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Geographical barriers to mental health service care among individuals with an intellectual disability in the Republic of Ireland
- Authors:
- RAMSAY Hugh, et al
- Journal article citation:
- Journal of Policy and Practice in Intellectual Disabilities, 13(4), 2016, pp.261-268.
- Publisher:
- Wiley
People with an intellectual disability (ID) are more likely to experience mental health difficulties than others. The United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) states that health services should be provided close to people's own communities. This article examines differences in access to psychiatry services for those with an ID according to geography, in the context of a small European country (Republic of Ireland). The sample consisted of 753 individuals aged 40 and over with ID in the Republic of Ireland, with data collected from the Intellectual Disability Supplement of the Irish Longitudinal Study on Aging (IDS-TILDA). The primary outcome of interest was attendance with any psychiatrist and the primary independent variables were area of residence (health service region and degree of county urbanicity). Logistic regression was used to analyse associations, unadjusted and then controlling for age group, gender and level of ID. Secondary analysis examined factors associated with anti-psychotic prescription without psychiatrist supervision. Treatment by a psychiatrist was associated with both health region (p = 0.029) and degree of urbanicity (p = 0.015) before controlling for group differences but only the health region was significantly associated after controlling for age, gender and level of ID. Antipsychotic use without a psychiatrist was associated with degree of urbanicity (p = 0.036) but not with health service region (p = 0.989). Geographic factors are associated with access to mental health services among those with ID in the Republic of Ireland. This may be partly due to movement of people with ID away from their area of origin, highlighting the need for locally tailored specialist ID mental health teams and for further research into barriers to treatment. Additional work in other countries will further understanding of similar roles of geographic factors in mediating mental health services access. (Edited publisher abstract)
‘I didn't know other people existed who hear voices…’ – qualitative perceptions of a hearing voices group for people with learning disabilities
- Authors:
- TOMLINS Rose, CAWLEY James
- Journal article citation:
- British Journal of Learning Disabilities, 44(3), 2016, pp.204-212.
- Publisher:
- Wiley
Group work for people who experience voice hearing in the mainstream population has been shown to have various benefits; however, there is little research describing hearing voices groups for people with learning disabilities. This study describes perceptions of a new hearing voices group for people with mild learning disabilities. Semi-structured interviews with twelve participants were conducted. This included three clients who attended the hearing voices group, three of their family members/carers and one professional. In addition, of those who were referred to the group but chose not to attend, one client, two family members/carers and two professionals were interviewed. Interview data were transcribed verbatim and thematic analysis was used to identify three overarching themes; the first ‘benefits of our hearing voices group’ described participants’ evaluations and perceptions of the hearing voices group. The second ‘making the decision to attend’ covers factors that influence clients when deciding whether or not to attend a hearing voices group. In the final theme ‘positive and negative contributors to the voice-hearing experience’, participants reflected on factors that affect the voice-hearing experience. The hearing voices group was valued by participants; however, services should consider the barriers to attendance faced by some clients. Strategies for addressing these are discussed. (Publisher abstract)
The subjective experience of adults with intellectual disabilities who have mental health problems within community settings
- Authors:
- ROBINSON Laura, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 10(2), 2016, pp.106-115.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to gain a greater understanding of how individuals with mild intellectual disabilities living in the community understand their psychotic symptoms and experiences. Design/methodology/approach: Five participants with intellectual disabilities and psychotic symptoms living in the community were interviewed. The interview schedule explored key areas: understanding and experiences of having an intellectual disability and a psychotic disorder, and of services provided. The data were analysed using Interpretative Phenomenological Analysis. Findings: The analysis elicited three main themes: self-concept: “How I understand and see myself”, incorporates what participants understood about their labels, their experiences, and how these labels fitted in with their self-concept; Impact: “How having mental health problems and learning difficulties affect my life”, encompasses communication barriers, lack of control, and stigma and vulnerability. The third main theme was coping: “How I cope with my mental health and learning difficulties”. Research limitations/implications: The findings suggest that the participants, rather than identifying with specific psychiatric labels perceive themselves as having individual and specific needs. The analysis highlights areas that can be developed to help with coping; ensuring people are respected and heard, empowerment through the development of positive social roles, and psycho-education. These results are a step towards developing understanding of this group of service users. (Edited publisher abstract)
A survey of consultant psychiatrists in intellectual disability based in England
- Authors:
- GUINN Ashley, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 10(4), 2016, pp.258-270.
