Advances in Mental Health and Intellectual Disabilities

Emerald Group Publishing Limited
Publication date:

Latest documents

  • Psychodynamic psychotherapy in severe and profound intellectual disability

    Purpose: Psychodynamic psychotherapy is increasingly adapted and used with individuals with intellectual disability (ID) and mental health difficulties. However, the evidence base is still small and largely based on case studies and small trials whose participants mainly have mild to moderate ID. This paper aims to review and critique the literature in regards to the adaptations; and the effectiveness of psychodynamic psychotherapy for those with severe and profound ID. Design/methodology/approach: A systematic literature search of PsycINFO, Social Policy and Practice, Medline, Cumulative Index to nursing and allied health literature and applied social sciences index and abstracts was conducted. Six studies met inclusion criteria and underwent a quality evaluation and critical review. Findings: Six papers (all case studies) met inclusion criteria and underwent a quality evaluation and critical review. Some adaptations to therapy were reported, such as a more flexible therapeutic frame and increased use of the physical environment as a therapeutic tool. Due to significant methodological weaknesses of the included studies, it is yet unclear whether psychodynamic psychotherapy is an effective intervention for individuals with severe and profound ID. Research limitations/implications: Only a small number of case studies met the inclusion criteria. Further research should use more robust outcome measures, larger samples and compare psychodynamic psychotherapy to alternative interventions. Originality/value: This paper is the first to review the psychodynamic psychotherapy literature with regard to its effectiveness as a treatment specifically for individuals with severe and profound ID and mental health difficulties.

  • DBT and intellectual disabilities: the relationship between treatment fidelity and therapeutic adaptation

    Purpose: There is growing literature on the application of Dialectical Behaviour Therapy (DBT) with adults with intellectual disabilities (IDs). To draw upon the evidence-base from mainstream approaches, adapted interventions must remain true to their theoretical foundations and retain key components. The purpose of this paper was to establish the extent to which DBT has been adapted for adults with ID, and whether existing adapted protocols can still be considered DBT. Design/methodology/approach: The theoretical underpinnings and key components of DBT were identified. Six DBT studies were critiqued according to these criteria. Findings: In terms of content, only one intervention comprised all necessary elements. All of the remaining interventions included a skills group; two included individual therapy and another two included group consultation. None of the remaining interventions provided 24-h telephone support. Furthermore, none of the studies explicitly described using dialectical strategies. Originality/value: To the best of the authors’ knowledge, this is the first paper to critically examine the evidence-base for the use of DBT in ID, particularly its fidelity.

  • Does training adequately equip psychiatrists for intellectual disability?

    Purpose: People with intellectual disability (ID) experience significant health and social inequality compared to their non-disabled peers. Individuals with ID who access mental health services can have complex comorbidities and presentations. In the UK, a significant proportion of individuals with ID are supported within general adult mental health services not by specialist ID teams. The purpose of this study is to explore whether psychiatry trainees in the Maudsley Training Programme (MTP) feel adequately skilled to support individuals with ID. Design/methodology/approach: An online survey of trainee psychiatrists in the MTP was completed to evaluate self-perceived skills and knowledge in the care of individuals with ID in mental health services. Statistical analysis of the results was completed. Findings: Experience of working in specialist ID teams is positively associated with greater confidence and skills among trainees in the care of people with ID; this is beyond what would be expected based on seniority alone. Research limitations/implications: The response rate was 16.7 per cent; a larger sample size would add strength to the study. Like all online surveys, there exists the risk of selection bias. Practical implications: UK Policy states that people with ID should be supported to access mainstream services where possible, including psychiatric care. Practical experience for all psychiatry trainees involving specialist ID services and people with ID could improve the care given to that particularly disadvantaged group. Originality/value: This is the only paper known to the authors that has focused specifically on the skills and knowledge of psychiatry trainees in the UK with regards to ID.

  • Dynamic support database clinical support tool: inter-rater reliability

    Purpose: The dynamic support database (DSD) clinical support tool structures the risk of admission rating for individuals with intellectual disabilities. This study aims to investigate inter-rater reliability between multi-disciplinary health care professionals within the North West of England. Design/methodology/approach: A small-scale quantitative study investigated reliability between raters on the DSD clinical support tool. A data set of 60 rating tools for 30 individuals was used. Descriptive statistics and Kappa coefficient explored agreement. Findings: The DSD clinical support tool was found to have strong inter-rater reliability between individual items and the differences between individual scores were spread suggesting variance found could not be attributed to specific questions. Strong inter-rater reliability was found in the overall ratings. Research limitations/implications: Results suggest the DSD clinical support tool provides stratification for risk of admission ratings independent of who completes it. Future studies could investigate inter-rater reliability between organisations, i.e. health and social care professionals, and use a larger data sample to ensure generalisability. Replication of the study within child and adolescent services using the children’s DSD clinical support tool is also recommended. Originality/value: The DSD clinical support tool has been implemented within the child and adult intellectual disability services across the North West. As more teams across England consider its implementation, the study provides reassurance that coding agreement is high, allowing for stratification for risk of admission independent of the rater.

