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Variation in rates of inpatient admissions and lengths of stay experienced by adults with learning disabilities in England
- Authors:
- JAMES Elaine, HATTON Chris, BROWN Mark
- Journal article citation:
- Tizard Learning Disability Review, 22(4), 2017, pp.211-217.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to analyse rates of inpatient admissions for people with learning disabilities in England and to identify factors associated with higher rates of inpatient admission. Design/methodology/approach: Secondary analysis of data submitted as part of the Transforming Care programme in England. Findings: 2,510 people with learning disabilities in England were inpatients on 31st March 2016. Findings indicate that people with learning disabilities are at risk of higher rate of inpatient admission than can be explained by prevalence within the general population; this risk may be associated with areas where there are higher numbers of inpatient settings which provide assessment and treatment for people with learning disabilities. Research limitations/implications: Variability in the quality of the data submitted by commissioners across the 48 Transforming Care Plan areas mean that greater attention needs to be paid to determining the validity of the common reporting method. This would improve the quality of data and insight from any future analysis. Practical implications: The study’s findings are consistent with the hypothesis that geographical variations in the risk of people with learning disabilities being admitted to inpatient services are not consistent with variations in prevalence rates for learning disability. The findings support the hypothesis that building alternatives to inpatient units should impact positively on the numbers of learning disabled people who are able to live independent lives. Originality/value: This is the first study which examines the data which commissioners in England have reported to NHS England on the experience of people with learning disabilities who are admitted as inpatients and to report on the possible factors which result in higher rates of inpatient admission. (Publisher abstract)
What is normal behaviour in persons with developmental disabilities?
- Authors:
- DOSEN Anton, De GROEF Johan
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 9(5), 2015, pp.284-294.
- Publisher:
- Emerald
Purpose: Annoying and bothersome behaviours among persons with developmental disabilities (DD) is a relatively frequent phenomenon. However, not all behaviour that is difficult to accept in its surroundings should be seen as abnormal or problem behaviour (PB). Some of these behaviours may be an expression of a person’s psychosocial needs and may be considered as adaptive and normal. The paper aims to discuss these issues. Design/methodology/approach: Authors attempt to discuss relevant issues in persons with DD which have an impact on their behaviour, intending in this way to define criteria for a reliable differentiation between normal and abnormal behaviour and psychiatric disorders. Findings: Differentiating between normal and abnormal may be a difficult task for a professional treating persons with DD because of the lack of adequate criteria for such differentiation. The problem becomes even more complex when one attempts to differentiate between PB and psychiatric disorder. By approaching the subject from a developmental perspective and by determining the level of the person’s emotional development, insight in subjective person’s experiences was achieved. On the ground of a “good practice” the authors made schemata outlining criteria for differentiation between these constructs. Originality/value: The application of these schemata in the practice made it easier to establish appropriate diagnoses and was favourable for the planning of adequate treatment and support of persons with DD and mental health problems. (Publisher abstract)
Application of community treatment orders (CTOs) in adults with intellectual disability and mental disorders
- Authors:
- GUPTA Jaya, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 9(4), 2015, pp.196-205.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore use of community treatment orders (CTOs) in adults with intellectual disability (ID) and mental health problems across England and Wales. Design/methodology/approach: A web-based exploratory survey was sent to 359 consultants on the database of the Faculty of the Psychiatry of ID, Royal College of Psychiatrists who had declared ID as their main speciality. Socio-demographic details of responding consultants, clinical characteristics of adults with ID on CTO, subjective views of consultants on using CTOs in people with ID were collected and analysed. Findings: In total, 94 consultant questionnaires were returned providing information on 115 patients detained under CTO. More than 75 per cent of the respondents had used CTO in their clinical practice. Patients subject to CTO were generally young, white males with mild ID and living in supported accommodation. CTOs were primarily used in situations of non-engagement (52.2 per cent), non-compliance with medication (47 per cent) or non-compliance with social care supports (49.6 per cent). Practical implications: Responding consultants expressed concerns about encroachment of civil liberties and ethics of using CTOs in people with ID who may lack capacity and stressed that decision to use CTOs needs to be therefore done on individual basis. Originality/value: This is the first national study to examine the practice of applying CTOs in adults with ID and mental disorders. Current practice is based on evidence from research done in adults with normal intelligence. Further research is needed to investigate the utility of CTOs in routine clinical practice in adults with ID and mental disorders. (Publisher abstract)
Thematic analysis of the effectiveness of an inpatient mindfulness group for adults with intellectual disabilities
- Authors:
- YILDIRAN Hatice, HOLT Rachel R.
- Journal article citation:
- British Journal of Learning Disabilities, 43(1), 2015, pp.49-54.
- Publisher:
- Wiley
The study focused on the effectiveness of group mindfulness for people with intellectual disabilities in an assessment and treatment unit. Six participants with mild or moderate intellectual disabilities were interviewed using semi-structured interviews. The interviews focused on identifying the benefits and difficulties of using mindfulness. The interviews were analysed using thematic analysis. Five themes were identified which were categorised into interpersonal ('helping people') and intrapersonal ('focusing on one particular thing'; 'improving skills'; 'get rid of all nasty bad stuff you want to get rid of') benefits. The theme 'bit too late to teach old dog new tricks' captured the difficulties encountered. The themes highlighted that people with intellectual disabilities were able to form an understanding of mindfulness and were able to benefit from the intervention. (Publisher abstract)
Expert opinions on community services for people with intellectual disabilities and mental health problems
- Authors:
- HEMMINGS Colin, AL-SHEIKH Alaa
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 7(3), 2013, pp.169-174.
- Publisher:
- Emerald
A total of 14 multidisciplinary professionals from specialist intellectual disabilities services in the UK were interviewed about their opinions on four key areas of community service provision. These included the review and monitoring of service users, their access to social, leisure and occupational activities, the support, advice and training around mental health for a person's family or carers and “out of hours” and crisis responses. The interview data was used for coding using the NVivo 7 software package and then analyzed using thematic analysis. Analysis of participants' views on these key essential service components produced wider themes of importance. The ten major emergent themes for services were: their configuration/structure, their clarity of purpose/care pathways, their joint working, their training, their flexibility, their resources, their evidence-base, being holistic/multidisciplinary, being needs-led/personalised and providing accessible information. Selective quotations are included in the article to illustrate the main themes. These views of experts can help inform further research for the development and the evaluation of services. (Edited publisher abstract)
Dialectical behaviour therapy for special populations: treatment with adolescents and their caregivers
- Authors:
- CHARLTON Margaret, DYKSTRA Eric J.
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 5(5), 2011, pp.6-14.
- Publisher:
- Emerald
The authors begin by discussing the adaptations that need to be made to dialectical behaviour therapy (DBT) when working with populations who have both intellectual disabilities and mental illnesses. They go on to report the preliminary findings of a pilot study conducted with adolescent clients in a day treatment program in Colorado. This was designed to determine the effectiveness of dialectical behaviour therapy for special populations (DBT-SP). The study, which involved 19 students, used all three components of DBT, in addition to the normal milieu management techniques. Clients received DBT-SP focused individual therapy, skills training groups using the DBT-SP skills training manual, and the whole treatment team staff participated in a DBT-SP supervision/consultation group. Data were collected through observations of client behaviour by staff, client outcome when leaving the program, and daily diary card information. The authors note that, as this was a pilot study, there are many limitations to the data. However they conclude that thus far, the data are suggestive, but not conclusive, regarding the effectiveness of DBT-SP.
Self-reported life events, social support and psychological problems in adults with intellectual disabilities
- Authors:
- HULBERT-WILLIAMS Lee, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 24(5), September 2011, pp.427-436.
- Publisher:
- Wiley
Previous research has demonstrated a relationship between life events and psychological problems in people with intellectual disabilities. However, these studies have typically relied on proxy informants, usually professional carers or family members. The aim of this study was to examine the relationship between life events and psychological problems in people with intellectual disabilities using self-report data. In addition, the study aimed to examine the direct effect of social support on psychological problems, and its moderating influence on the relationship between life events and psychological problems. The participants, 38 adults with intellectual disabilities, completed 3 psychological measures in a semi-structured interview setting: the Bangor Life Events Schedule for Intellectual Disabilities Self-Report; the Brief Symptom Inventory; and the Social Network Map. The findings showed that exposure to life events, such as death of a close friend or relative or a permanent change in staffing, were positively associated with measures of psychological problems. Social support was generally not found to be associated with psychological problems, although more psychological problems were reported by participants who also reported more criticism of them by others.
Service user views of long-term individual psychodynamic psychotherapy
- Authors:
- MERRIMAN Charlotte, BEAIL Nigel
- Journal article citation:
- Advances in Mental Health and Learning Disabilities, 3(2), June 2009, pp.42-47.
- Publisher:
- Emerald
Long-term psychodynamic psychotherapy is a costly service to provide, but many clinicians believe it is of benefit for people who have learning disabilities and psychological problems. There is also now some evidence for its effectiveness. However, the views of recipients is unknown. In this study, recipients of more than two years of psychodynamic psychotherapy were interviewed about their experiences and views. Themes emerged about the referral process, the experience and the outcome. Areas of strength were identified, as well as areas for improvement. The findings concur with previous findings on group therapy and help inform current and future provision of long-term psychodynamic psychotherapy.
Arson: characteristics and predisposing factors in offenders with intellectual disabilities
- Authors:
- DEVAPRIAM John, et al
- Journal article citation:
- British Journal of Forensic Practice, 9(4), December 2007, pp.23-27.
- Publisher:
- Emerald
This retrospective study focuses on examining the characteristics of offenders with intellectual disabilities (ID) and the range of identified reasons for the offence. The study population consisted of 1,100 patients with ID who were in contact with psychiatric services at the Leicestershire Frith Hospital. Fifteen patients were identified as having committed arson. The findings indicate a higher prevalence of arson in this population, along with the fact that the majority of people with ID who have committed arson tend to bypass the criminal justice system. A significant number are likely to repeat the behaviour and will also commit other offences. The most common reason for arson appears to be revenge, closely followed by suggestibility. The majority has an associated diagnosis of personality disorders along with Axis 1 psychiatric diagnosis. Other factors include large family size, history of childhood psychiatric disorders, abuse, homelessness, unemployment and relationship difficulties.
Mental health services for individuals with intellectual disabilities in Canada: findings from a national survey
- Authors:
- LUNSKY Y, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 20(5), September 2007, pp.439-447.
- Publisher:
- Wiley
This study aimed to document both the range of mental health services available to individuals with intellectual disabilities across Canada and the perceived service gaps. A 30-item questionnaire was developed that included questions on mental healthcare services for children, adolescents and adults with intellectual disabilities. This survey was sent to key informants in the 10 Canadian provinces and three territories. More than half of the respondents reported that generic mental health providers were poorly equipped to meet the needs of individuals with intellectual disabilities and mental health issues. Certain specialized services (inpatient treatment, emergency room expertise) were reported to exist by less than half of the respondents. Waitlists for specialized services were typically four months or longer. Respondents thought that training for staff and professionals was very important. Some specialized services for individuals with intellectual disabilities and mental health issues were reported to exist in Canada but the need for more specialized services and further training was identified. Documentation of these service gaps should lead to further efforts in Canada for the improvement in services and developing policy.