- Publisher:
- Emerald
Purpose: Community mental health services are of increasing importance for people with an intellectual disability (ID), as the government aims to reduce the number of people treated within inpatient services. However, due to limited evidence base, it is unclear which service models are most effective for treating people with both ID and a mental health condition. Therefore, the purpose of this paper is to carry out a survey in order to gain a better understanding of the current state of ID community services. Design/methodology/approach The survey was e-mailed to 310 consultant psychiatrists based in England and whose main specialism was in ID. In total, 65 consultants responded to the survey with 53 complete data sets. Findings: In total, 84 per cent of consultants identified themselves as working in a generic community ID team. The majority of services were not integrated with social care (71 per cent). Regional differences were found. In contrast to the rest of England, the majority of services in London were integrated with social care. The Health of the Nation Outcome Scale for people with Learning Disabilities (HoNOS-LD) was found to be the most common outcome measure used by services. A range of interventions are widely available across services including psychological therapies and specialist memory assessments. The survey also provides evidence for increased decommissioning of specialist inpatient units and a need for more robust community services. Research limitations/implications: Findings limited by low return rate (21 per cent) and because responses could not be matched to specific services. The implications of this survey are that there is still a variable level of integration with social care and that lack of integration could affect the quality of service. While HoNOS-LD is used consistently across services, there may be a need to supplement it with other outcome measures. There is a need for larger scale and higher quality studies in this area to strengthen the evidence base and therefore demonstrate the benefits of integration and specialisation more convincingly to health professionals and commissioners. Originality/value: This survey presents an overview of the current state of community services for adults with ID in England. This information can be harnessed to add to revised approaches to mental health service models for people with ID. (Publisher abstract)
The relationship between problem-solving ability and self-harm amongst people with mild intellectual disabilities
- Authors:
- REES Joanna, LANGDON Peter E.
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 29(4), 2016, p.387–393.
- Publisher:
- Wiley
Background: The purpose of this study was to investigate the relationship between depression, hopelessness, problem-solving ability and self-harming behaviours amongst people with mild intellectual disabilities (IDs). Methods: Thirty-six people with mild IDs (77.9% women, Mage = 31.77, SD = 10.73, MIQ = 62.65, SD = 5.74) who had a history of self-harm were recruited. Participants were asked to complete measures of depression, hopelessness and problem-solving ability. Results: Cutting was most frequently observed, and depression was prevalent amongst the sample. There was a significant positive relationship between depression and hopelessness, while there was no significant relationship between self-harm and depression or hopelessness. Problem-solving ability explained 15% of the variance in self-harm scores. Conclusions : Problem-solving ability appears to be associated with self-harming behaviours in people with mild IDs. (Publisher abstract)
Prader Willi syndrome: systematic review of the prevalence and nature of presentation of unipolar depression
- Authors:
- WALTON Catherine, KERR Mike
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 10(3), 2016, pp.172-184.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to assess the prevalence and nature of presentation of unipolar depression in individuals with Prader-Willi syndrome (PWS). Design/methodology/approach: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (2009) checklist for systematic reviews was followed where possible. Findings: Seven studies were included in the qualitative synthesis from a total of 261 records identified. The quality of the studies was then assessed: scores for each study design ranged from between 3 and 6 of a possible score total of 6. The frequency of depression ranged between studies from 4 to 22 per cent. four studies showed over 50 per cent of patients appeared to suffer from psychotic symptoms. Low mood, anhedonia and irritability were described as features of depression, although no fixed pattern of psychopathology arose from across the studies (excluding psychosis). This review has provided evidence to suggest that depression is a frequent occurrence in the PWS population. One study found that the incidence of depression differed between the genetic subtypes, raising questions regarding the relationship between genotype and behavioural phenotypes. A high proportion of individuals with depression suffered from psychotic symptoms. Research limitations/implications: The small number of heterogeneous studies included in this study precluded meta-analysis of the results. This highlights the need for further original research in this field. Practical implications: An increased awareness of the frequency of depressive symptoms within the PWS population will aid in the timely diagnosis and management of the disorder which will reduce psychiatric morbidity. The noted high proportion of psychotic symptoms associated with depression should raise the index of suspicion with clinicians and aid appropriate management decisions. Originality/value: This review has provided preliminary evidence for the nature of presentation of unipolar depression in PWS. It has highlighted the possibility of an increased propensity towards depression with psychotic symptoms. There is some suggestion of a differing presentation and course of unipolar depression between the common genetic subtypes of PWS which warrants further investigation. (Publisher abstract)
Adapted DBT programme for individuals with intellectual disabilities and problems managing emotions: staff awareness training
- Authors:
- ASHWORTH Sarah, MOONEY Paul, TULLY Ruth J.
