Niki Edwards

Prevalence of intellectual disability and comorbid mental illness in an Australian community sample

Objective: The aim of this study was to bring to light the high prevalence of Australians affected by intellectual disability and comorbid serious mental illnesses. Results from a broad scale study are used to explore the reasons for this regularly overlooked phenomenon. Methods: This study was based on secondary analysis of data collected in the national ‘Disability, Ageing and Carers Survey, 1998’. The analysed data consisted of an Australian wide sample of 42 664 individuals living at home or in cared accommodation. Classification of intellectual disability and comorbid psychosis, anxiety and depressive disorder was based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Results: The prevalence of intellectual disability in the sampled population was 1.25%. Of these people 1.3% had a psychotic disorder, 8% had a depressive disorder and 14% had an anxiety disorder that had been present for at least 6 months and was of such severity that it too was disabling. Conclusions: Findings indicate that people with intellectual disability are at high risk of developing comorbid serious mental illness. Dual diagnosis is however, often overlooked due to difficulties associated with establishing a diagnosis of a mental disorder in people with an intellectual disability, a problem which is heightened when the individuals capacity to participate in a clinical assessment is limited.

Stress and burnout amongst professional carers of people with intellectual disability: another health inequity.

Purpose of review This paper summarizes trends in the research literature about stress and burnout in the lives of people who are the professional carers of people with intellectual disability. The principal time period considered was from 2004 to 2006. Recent findings Studies reviewed here focus on several themes including inequities affecting professional carers of people with intellectual disability and the possible effects of some models of care on inequities. Implications for people with intellectual disability are also considered. Summary The diaspora of people with intellectual disability into the community and their accompanying services found a whole new set of unpredicted and unprecedented challenges. Life in the community has rendered professional carers of people with intellectual disability more clearly vulnerable to stress and burnout for a variety of complex reasons, some identified and others as yet unrecognized. Lack of support and lack of role definition are particular problems. Presence of physical and mental health inequities result in major disparities in community care for people with intellectual disability.

Supporting People With an Intellectual Disability and Mental Health Problems: A Scoping Review of What They Say About Service Provision

This article reports on the findings of a scoping review of peer-reviewed research that investigates the formal support experiences of adults with an intellectual disability and mental health problems. Seven databases and 21 sources of grey literature were searched and 17 articles were retained for review, demonstrating the dearth of literature in this area. Key findings were organized in terms of service types studied and social justice issues. Findings indicate that people with an intellectual disability and mental health problems often experience distress and alienation in both mainstream and specialist psychiatric inpatient units, and in emergency departments. Since respect for personhood is central to positive experiences of formal support the significance of service users’ appeals to be treated with dignity and respect should not be underestimated. A new “integrated” model of inpatient care offers the potential of redressing some of the shortcomings of conventional care, but further research is needed. Despite well-documented challenges in conducting research with people with an intellectual disability, the authors conclude that the use of inclusive research designs must be expanded in order to enhance the formal support experiences of people with an intellectual disability and mental health problems.

Professional training for those working with people with intellectual disabilities and mental health problems

• Many, and in some countries most, health care professionals receive little training in the assessment, treatment and management of mental health problems in people with ID. • In the UK, ID is a compulsory component of the training of psychiatrists. This is not the case in the USA, Canada, Australia and Austria. • ID is included in some training programmes for psychologists, but clinical experience in the field is less available, is optional and usually post-qualifications. • Primary car physicians in all the countries reviewed receive little or no exposure to the health care needs of people with ID, including mental health, at both an undergraduate and postgraduate level. • Positive developments in training were evident in all the countries reviewed. these often are linked to charismatic individuals who pioneer the initiatives. • An infrastructure is necessary to support training, including national standards of care for people with ID and mental health problems, to drive accreditation and certification of courses, together with secure career paths.

