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The challenge of a “triple diagnosis”: identifying and serving homeless Canadian adults with a dual diagnosis
- Authors:
- LOUGHEED Donna C., FARRELL Susan
- Journal article citation:
- Journal of Policy and Practice in Intellectual Disabilities, 10(3), 2013, pp.230-235.
- Publisher:
- Wiley
Adults with both a mental illness and intellectual disability (in Canada, a “dual diagnosis”) and who reside in shelters for the homeless are vulnerable and at risk for physical, sexual, and financial abuse. Their mental illnesses are difficult to diagnose and treat, and their intellectual impairments are difficult to ascertain. The authors review the existing literature on homelessness and intellectual disability, and use this and their extensive clinical experience with the homeless in a large Canadian city to identify and extrapolate reasons for the challenges facing both these individuals and the agencies and organizations that serve them. Challenges to providing appropriate services include, identifying and linking with these adults; recognizing the implications of the level of the intellectual delay and the mental illness on the individual's ability to cope, and stay safe; understanding the wants and needs of the individual; expanding the mandate of the agencies and professionals wanting to serve this group; and developing policy that will both provide appropriate support of the individual, but also provide protection, if necessary by legal means. They further suggest that focal services should be based on the following characteristics: flexibility, meeting the client where he or she lives, consideration of capacity to consent in order to avoid neglect issues, and understanding of the lifelong and pervasive effects of intellectual delay in all facets of life. Though the population discussed is resident in Canada, these issues apply to individuals in other countries, as well, where there are concerns about these vulnerable adults with a “triple diagnosis.” (Edited publisher abstract)
Adult protection: incidence of referrals, nature and risk factors in two English local authorities
- Authors:
- MANSELL Jim, et al
- Journal article citation:
- Journal of Social Work, 9(1), January 2009, pp.23-38.
- Publisher:
- Sage
This study focused on the incidence of adult protection referrals, the people involved as victims, perpetrators and referrers and the type of abuse in two local authorities in the south-east of England. The number of referrals increased over time; those for older people stabilized but those for younger adults were still rising. There was a clear association between location or setting, perpetrator and type of abuse. A referral about someone living in a care home was more likely to identify abuse by multiple staff and institutional abuse or neglect, especially if the individual was an older person with mental health problems. People with learning disabilities were more likely to experience sexual abuse, mainly from other service users or members of their family. Those living in a private home with others, primarily relatives, tended to be at risk of financial, physical or psychological abuse. Older people living alone were particularly vulnerable to financial abuse by family members or, less frequently, home care workers. This study suggests that well-developed adult protection procedures identify many more cases than previously estimated. Further research is needed to explain the low level of referrals from mental health services and variation between territories.
Suspect transactions
- Author:
- HOPKINS Graham
- Journal article citation:
- Community Care, 3.4.03, 2003, pp.46-47.
- Publisher:
- Reed Business Information
Presents a case study of a women with mental health problems and learning difficulties who depended on her in-laws for support. Looks at the process of risk assessment when her community social worker suspected she was being abused.
A five decade retrospective review of admission trends in a NHS intellectual disability hospital
- Authors:
- WONG Yim Lun, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 9(3), 2015, pp.108-115.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to examine the trend of admissions and inpatient characteristics in a NHS intellectual disability hospital from 1975 to 2013, in particular looking at the effect following the Winterbourne View scandal. Design/methodology/approach: A retrospective review of all admissions over a three-year period (January 2011-January 2013) was completed. This information was compared with admissions to the same hospital in three-year period over the last four decades (1975-1977, 1985-1987, 1995-1997, and 2003-2006). Number of admissions, gender, age, source of admission, length of stay, reasons for admission, type of admission, and diagnosis of psychiatric illnesses were included. Findings: There were 87 admissions (including 29 from out of area) in the study period of 2011-2013. The number of admissions had varied over the years but male admissions were consistently higher than female. A majority of people stayed over six months. For the first time in five decades, there were more formal inpatients than informal ones. The diagnosis of Autism Spectrum Disorder (ASD) and of Attention Deficit Hyperactivity Disorder had increased. Originality/value: This study has examined admission trends over five decades. It has highlighted that the Mental Health Act legislation is being used more frequently and that co-morbid mental disorders, such as ASD are commonly associated with those admitted to hospital. A well planned-out community health care system, as well as adequate social provision are keys to maintain people with intellectual disability in the community. Furthermore, a better understanding of the symptomology of challenging behaviours, and appropriate use of mental health legislation are crucial in providing a high-quality service that has clear treatment goals and values. Some of these issues have contributed to the failure of the recent initiative to reduce the size of the inpatient intellectual disability following Winterbourne View scandal. (Publisher abstract)
Winterbourne View Hospital: a glimpse of the legacy
- Authors:
- FLYNN Margaret, CITARELLA Vic
- Journal article citation:
- Journal of Adult Protection, 15(4), 2013, pp.173-181.