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 10(3), 2016, pp.185-198.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to present the development and evaluation of an original training package for staff members on an awareness of an adapted Dialectical Behaviour Therapy programme, the “I Can Feel Good” programme (Ingamells and Morrissey, 2014) designed for individuals with intellectual disabilities (ID) and problems managing emotions. The quality and effectiveness of the training was assessed and is reported in this paper. Design/methodology/approach: The training was delivered for staff working with individuals with ID in a UK medium-secure psychiatric hospital and was attended by nursing staff. The workshop consisted of six modules: “Introduction to the programme”, “Mindfulness”, “Managing feelings”, “Coping in Crisis”, “People skills” and “Application and summary”. Level of self-reported knowledge, confidence and motivation regarding seven aspects of the training was measured by an evaluation questionnaire completed pre and post training. Findings: The results of this study showed that following the training there was a significant increase in self-reported knowledge, confidence and motivation regarding the seven aspects of the training. When perceptions of staff behaviours are observed, although in the right direction, this change was found not to be significant. Originality/value: This study highlights the potential for staff training to increase awareness of newly adapted therapeutic programmes for individuals with ID. The staff training may increase their ability and willingness to facilitate the running of such programmes and ability to support learning transfer in group members. (Publisher abstract)
Child protection and parents with a learning disability: good practice for assessing and working with adults: including autism spectrum disorders and borderline learning disability
- Author:
- MORGAN Penny
- Publisher:
- Jessica Kingsley
- Publication year:
- 2016
- Pagination:
- 176
- Place of publication:
- London
This book provides practical advice and knowledge to help professionals understand common intellectual disabilities and how they might affect parenting capability. It provides guidance on how to carry out effective assessments and explains how interventions might differ when working with parents who have a learning disability. It includes chapters on: mild learning disabilities and parenting; borderline learning disability; autistic spectrum conditions; parenting, emotions and attachment; and working with families. It also explores emotional and mental health issues that can occur alongside learning disabilities, such as anxiety, depression, and attachment disorders, to show how they should be understood in the context of cognitive abilities and the parenting role. (Edited publisher abstract)
Building resilience through group visual arts activities: findings from a scoping study with young people who experience mental health complexities and/or learning difficulties
- Authors:
- MACPHERSON Hannah, HART Angie, HEAVER Becky
- Journal article citation:
- Journal of Social Work, 16(5), 2016, pp.541-560.
- Publisher:
- Sage
Summary: This article reports research that aimed to identify and evaluate potential resilience benefits of visual arts interventions for young people with complex needs. The study involved a review of the ‘arts for resilience’ literature and a case study of 10 weekly resilience-building arts workshops for 10 young people experiencing mental health complexities and/or learning difficulties. Findings: The results found a significant existing evidence-base linking visual arts practice to individual and community resilience, across disciplinary fields including art therapy, social work, community health, visual arts practice and geographies of health. Visual art activities were utilised to both educate young people about resilience and enhance young people’s overall resilience. Qualitative research material developed from the case study shows that even short-term visual arts interventions can impact on young people’s resilience. Participation was extremely beneficial to young people’s sense of belonging and ability to cope with difficult feelings. Applications: The review and findings from this small case study provide some initial insights into the resilience benefits of participation in visual arts activities. This, combined with the resilience-based practice framework presented, could aid the effective targeting of interventions for social workers and others working with young people with complex needs. Alongside this research paper, an arts for resilience practice guide has been produced by the project team (including young people). It contains instructions on how to conduct a range of practical visual arts activities that we identified as being resilience-promoting. (Edited publisher abstract)
Quality of diagnosis and treatment plans after using the ‘diagnostic guideline for anxiety and challenging behaviours’ in people with intellectual disabilities: a comparative multiple case study design
- Authors:
- PRUIJSSERS Addy, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 29(4), 2016, pp.305-316.
- Publisher:
- Wiley
Background: People with intellectual disabilities often have a multitude of concurrent problems due to the combination of cognitive impairments, psychiatric disorders (particularly anxiety) and related challenging behaviours. Diagnoses in people with intellectual disabilities are complicated. This study evaluates the quality of the diagnoses and treatment plans after using a guideline that was developed to support professionals in their diagnostic tasks. Materials and Methods: A comparative multiple case study with an experimental and control condition, applying deductive analyses of diagnoses and treatment plans. Results: The analyses revealed that the number of diagnostic statements and planned treatment actions in the experimental group was significantly larger and more differentiated than in the control condition. In the control group, consequential harm and protective factors were hardly mentioned in diagnoses and treatment plans. Conclusions: Working with the ‘Diagnostic Guideline for Anxiety and CB’ leads to improved diagnoses and treatment plans compared with care as usual. (Publisher abstract)