Janelle Weise

Preparedness and training needs of an Australian public mental health workforce in intellectual disability mental health

ABSTRACT Background: Australian publicly funded mental health services play a significant role in the assessment and management of mental illness for people with intellectual disability. However, there is limited knowledge on their preparedness to meet the needs of this population. Method: Public mental health professionals (n=566) completed an online survey that explored their attitudes, confidence, and training needs in the area of intellectual disability mental health. Descriptive analyses were undertaken. Results: Participants agreed that people with intellectual disability have the right to receive good mental health care, and have the same access to their service. They viewed treating them as part of their role, but given the resources available it was not possible to provide comprehensive care. Participants reported low confidence in key clinical areas and insufficient training. Conclusions: A comprehensive workforce development strategy is required to facilitate the engagement and capacity of public mental health professionals in this area.

Primary health care for people with an intellectual disability: an exploration of consultations, problems identified, and their management in Australia

Background People with an intellectual disability (ID) have more complex and different patterns of health care needs than the general population. They experience a greater burden of multi‐morbidity, high levels of undetected and unmanaged health issues, and premature mortality than the general population. Primary care has a key role in the health care of people with an ID. Currently, very little is known about the consultation type and length, problems managed, and how general practitioners (GPs) manage these problems for people with an ID compared with the general population. This information would provide valuable insights into how GPs are achieving the health guidelines and facilitating people with an ID to achieve the highest attainable standard of health. Methods A secondary analysis of data was collected from January 2003 to December 2012 from the Bettering the Evaluation and Care of Health (BEACH) programme. Consultation type, consultation length in minutes, problem(s) managed during the consultation, medications, treatments provided, and referrals made, pre and post age‐sex standardisation, at all GP encounters with people identified in the encounter record as having an ID (‘ID’ encounters, n = 690) were compared with those at ‘non‐ID’ encounters (n = 970 641). Statistical significance was tested with 95% confidence intervals. Results This study identified significant differences in consultation types, consultation length, problem(s) managed during the consultation, medications, treatments provided, and referrals made at ‘ID’ encounters compared with ‘non‐ID’ encounters. ‘ID’ encounters had more indirect encounters, longer consultations, more problems managed, but an under management of common health conditions in people with an ID. Administrative rather than medically related actions dominated clinical treatments for people at ‘ID’ encounters, and they received fewer procedural treatments, referrals to specialists, and medications compared with those at ‘non‐ID’ encounters. Conclusion The significant differences in consultations, problems identified and managed suggest that GPs may require additional support to (1) identify and manage common medical conditions experienced by people with an ID; (2) manage the increased time required for consultations; and (3) directly consult with people with an ID. Further research is required to determine why GPs managed problems in a significantly different way for people with an ID.

Establishing core mental health workforce attributes for the effective mental health care of people with an intellectual disability and co‐occurring mental ill health

BACKGROUND People with intellectual disability experience high rates of mental ill health but multiple barriers to access to quality mental health care. One significant barrier to access is a generalist mental health workforce that lacks capacity, and consensus on what constitutes core workforce competencies in this area. As such, the first step in developing a comprehensive strategy that addresses these barriers is to define the core mental health workforce attributes. METHODS Thirty-six intellectual disability mental health experts from across Australia participated in a modified online Delphi which aimed to reach consensus on the core attributes required of the generalist mental health workforce. At the end of each Delphi round, descriptive analyses and thematic analyses were completed. RESULTS Consensus was reached among the participants for 102 attributes across 14 clinical domains. The results highlighted specific attributes in all areas of clinical practice, especially for communication (e.g., utilizes assistive communication technology), assessment (e.g., assess contributing factors to behaviours) and intervention (e.g., uses integrative interventions). CONCLUSION A comprehensive strategy is required to facilitate the generalist mental health workforce to obtain these attributes.

What makes generalist mental health professionals effective when working with people with an intellectual disability? A family member and support person perspective

BACKGROUND Generalist mental health professionals are inadequately equipped to meet the rights of people with intellectual disability. A better understanding of the attributes of effective professionals may assist in the development of workforce capacity in this area. METHODS Twenty-eight family/support persons of people with intellectual disability participated in four focus groups. Thematic analysis was undertaken applying the Intellectual Disability Mental Health Core Competencies Framework. RESULTS Participants described attributes that aligned with current professional expectations such as working together and new attributes such as differentiating between behaviour and mental health. An unexpected finding was the need for professionals to be able to infer meaning by interpreting multiple sources of information. Participants also wanted professionals to acknowledge their professional limitations and seek professional support. CONCLUSION Family/support persons identified a range of attributes of effective mental health professionals to support people with intellectual disability. Further research is necessary, particularly from the perspective of people with intellectual disability.