- Publisher:
- Emerald
This paper concerns the fall-out from a TV programme “Undercover Care: the Abuse Exposed” which exposed cruelty at Winterbourne View Hospital, a private hospital that purported to provide assessment, treatment and rehabilitation to adults with learning disabilities, autism and mental health problems. It describes the principal findings of the Serious Case Review which was commissioned after the TV broadcast, and outlines some of the activities designed to reduce the likelihood of such abuses recurring. From policy, commissioning, regulation, management, service design and practice perspectives, events at Winterbourne View Hospital highlight a gulf between professionals, professionals and their organisations, and leadership shortcomings. The English government responded promptly and encouragingly to the circumstances of patients at Winterbourne View Hospital with a “Timetable of Actions”. (Edited publisher abstract)
Managers' and staff experiences of adult protection allegations in mental health and learning disability residential services: a qualitative study
- Authors:
- REES Paul, MANTHORPE Jill
- Journal article citation:
- British Journal of Social Work, 40(2), March 2010, pp.513-529.
- Publisher:
- Oxford University Press
Adult protection policy slowly developed in England and Wales during the 1990s. In the same decade specialist residential services expanded for people with mental health problems and with learning disabilities. Many referrals to adult protection systems emanate from this sector but few result in conclusive outcomes. This article reports on a small study exploring the impact of adult protection legislation and guidance within a small number of residential adult mental health and learning disability units in England and Wales. The focus of the article is the issues for staff who have been accused of abuse and for the managers of such services during investigations. Data from interviews with 13 residential unit managers and 10 care workers, who were suspended following an allegation but later exonerated, are presented. Perceptions of the development of adult protection practice, policy and legislation were that these have generally led to positive outcomes. However, these data reveal other outcomes including service disruption, stress for residents, staff and managers. Multi-agency collaboration, transparency of practice, training, reflective practice, and effective supervision of frontline staff, appeared to assist managers and care workers in negotiating the positive and negative experiences of the implementation of adult protection systems.
Implications for practice: research into the effects of sexual abuse on adults with intellectual disabilities
- Author:
- SEQUEIRA Heather
- Journal article citation:
- Journal of Adult Protection, 8(4), December 2006, pp.25-31.
- Publisher:
- Emerald
This article begins by reviewing the research into the effects of sexual abuse on people with a learning disability. These include the implications for abuse evaluations, identification of individuals at increased risk of disturbance, implications for treatment and provision of psychotherapeutic services.
Becoming a trainer in adult abuse work: a practical guide
- Author:
- PRITCHARD Jacki
- Publisher:
- Jessica Kingsley
- Publication year:
- 2001
- Pagination:
- 176p.,bibliog.
- Place of publication:
- London
Aims to provide agencies dealing with vulnerable adults develop basic awareness programmes on adult abuse. Covers questions such as; selection of trainers; venue and equipment; training for trainers; policy, law and evaluation; disclosure and confidentiality. Includes case histories, exercises and worksheets.
Mental Welfare Commission for Scotland annual report 1998-99
- Author:
- MENTAL WELFARE COMMISSION FOR SCOTLAND
- Publisher:
- Mental Welfare Commission for Scotland
- Publication year:
- 1999
- Pagination:
- 81p.,bibliog.
- Place of publication:
- Edinburgh
Annual report of the Mental Welfare Commission for Scotland. The Commission has a statutory duty, under the Mental Health (Scotland) Act 1984, to protect people with learning difficulties or mental health problems from abuse, poor care, and inappropriate detention.
Inter-agency policy and procedures relating to abuse of vulnerable adults
- Author:
- KNOWSLEY. Social Services Department
- Publisher:
- Knowsley. Social Services Department
- Publication year:
- 1996
- Pagination:
- 20p.
- Place of publication:
- Kirkby
Policy and procedure document applying to all agencies in Knowsley working with vulnerable adults who may be at risk of abuse. Provides a framework for those involved to respond. Intended as a guide to staff to ensure a consistent response so that the various agencies involved work together.