabilities are mostly cared for by their families. In a third group of countries the dominant form of care remains institutional and how to replace this is at the heart of the debate. The purpose of this position statement by the Comparative Policy and Practice Special Interest Research Group of the International Association for the Scientific Study of Intellectual Disabilities was to set out concisely the evidence for comparing institutional to community services and to draw out implications for policy makers. The UN Convention on the Rights of Persons with Disabilities obliges states to develop community living to replace institutional care. The authors suggest that in addressing this task, policy makers should be aware of the evidence that; community living offers the prospect of an improved lifestyle and quality of life over institutional care for people with intellectual disabilities, that this applies to old and new institutions alike whatever they are called; that community care is no more expensive than institutional care on the basis of comparative need and quality of care; and successful community living requires close attention to the way services are set up and run, especially the quality of staff support.