  • An exploratory factor analysis of HONOS-LD scales

    Purpose: The purpose of this study is to identify clinically meaningful groups of Health of the Nation Scales Learning Disabilities (HONOS-LD) single-item scales that might be used as short scales that are more reliable than single-item scale scores and more focused than the sum of scale scores. The single-item scales are likely to be unreliable in many applications. The sum of scale scores is a heterogeneous measure that is not a good representative of any specific difficulties that people who have intellectual disabilities may have and the effects of interventions on any specific difficulties may be masked by fluctuations in the ratings of other scales. Design/methodology/approach: A total of 2,109 pseudonymised complete HONOS-LD ratings were factor-analysed using principal factor extraction and oblimin rotation. Three-, four- and five-factor rotated patterns were examined. Findings: Three factors that each have three or more strong loadings (≥|0.50|) were identified that jointly included 11 single-item scales: one representing problems with cognitive competencies, one representing depressive phenomena or other mood problems and one representing problems with social competencies. A weaker factor that represents behaviour that challenges services is indicated; it includes five single-item scales. Both the cognitive competencies and social competencies groups of items were also reported in a previous study by Skelly and D’Antonio (2008) and may be stable. The present study’s factor representing behavioural difficulty has some similarity to Skelly and D’Antonio’s “functional behaviour and attachment disturbance” group. In other respects, the present study and the previous study differ. Research limitations/implications: The outcomes of these factor analyses indicate that some of the single-item scales can be combined into groups. However, the specific groups found in this study must be regarded as possibly unstable because of the likelihood of weak inter-rater reliability in HONOS-LD data and differences between this analysis and Skelly and D’Antonio’s. Further research is needed to support or modify them. Practical implications: The cognitive competence and social competence groups of items may be used as subscales if they are convenient. The groups representing mood and behavioural problems should be supported by further research before being used. Originality/value: This is the second published factor analysis of the HONOS-LD and includes a much larger data set than the first. It has some similarities to and differences from the first and is a further step in the process of identifying useful groupings of HONOS-LD single-item scales.

  • Knowledge of mental capacity assessment in staff working with people with learning disabilities

    Purpose: The purpose of this paper is to evaluate staff knowledge of Mental Capacity Act (MCA) capacity assessments within the Learning Disabilities division of a Mental Health and Learning Disabilities Trust. The limited research available suggests staff knowledge tends to be poor, particularly concerning who is the decision maker. Design/methodology/approach: A 12-item multiple choice questionnaire, which reflects the five core principles of MCA (2005), was developed. Questionnaires were completed by 262 health and social staff members who support people with LD. Findings: Results show high variability of MCA capacity assessment knowledge within the LD division. However, qualified staff and those from health services scored significantly higher across all categories on the questionnaire compared to non-qualified and social care staff, respectively. On average, all staff scored poorly when asked to identify “who is the decision maker?” in a case scenario question. Research limitations/implications: The main limitation is that we did not collect data on how many previous capacity assessments and discussions each person had been involved with. The findings clearly suggest current methods of training lack efficacy in helping staff apply MCA knowledge to their clinical work. Originality/value: Compared to past literature, this study utilised a novel and more comprehensive questionnaire. This focused on case scenario questions to assess staff situational judgement. In addition, the findings add to a sparse evidence base that provides a foundation for future research.

  • Self-reported experiences of intimate partner violence in a female forensic intellectual disability population

