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Cognitive behavioural therapy and the impact of internalised societal discourses in people with intellectual disabilities: a case example
- Authors:
- GERRY Louise, CRABTREE Jason
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 7(1), 2013, pp.59-65.
- Publisher:
- Emerald
Cognitive behaviour therapies (CBT) are being seen as the treatment of choice for people with intellectual disabilities. And, the authors suggest, as the focus of national services change, more people with learning disabilities are likely to access mainstream health services such as Improving Access to Psychological Therapies in which CBT is often the primary mode of therapy. With this in mind they describe a cautionary case that demonstrates some of the potential dilemmas and challenges that can be experienced when working with clients with intellectual disabilities. The challenges stem from using an approach that locates problems within people rather than as being generated and maintained through social relations and social discourses. The case describes work with Mark, a young man with intellectual disabilities who accessed services for support with his low mood. It appears from this case example that there is the potential for therapeutic techniques used in CBT to promote questions that invite, generate and reinforce feelings of incompetence and inability in people with intellectual disabilities. The authors discuss the use of narrative techniques as a means of avoiding locating the problem as being within clients with intellectual disabilities; the implications that this has for the use of CBT with this client group are considered.
Asperger's syndrome and atypical eating disorder in a man with late diagnosed XYY syndrome
- Authors:
- GRAVESTOCK Shaun, VEKARIA Dinal, HURAULT Elaine
- Journal article citation:
- Advances in Mental Health and Learning Disabilities, 1(4), December 2007, pp.44-46.
- Publisher:
- Emerald
Reports on the case of a man with Asperger's syndrome and learning disabilities, atypical eating disorder (food faddiness/refusal due to fear of choking) and XYY syndrome. Multi-modal management and inter-agency service provision issues are considered in meeting his complex mental health service and social needs.
FraX-E: underdiagnosed, undertreated, under-researched and misunderstood
- Authors:
- FREEMAN Laura, TURK Jeremy
- Journal article citation:
- Advances in Mental Health and Learning Disabilities, 1(3), September 2007, pp.40-51.
- Publisher:
- Emerald
This article focuses on the consequences of having FraX-E, a variant of fragile X syndrome. The authors provide some background on the condition and report on recent research and evidence. Three case reports are outlined and the specific behavioural aspects of the syndrome are considered. The authors argue that it is important that the behavioural phenotype for FraX-E is clearly identified and defined in order to give those with the condition relevant psychological and educational support in the future.
Building the Right Small Supports: evaluation report
- Author:
- MASON-ANGELOW Victoria
- Publisher:
- National Development Team for Inclusion
- Publication year:
- 2021
- Pagination:
- 10
- Place of publication:
- Bath
- Edition:
- Updated version
This document explores the costs and benefits of individuals with a learning disability, mental health condition and/or autism receiving support from a Small Support organisation in England. Small Support organisations are unique support providers that have a number of things in common, including: planning and delivering support in a truly person-centred way; person-led staff recruitment and training; structuring and using funding around the person; a separation of housing and support; strong partnerships between the individual and family, commissioners, and providers; and staying small. Reducing costs to the public purse is not the primary aim of any Small Support organisation. Each organisation’s purpose is to improve the lives of people with a learning disability, mental health condition and/or autistic people, through bespoke support – and that can come at a cost. However, consideration of whether something represents value for money is of inevitable interest to those providing and commissioning services. In the absence of sufficient data to conduct a full cost-benefit analysis of a Small Support organisation in England, the five costed case studies outlined in this paper provide an illustration of the fiscal and social value of such organisations. The case studies represent a saving of over half a million pounds to the public purse a year; particularly to health, social care and police budgets in England. This information suggests that Small Support organisations offer both good value for money as well as improved outcomes for those they support. As a result, Small Support organisations should be considered more widely as an option for individuals with learning disabilities, mental health condition and/or autism. (Edited publisher abstract)
Narrating personal experience of living with learning disabilities and mental health issues in institutional and community settings: a case study
- Authors:
- SUTTON Paul, GATES Bob
- Journal article citation:
- British Journal of Learning Disabilities, 48(4), 2020, pp.323-331.
- Publisher:
- Wiley
Background: Historically, the emotional lives and mental health needs of adults with learning disabilities received scant attention, especially when the policy of institutionalisation was at its zenith in the UK. Materials and Methods: This case study employed biographical narrative interviews based on a psychosocial approach. The main sources of data production were two loosely structured, audio‐taped, interviews with a man with learning disabilities. This approach uses free association to elicit an individual's stories about his lived experiences. Additional information was acquired from consultations with key care staff and clinical records maintained by the man's service provider. Results: Data revealed insights into the biography of this man who had a diagnosed mental health disorder. These data recall his personal journey through the care system which took place during an important historical period encompassing both long‐term institutionalisation in segregated settings, and the subsequent implementation of the policy of community care in the UK. He recalls positive and negative experiences while residing in a long‐stay hospital, and the related thoughts and feelings about his life in a community setting in more recent years. Conclusion: This case study contributes to an increasing body of studies that perceive the use of in‐depth interviewing of individuals with learning disabilities as having high ecological validity in the development of authentic knowledge, not readily available through other methods used in the co‐production of data. (Edited publisher abstract)
Balancing care and work: a case study of recognition in a social enterprise
- Authors:
- BLONK L., et al
- Journal article citation:
- Disability and Society, 35(6), 2020, pp.972-992.
