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Mainstream in-patient mental health care for people with intellectual disabilities: service user, carer and provider experiences
- Authors:
- DONNER Ben, MUTTER Robin, SCIOR Katrina
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 23(3), May 2010, pp.214-225.
- Publisher:
- Wiley
Government guidelines promote the use of mainstream mental health services for people with intellectual disabilities whenever possible. This study aimed to explore how people with intellectual disabilities fare in such services, by examining how service users with intellectual disabilities, their carers and service providers perceive mainstream in-patient mental health services, and to what extent their accounts are in line with key policy objectives. Face-to-face interviews with 9 service users, 9 carers and 4 community nurses were completed and analysed on a case by case basis using interpretative phenomenological analysis. The results were followed up in focus groups with service providers. The positive aspects of admission included the provision of respite, particularly for carers, and good basic care. These were outweighed by a perception of the admission as disempowering and lacking in flexible treatment provision. Accessing help emerged as a major problem, as well as the prospect of staff neglecting the specific needs of people with intellectual disabilities. The article concludes that, while there were some indications of improvements in line with recent policies and guidance, mainstream services seem a long way off realising aims of easy accessibility, person-centred practices and active partnership with intellectual disability services.
Service provision for young people with intellectual disabilities and additional mental health needs: service-providers’ perspectives
- Authors:
- SCIOR Katrina, GRIERSON Kate
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 17(3), September 2004, pp.173-179.
- Publisher:
- Wiley
Very little is known about young people with intellectual disabilities who experience additional mental health problems. The perspective of service providers has been highlighted as one unresearched area. Semi-structured interviews were completed with senior service providers. Aims: (1) to explore experiences of working with young people with intellectual disabilities and additional mental health problems and their families; (2) to examine views on services’ ability to meet the needs of this group. Service providers identified a gulf between current policy and the reality for this group, not least in terms of all agencies working in partnership. All agencies described instances when young people in this group fall through gaps between services. Interviewees identified a range of factors that promote good outcomes. The results suggest that the focus of current policies to promote joint working needs to be broadened beyond health and social services to ensure much improved links with education providers and the voluntary sector if the needs of this group are to be met.
‘Diagnostic Overshadowing’ amongst clinicians working with people with intellectual disabilities in the UK
- Authors:
- MASON Jonathan, SCIOR Katrina
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 17(1), June 2004, pp.85-90.
- Publisher:
- Wiley
Mental health problems are known to be hard to recognize in people with intellectual disabilities. One factor that may contribute to this is the diagnostic overshadowing bias, which describes the tendency of the clinicians to overlook symptoms of mental health problems in this client group and attribute them to being part of ‘having an intellectual disability’. Although a small amount of research has investigated this in the USA, very little has taken place in the UK. Two clinical vignettes were produced. Both described identical clinical problems, except that one vignette described a man with an IQ of 58 and impaired social functioning (i.e. an intellectual disability) and one a man with an IQ of 108 and normal social functioning (i.e. non-intellectually impaired). Psychiatrists (n = 274) and clinical psychologists (n = 412) throughout UK were randomly assigned to either the low IQ or normal IQ condition, and sent a corresponding clinical vignette. One hundred and thirty-three psychologists and 90 psychiatrists responded. Diagnostic overshadowing did appear to be present. Clinicians were more likely to recognize a range of symptoms in those with IQs in the normal range than those with intellectual disabilities. Furthermore, psychiatrists appeared more likely to make this error under some circumstances than clinical psychologists. Diagnostic overshadowing may contribute to the difficulties that mental health professionals commonly experience in identifying mental health problems in people with intellectual disabilities. However, the methodology commonly used in this type of research has a number of weaknesses, and would benefit from an alternative approach.
In-patient psychiatric care for individuals with intellectual disabilities: the service users' and carers' perspectives
- Authors:
- LONGO Silvia, SCIOR Katrina
- Journal article citation:
- Journal of Mental Health, 13(2), April 2004, pp.211-221.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Little is known about the experiences of individuals with intellectual disabilities and additional mental health problems who are admitted for inpatient psychiatric care. In the UK such care is delivered in both generic psychiatric and specialised treatment settings. The present study explored service users' and carers' views on in-patient psychiatric treatment received across these two settings. Thirty service users and wherever possible their main carers were interviewed about their views on the psychiatric admission, treatment and discharge process. Data was gathered during semi-structured, one-to-one interviews. Both service users and carers identified positive and negative aspects of the psychiatric admission. For service users lack of control and information, support from staff, or conversely its absence emerged as key themes. For carers concerns about service users' vulnerability, negative staff attitudes and opportunities for involvement emerged as key themes. The accounts of both groups regarding generic psychiatric settings were predominantly negative. In contrast, specialized settings were frequently described as providing a pleasant environment, supportive and caring staff, good information sharing and satisfactory discharge arrangements. Important areas for service improvements are highlighted. Implications in particular for generic settings are considered.