Restrictive practices on refugees in Australia with intellectual disability and challenging behaviours: a family’s story

Purpose - The purpose of this paper is to explore the experiences of a refugee family navigating complex disability and restrictive practice service systems. Living with disability, or caring for someone with disability can compound the disadvantage and marginalisation already experienced by refugees. The nexus between disability and refugee status, particularly intellectual disability and restrictive practices, has received little scholarly attention and almost nothing is known of people’s experiences in this situation. Design/methodology/approach - Thematic analysis of a case study is used to illustrate the experiences of a refugee family in this situation. The case study presented was part of a larger ethnographic study exploring the experiences of people of refugee background living with disability. Findings - There were numerous barriers to accessing appropriate services. The family experienced high levels of stress simultaneously navigating the resettlement process and the disability service system. They were poorly informed and disempowered regarding the care of their loved one and the use of restrictive practices. Experiences in the country of origin, employment responsibilities, and unfamiliarity with the service system were key factors in this family’s difficulty in safeguarding the rights of their family member with disability. Originality/value - This case study examines the complexity experienced when disability intersects with refugee background. Areas for additional research and significant gaps in service provision are identified. The case study clearly demonstrates the importance of understanding people’s pre- and post-settlement experiences to inform policy and service provision.

Psychotropics and challenging behaviour in people with an intellectual disability.

Free to read on journal website (may need to create free account first) Hilmer and Gnjidic drew attention to the pharmacological management of behavioural problems in nursing home residents, and called for a reduction in inappropriate prescribing and the development of alternative management strategies.1 We extend these concerns to another vulnerable population — people with intellectual disability. Historically, this population is one of the most medicated groups in modern society.

Pretending to be authentic: challenges for students when reflective writing about their childhood for assessment

Abstract Critical reflection potentially allows social work and human service (SWHS) students to understand how past experiences can shape their future practice. This study of 20 Australian undergraduate SWHS students with a history of childhood adversity found reflective writing for this purpose was not a useful pedagogical practice. Rather than developing skills in critical reflection students found the task performative, linked to academic requirements, where they needed to display emotional containment. Consequently, SWHS academics need to examine reflective writing about childhood adversity for assessment as this process may not enable students to build skills in critical reflection that drive professional development.

Human-trafficking prevention is not “sexy”: Impact of the rescue industry on Thailand NGO programs and the need for a human rights approach

ABSTRACT “Raid and rescue” operations are aimed primarily at women and children in the sex industry and have proved popular with donors supporting anti-trafficking activities of nongovernmental organizations (NGOs). The popularity of this rescue industry leads to the diversion of funding, shifting focus away from other critical aspects of human trafficking (HT). This article discusses findings from qualitative research undertaken in 2014 with staff at Thai-based NGOs. This research explored the impact of the rescue industry on the implementation of sustainable anti-trafficking prevention programs and how a human rights perspective could do a better job of protecting victims. Findings suggest that the rescue industry is attractive to donors because it caters to stereotypical assumptions about HT, produces measurable outcomes and relies on the concepts of a hero, victim, and villain. This limited view fails to respond adequately to the complexities of HT, including irregular migrants who are trafficked, who fall outside the legislative framework they require for protection. There is pressure on NGOs to adapt their programs to meet donor desires. However, participants argue that NGOs active in this space need to adopt a contextual and holistic human rights approach that recognizes individuals and accommodates the complexity of HT.

Service user or service provider? How social work and human services students integrate dual identities

Abstract Students studying undergraduate social work and human services (SWHS) degrees may have used health and human service agencies, before and during their university education. Using services provides them with insights that are useful for professional practice. However, this article identifies that they experience a fear of shame and stigma revealing this during their studies. In examining interview data from 15 undergraduate SWHS students they recounted how they integrated their experience of being a service user into their professional development. It is argued that insider knowledge of services can provide them with valuable insights for practice. Students spoke about how positive experiences motivated them to study and provided models of effective practice, exemplifying its potential power to assist those in need. Negative experiences of service use can also be beneficial for learning what ‘not to do’. Although students found the experience of service use invaluable, they felt it was never acknowledged within the curriculum. Consequently, students interviewed in this study identified service users as ‘others’. They feared disclosing their own use of services due to perceived shame and stigma. Failing to provide opportunity for students to integrate their service user experience into their professional development creates a false dichotomy which does not acknowledge the intersection of these dual identities.

Childhood Adversity and Self-Care Education for Undergraduate Social Work and Human Services Students.

ABSTRACT Many students pursuing social work and human services courses have experienced adverse childhoods. This article focuses on their learning about self-care, an important skill for future practice. Interviews with 20 undergraduate students with a history of childhood adversity found unmet needs both for conceptualizing self-care and developing strategies to implement self-care in their day-to-day lives. Many cited limited role modeling and little importance placed on self-care during childhood. Teaching self-care is conceptualized as not only a core skill for practice but also an equity issue for students with a history of childhood adversity.