Development and dissemination of a core competency framework

Purpose The purpose of this paper is to describe and critique the methodology used to develop a core competency framework for mental health professionals working with people with an intellectual disability and co-occurring mental ill health. Design/methodology/approach A multi-phase, multi-method design was used to collect qualitative and quantitative data, including a scoping survey, modified online Delphi, and consultation with multiple stakeholders. The implementation phase involved a launch forum and workshop, toolkit development, and evaluation strategy. Findings Results from the scoping survey and consultation process informed the development of a core competency framework with 11 domains. An accompanying toolkit was also developed with practical guidance to assist with the implementation of the core competencies. In total, 93 professionals attended the launch forum, and the framework has been downloaded 998 times during the first year it has been available. Research limitations/implications Detailed information specific to each profession cannot be included when a whole of workforce approach is used. The ways in which to use the framework in conjunction with other core competency frameworks is discussed. Practical implications This framework can be utilised by mental health workers including clinicians, managers, service developers, and educators, from multiple professional backgrounds. The approach taken can also be used by others to develop similar frameworks. Originality/value This is the first core competency framework, to the authors’ knowledge, specifically designed for public mental health professionals from varied backgrounds working with people with an intellectual disability. Consulting with multiple stakeholders, not just experts, elicited new information that may otherwise have been overlooked.

Who provides primary health care for people with an intellectual disability: General practitioner and general practice characteristics from the BEACH dataset

ABSTRACT Background People with an intellectual disability (ID) have complex healthcare needs yet experience barriers to participation in primary care. Further research is required to examine if the characteristics of general practitioners (GPs) and their practices influence their delivery of care to people with ID. Methods Data from the Bettering the Evaluation and Care of Health program was used to determine if there are significant differences in the ID-GP and Non ID-GP group. Analysis included characteristic-specific rates, chi-square, and odds ratios. Results This study found that GPs who were Australian medical graduates, practising in rural areas, in accredited practices, and in some states of Australia were significantly more likely to be classified to the ID-GP than the Non ID-GP group. Conclusions This research suggests that certain GP and practice characteristics may present barriers to primary care participation for people with ID and supports the need for a comprehensive national action framework.

What Can the Experiences of People With an Intellectual Disability Tell Us About the Desirable Attributes of a Mental Health Professional

ABSTRACT Introduction: Mental health professionals have reported that they have limited knowledge, skills, and confidence in the area of intellectual disability mental health. This article aims to learn from the experiences of people with intellectual disability about the attributes that may assist mainstream mental health professionals to provide them with a quality mental health service. Methods: Six people with intellectual disability participated in an interview or focus group. Thematic analysis was undertaken applying the Intellectual Disability Mental Health Core Competencies Framework. Results: The findings supported previous research for the need for mental health professionals to be adaptable, able to communicate, and work with a person’s support network. The study reinforced the need for professionals to undertake professional development in the area but also suggested that people with intellectual disability be included as educators and as peer workers. New attributes were identified, including the need for mental health professionals to be able to build rapport and trust through demonstrating their experience and respect for working with people with intellectual disability, and their ability to understand trauma and how it may influence mental health needs. Conclusions: The attributes identified in the study could be used to inform an intellectual disability mental health workforce development framework.

Building workforce capacity in Australia and New Zealand: a profile of psychiatrists with an interest in intellectual and developmental disability mental health:

Objective: To describe the characteristics of psychiatrists working in the area of intellectual and developmental disability mental health (IDDMH) across Australia and New Zealand. Methods: A secondary analysis of data collected by the Royal Australian and New Zealand College of Psychiatrists 2014 workforce survey. Characteristics of the IDDMH workforce (n=146 psychiatrists) were compared with those of the broader psychiatry workforce (n=1050 psychiatrists). Results: The IDDMH workforce were more likely than the broader psychiatry workforce to be working across both the public and private health sectors, be engaged in outreach work, endorse specialty practice areas pertinent to IDDMH, treat younger patients and work more clinical hours per week. Part-time status and retirement plans of the IDDMH workforce matched those of the broader psychiatry workforce. Conclusions: While some elements of the IDDMH workforce profile suggest this workforce is tailored to the needs of the population, the potential shortage of IDDMH psychiatrists highlights the need for the development of a specific training programme and pathway in this area.