- Publisher:
- Taylor and Francis
This paper discusses a case study of a Dutch work-integration social enterprise (WISE) to add to the debate on the contribution of employment to the citizenship of intellectually disabled people and those experiencing mental health conditions. In current welfare state policies, the value of labour market participation is narrowed down to regular employment, as workplace support and care provisions are seen as stigmatising and segregating. This paper argues that a more nuanced understanding is needed of the intersection of support arrangements with the benefits of employment. Building on ‘recognition theory’ by the German philosopher Honneth, the findings show that the work-integration social enterprise under study is successfully balancing the contrasting demands of logics of care and work, leading to experiences of ‘recognition.’ However, this balance is fragile and does not undo the misrecognition of disabled people as unable to live up to the productivity norms of a capitalist labour market. (Edited publisher abstract)
Mateo's experience leaving residential care: systemic constraints as obstacles to placement
- Author:
- CIMMARUSTI Rocco A.
- Journal article citation:
- Residential Treatment for Children and Youth, 29(1), January 2012, pp.1-12.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Sometimes a case will remain intractable despite efforts to create or support change. This article uses a multisystems perspective to examine the concept of constraints to change. The multisystems model focuses on the interactions within and between the client and the variety of levels of the environment that surrounds the client and within which the client interacts. A case example of transition planning for Mateo, an intellectually disabled and mentally ill 20-year-old male residing in a residential treatment programme, is used as a means for examining this concept. A multileveled systemic perspective is applied to analyse the contribution of various constraints on the progress of the case. The constraints that affected Mateo were: his predisposition to mental illness; his mild intellectual disability; the psychological impact of early childhood trauma; and his occasional physical aggression. Lessons to be learned from this case are elucidated. They include: the importance of and guidelines for thinking in a multileveled systemic way when dealing with clients involved in numerous service systems; and the value of professionals exploring their own constraining impact on a case.
Foucault gets into nursing
- Author:
- SHARKEY Valerie
- Journal article citation:
- Nursing Times, 24.11.99, 1999, pp.50-51.
- Publisher:
- Nursing Times
How useful is philosophy to nursing? This article looks at the relevance of the ideas of the modern French philosopher Michel Foucault on knowledge and power. Discusses the notion of the 'clinical gaze' in relation to the treatment of a man with mental health problems and mild learning difficulties.
Critical components in implementing evidence‐based practice: a multiple case study of individual placement and support for people with psychiatric disabilities
- Authors:
- BERGMARK Magnus, BEJERHOLM Ulrika, MARKSTROM Urban
- Journal article citation:
- Social Policy and Administration, 52(3), 2018, pp.790-808.
- Publisher:
- Wiley
When developing Community Mental Health Services to support people with psychiatric disabilities, European countries are advocating evidence‐based practice (EBP). Individual Placement and Support (IPS) is an evidence‐based model designed to support people in acquiring and maintaining competitive employment. Implementation science is a growing research field, with a focus on components that impact the process of implementing EBP programmes. In this multiple case study, three IPS demonstration sites are followed for two years, in order to describe and analyze barriers and facilitators for implementation, according to constructs described in the Consolidated Framework for Implementation Research(Damschroder et al. 2009). The results highlight the importance of strategic networking, as well as the need for planning and preparations carried out before the start of an EBP programme, since deficiencies related to these constructs are difficult to compensate for. (Edited publisher abstract)
The bounds of liberty: lessons learnt from treating a man with alcohol use disorder, autism and learning disability
- Authors:
- DRAKE Alexander C.L., et al
- Journal article citation:
- Tizard Learning Disability Review, 23(1), 2018, pp.27-34.
- Publisher:
- Emerald
Purpose: A man in his 40s with alcohol use disorder, learning disability and autism was referred to the learning disability team due to anxiety and low mood. He had been abstinent from alcohol for ten years prior to a recent relapse. The purpose of this paper is to describe his case. Design/methodology/approach: Treatment was person centred, followed standard practice for clients with alcohol use disorder and targeted harm minimisation. Initially, alcohol consumption reduced; however, at month three, he relapsed. Thereafter, he was repeatedly admitted to inpatient settings, drank excessively and engaged in risky behaviours. Findings: Conventional approaches to treating alcohol dependence may not be entirely appropriate for this client group. The client’s alcohol consumption was only curtailed with the use of restrictions to his liberty agreed by him and incorporated into his tenancy agreement. Originality/value: To the best of the authors’ knowledge, this is the first paper to discuss issues pertaining to people with co-occurring learning disability, autism and alcohol dependence. The authors discuss the use of restrictions, reasonable adjustments and policy issues relevant to treating this complex client group. (Publisher abstract)