    Purpose: Intimate partner violence (IPV) is a complex public health and social issue. Women with an intellectual disability (ID) are at greater risk of experiencing IPV. However, little is known about the IPV experiences of women with an ID and forensic care needs. The purpose of this paper is to explore the history of experienced and perpetrated IPV in women detained to secure specialist ID forensic service. Design/methodology/approach: Participants completed the Conflict Tactics Scale-2 (CTS-2, Straus et al., 1996). The CTS-2 measures experienced and perpetrated relationship tactics of common forms of IPV. Findings: Participants reported high levels of experiencing and perpetrating IPV across all relationship tactics measured by the CTS-2. Participants reported they engaged in similar levels of experiencing and perpetrating positive and negative relationship tactics. The only significant difference was “minor sexual coercive behavior” where participants were significantly more likely to experience than perpetrate this behaviour. Research limitations/implications: Further research exploring the risk factors that contribute to IPV is needed. Shortcomings in the current study are acknowledged. Practical implications: Women with an ID and forensic profiles may present with treatment needs as victims and perpetrators of IPV. Clinical activities of women in Forensic ID services should include possible IPV care needs. The importance of developing national guidance and interventions to prevent and manage IPV are discussed. Originality/value: This is the first paper, to the authors’ knowledge, to explore experiences of IPV in women with an ID and forensic care needs.

  • Enhancing care: simplified clinic letters

    Purpose: The purpose of this paper is to examine the content and style of clinic letters written by psychiatrists and to compare these with national guidelines and standards. To then consider the impact that writing directly to patients and carers has on their feeling of inclusion and understanding via a questionnaire. Design/methodology/approach: Two audits were completed, the first was carried out in 2012 and the second during 2014 with both being over a three-month period. The first 50 clinic letters sent out during these periods were examined using an audit tool that was developed using national standards from the Department of Health and the Royal College of Psychiatrists. A questionnaire was then devised in 2016 and sent to patients and carers regarding their views on the simplified clinic letters that were written directly to them. Findings: In the original audit none of the letters were simplified and written to the patient whereas in the re-audit 66 per cent were simplified. The questionnaire sent out to patients and carers revealed that 50 per cent of patients felt that the simplified letter helped them to feel more included and gave them a better understanding of their care. Originality/value: This paper highlights the potentially positive impact of writing simplified clinic letters directly to patients with intellectual disability and their carers. It also includes a clinic letter format designed so that medical information is not lost in the written communication and so that the service’s workload is not impacted on by having to write two separate letters to the patient and to their GP.

  • Two cases of Acceptance and Commitment Therapy leading to rapid psychological improvement in people with intellectual disabilities

    Purpose: The purpose of this paper is to show that Acceptance and Commitment Therapy (ACT) may have utility with this client group in routine clinical practice. Design/methodology/approach: This uncontrolled double case study describes the targeting of ACT processes with people referred to a mental health service for people with intellectual disabilities because of distressing intrusive thoughts. It includes qualitative data to illustrate the opinions of the participants eight weeks after the end of therapy. Findings: Both clients described rapid relief from distress, with some additional untargeted benefits emerging too. The participants provided follow-up qualitative data in which they described how the therapy had helped them as well as areas where it had not. Research limitations/implications: This paper presents uncontrolled case studies selected from routine clinical practice. They were selected due to their similarity of outcome and will not represent the experience of every client treated this way. Practical implications: The practical implications are that a therapy often considered to rely on the use of metaphors and the manipulation of complex metacognitions may be useful for people with more limited verbal and cognitive ability if the therapy is adapted to meet their level of ability. Originality/value: There has been very little published on using ACT with an intellectual disabilities population. This paper has originality value in that it illustrates the application of the approach in routine clinical practice. Additionally, the qualitative follow-up allows the participants’ voices to be heard about their experience of this approach.

  • Establishing the concurrent validity of the Clinical Outcome in Routine Evaluation-Learning Disabilities scale

    Purpose: Individuals with an intellectual disability (ID) develop mental health difficulties at similar rates to individuals in the general population. Using Patient Reported Outcome Measures can help track deterioration and improve the outcomes of individuals seeking help for their difficulties. The Clinical Outcome in Routine Evaluation-Learning Disabilities (CORE-LD) is a multi-trait measure of psychological distress which has shown moderate test-rest reliability. However, the CORE-LD is yet to be validated for the population it was designed for. Therefore the purpose of this paper is to establish the concurrent validity of the CORE-LD in a population of individuals with a diagnosis of mild–moderate ID. Design/methodology/approach: Participants with a diagnosis of mild–moderate ID, as well as other co-morbidities, were recruited from two UK inpatient hospitals and asked to complete the CORE-LD and its general population counterpart the Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM). Findings: Statistically significant differences were found regarding the CORE-LD across gender, with females scoring higher on the CORE-LD than males. There was no significant difference between security levels. The overall mean scores on each measure were moderately correlated. The data from this analysis suggest a significant positive correlation (rs=0.68). Originality/value: This initial study’s findings have demonstrated the CORE-LD may have concurrent validity, and further replication studies in larger and more diverse samples are needed.

Featured documents

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT