Colin Hemmings

Challenging behavior and co-morbid psychopathology in adults with intellectual disability and autism spectrum disorders

We investigated the relationship between challenging behavior and co-morbid psychopathology in adults with intellectual disability (ID) and autism spectrum disorders (ASDs) (N=124) as compared to adults with ID only (N=562). All participants were first time referrals to specialist mental health services and were living in community settings. Clinical diagnoses were based on ICD-10 criteria and presence of challenging behavior was assessed with the Disability Assessment Schedule (DAS-B). The analyses showed that ASD diagnosis was significantly associated with male gender, younger age and lower level of ID. Challenging behavior was about four times more likely in adults with ASD as compared to non-ASD adults. In those with challenging behavior, there were significant differences in co-morbid psychopathology between ASD and non-ASD adults. However, after controlling for level of ID, gender and age, there was no association between co-morbid psychopathology and presence of challenging behavior. Overall, the results suggest that presence of challenging behavior is independent from co-morbid psychopathology in adults with ID and ASD.

Services in the community for adults with psychosis and intellectual disabilities: a Delphi consultation of professionals' views.

BACKGROUND There remains a severe lack of evidence on the effectiveness of community services for adults with psychosis and intellectual disabilities (ID). There has been little consensus even of what services should provide for this service user group. METHOD A consultation of multidisciplinary professionals was carried out by using a three-round Delphi exercise. Participants were recruited nationally. They rated their views on the importance of 139 items for the care of adults with psychosis and ID. These included 85 routine service components, 23 service user characteristics for those needing a more intensive service and 31 more intensive service components. RESULTS Forty-nine out of 52 participants completed all three rounds of the Delphi consultation. Consensus of opinion (> or = 80% agreement as essential) was obtained on 18 of the routine service components, nine of the service user characteristics and five of the more intensive service components. The routine service components considered essential can be broadly considered under a need for a focused approach on the service user and their illness (e.g. monitoring of mental state) and the added need to work within the wider context of the service user with psychosis and ID (e.g. access to social, leisure or occupational activities). Five of the more intensive service components were considered to be essential (e.g. can react to a crisis that day). However, the routine service components considered essential already contained many components such as out-of-hours support and crisis plans also relevant to more intensive services. CONCLUSION These findings can be used to develop further the evidence base for services in the community for this user group and to assist in the preparation of much needed service evaluation studies.

Review of Research for People with ID and Mental Health Problems: A View from the United Kingdom.

This review of research into mental disorders in people with intellectual disabilities (ID) focuses on research in this field that has originated from the United Kingdom in the last 2 decades. It considers research developments into the epidemiology of mental disorders and problem behaviors, psychopharmacology, psychosocial interventions, and services for people with ID.

What should community services provide for adults with psychosis and learning disabilities? A comparison of the views of service users, carers and professionals

Three separate focus groups were conducted to compare the views of service users, carers and specialist health professionals on community services for adults with psychosis and learning disabilities. Participants were asked which staff, treatments or interventions and methods of working or style of service organisation make a significant contribution to helping people with psychosis and learning disabilities. Although there were few direct contradictions or conflicts between the three groups, the priorities of service users, carers and professionals often differed. Development of community services for adults with psychosis and learning disabilities should incorporate the views of service users and their carers as well as clinicians.

Clinical predictors of severe behavioural problems in people with intellectual disabilities referred to a specialist mental health service

Associations between demographic and clinical variables and severe behavioural problems in people with intellectual disabilities were examined in a cross-sectional survey of 408 adults consecutively referred to a specialist mental health service. Severe behavioural problems were present in 136 (33.3%) of the sample. The demographic and clinical predictors of severe behavioural problems in this sample were identified by logistic regression. Age and gender were not associated with severe behavioural problems. The presence of severe ID independently predicted the presence of severe behavioural problems. Schizophrenia spectrum disorders and personality disorders independently predicted the presence of severe behavioural problems, whereas the presence of an anxiety disorder independently predicted their absence. There is an increasing evidence base of relationships between mental disorders and behavioural problems in people with ID although the pattern of these relationships remains unclear.

How should community mental health of intellectual disability services evolve

Services for people with Intellectual Disability (ID) and coexisting mental health problems remain undeveloped; research into their effectiveness has been lacking. Three linked recent studies in the UK have provided evidence on essential service provision from staff, service users and carers. Interfaces with mainstream mental health services were seen as problematic: the area of crisis response was seen as a particular problem. Further services’ research is needed, focusing on service components rather than whole service configurations. There was not support for establishing more intensive mental health services for people with ID only. The way forward is in developing new ways of co-working with staff in “mainstream” mental health services. Mental health of ID staff might often be best situated directly within these services.

Mental health crisis information for people with intellectual disabilities

Purpose – The use of accessible, portable, mental health crisis information in people with intellectual disabilities has not been previously reported. The purpose of this paper is to explore whether crisis information could be modified to be made accessible and meaningful for people with intellectual disabilities.Design/methodology/approach – Personalized information to help in a mental health crisis was recorded on folded A4 sized sheets that could be carried in a conveniently sized wallet.Findings – Three quarters of the participants carried their crisis information wallets on a daily basis for six months before evaluation. They and their carers expressed positive feedback about them carrying the crisis information. No one carrying the information actually experienced a mental health crisis in the six months follow up period so their usefulness in such crises could not be evaluated. However, they were unexpectedly used in other non‐mental health settings and reported to have been helpful.Originality/val...

Expert opinions on community services for people with intellectual disabilities and mental health problems

Purpose – There has been limited evidence on which to base services in the community for people who have intellectual disabilities and coexisting mental health problems. Recent research involving service users, carers and professionals has identified a number of key service components that community services should provide. More detail is needed to explore how best these components could be implemented and delivered. This paper aims to discuss these issues.Design/methodology/approach – 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 persons 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 anal...

Using explanatory models in the care of a person with intellectual disabilities

Purpose – This case study seeks to explore the differences between carer and professional perspectives in the assessment and treatment of a young man with intellectual disabilities, autism and mental health problems.Design/methodology/approach – The opinions and perspectives of psychiatrists involved in the care and treatment of “S” and “S”s mother about the aetiology, course, treatment and prognosis of “S”s condition, are explored using “explanatory models”.Findings – This paper shows the similarities and the differences of opinions and perspectives about the mental health care of a person with intellectual disabilities.Originality/value – It shows how the explicit comparison of notions about a persons condition, assessment and treatment may help all involved to work together for the common ground of achieving the best outcomes for service users.

A community supervision order for a person with learning disabilities and severe mental health problems

We describe how Supervised Discharge (Section 25) of the Mental Health Act 1983 was used to promote mental health care in the community for a man with mild learning disabilities and paranoid schizophrenia who has had repeated relapses and hospital admissions. The new compulsory Community Treatment Order in England and Wales introduced by the Mental Health Act 2007 is explored in comparison with Section 25 Supervised Discharge, which it has now replaced, and compared with similar legislation already introduced in Scotland. The practice implications of the new supervised community treatment orders are discussed.