Advances in Mental Health and Intellectual Disabilities

Emerald Group Publishing Limited
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  • Development, use and evaluation of a web based mental capacity assessment tool for staff working with people with learning disabilities

    Purpose: This paper aims to describe the development, use and evaluation of a web-based mental capacity assessment tool (MCA WAT) within the Learning Disabilities division of a Mental Health and Learning Disabilities Trust in England. Design/methodology/approach: The MCA WAT was developed to ensure there was contemporaneous recording of each capacity assessment; help staff improve their knowledge, confidence and satisfaction in completing assessments of capacity; and analyse the number and type of capacity assessments completed. Three questionnaires were developed: a 12-item multiple-choice knowledge questionnaire, a nine-item confidence questionnaire and a 10-item satisfaction questionnaire, which reflect the five core principles of the MCA (2005). Eight-five health and social care staff who were trained to use the MCA WAT and had used it at least once had their scores from pre- and post-use of the questionnaires analysed using Wilcoxon signed-ranks tests. Data on the use of the MCA WAT was analysed. Findings: Results showed a significant increase in knowledge, confidence and satisfaction from pre- to post-questionnaires. Concerns remain regarding staff understanding of who is the decision maker and the use of communication aids to enhance capacity. These issues are being addressed through training and updating the information boxes in the MCA WAT. The MCA WAT has been used to complete 3,645 capacity assessments over a five-year time scale, covering a wide range of decisions. Originality/value: This project demonstrates the effectiveness of a contemporaneous method of conducting and recording MCA assessments.

  • Individuals with intellectual disabilities experiences of the therapeutic relationship

    Purpose: This research aimed to explore individuals with intellectual disabilities (ID) experiences of the therapeutic relationship. Design/methodology/approach: Six individuals with ID were recruited who were currently having 1:1 therapy. Semi-structured interviews focused on their experiences of the therapeutic relationship. Findings: Using interpretative phenomenological analysis, six personal experiential themes were identified. These were labelled as a person-centred experience, the importance of adaptions, “I feel like I know you”, a secure base is offered, change does occur and an overlap of subjective experience. The results indicate that participants’ accounts of their experiences indicated that the relationship was important to them. This research also demonstrated that the benefits and value of involving individuals with ID in qualitative research. Originality/value: To the best of the authors’ knowledge, exploring the therapeutic relationship from the perspective of individuals with ID has not been previously explored in the literature. This research highlights considerations for therapists working with this population to help them facilitate positive therapeutic outcomes.

  • Intellectual disability and autism in adults influence psychological treatments for mental health comorbidities

    Purpose: The purpose of the study was to examine whether there were differences in the provision of non-pharmacological interventions based on the level of intellectual disability and the presence or absence of autism. Mental health conditions are often underdiagnosed in adults with intellectual disability and do not always receive psychological interventions as recommended by the National Institute for Health and Care Excellent guidelines. To realise the national UK programme’s aim of stopping the overuse of medications in people with intellectual disability, it is important that these individuals have access to appropriate non-pharmacological interventions. The authors examined the relationship between an individual’s level of intellectual disability and the presence or absence of autism with access to relevant non-pharmacological interventions from specialist community intellectual disability services. Design/methodology/approach: A cross-sectional study of adults accessing four specialist intellectual disability services in North West England in 2019. Findings: There was a high prevalence of mental health comorbidity, even higher for autistic adults. However, a relatively small percentage of the study population was receiving psychological interventions. The most frequent non-pharmacological intervention was a positive behaviour support plan, irrespective of comorbid mental illnesses. Research limitations/implications: Not having access to psychological interventions for the treatment of mental illness could result in poor health outcomes and increasing health inequalities. The study highlights the need for developing psychological interventions, particularly for those with moderate to severe intellectual disability and for those with associated autism. Originality/value: This large sample study examined the relationship between intellectual disability level and the presence of autism with accessing psychological interventions.

  • Examining the relationship of age with fears among adolescents and young adults with and without intellectual disabilities

    Purpose: This paper aims to examine for differences in potentially productive fear versus all other fear scores comparing adolescents and young adults with intellectual disabilities versus their typically developing peers without intellectual disabilities while statistically controlling for chronological age. Design/methodology/approach: The authors examined for differences in potentially productive fear scores versus all fear scores comparing adolescents and young adults with intellectual disabilities versus their typically developing peers without intellectual disabilities. Findings: Results of the current study highlight the importance of examining and statistically acknowledging the form of the relationship between age and fear. As previous research has indicated the relationship of age with fear, this form of the relationship should be acknowledged in subsequent analyses. Results also present a conceptualization of fear with some fears being considered as potentially productive fears as it relates to independent living. Research limitations/implications: As previous research has indicated the relationship of age with fear, this form of the relationship should be acknowledged in subsequent analyses. Finally, results present a conceptualization of fear with some fears being considered as potentially productive fears as it relates to independent living as an outcome. Practical implications: The current study presents a conceptualization of fear with some fears being considered as potentially productive fears as it relates to independent living as an outcome. Originality/value: Results support that potentially productive fears can be considered fears that can be used to promote learning that leads to independent living outcomes such as safety and security.

  • Informed consent with people judged incapable of legally consenting

    Purpose: The purpose of this study is to consider informed consent with those who may be legally judged incapable of consent. Frequently individuals with traumatic brain injuries and intellectual disabilities may fall into this category. This paper seeks to consider aspects of guardianship, moral and legal implications and best practices for mental health professionals. Design/methodology/approach: This practice piece reviews literature regarding informed consent, as well as pertinent issues in the professional literature regarding types of guardianship as well as the occurrence of “Lucid intervals.” Furthermore, literature from moral philosophy and current legal research was examined to fully provide readers with a grasp of the legal and ethical landscape of this issue. Findings: The paper finds that treating consent as a one-time binary event is lacking in both practicality and nuance. Moral philosophy and issues regarding paternalism are raised, as well as practice approaches to assessment of capability and how to engage in therapy in meaningful ways. Originality/value: This paper provides insight into providing dignity-affirming therapy with a population that is often not considered in the literature of mental health ethics. When it is considered, the suggestions are so vague as to be of limited use. This manuscript provides nuance and practical applications to be a therapist that promotes dignity in those who might have varying levels of capacity to consent.

  • Staff views on reflective practice groups in an inpatient assessment and treatment unit for people with intellectual disabilities

    Purpose: Although it is recommended that reflective practice groups (RPGs) are used to support staff in inpatient intellectual disability (ID) services, there is to date no research on their effectiveness or how staff perceive RPGs in these settings. This paper aims to evaluate staff perceptions of the RPGs in an assessment and treatment unit for people with ID and to ascertain the nature of any barriers for staff in attending the group. Design/methodology/approach: Thirteen staff completed questionnaires ascertaining their views on the purpose, process and impact of the RPG run within the service. Questionnaires included a version of the clinical supervision evaluation questionnaire (CSEQ; Horton et al., 2008) adapted for this context and a questionnaire designed by the authors examining barriers to attending the group. Findings: Staff responses indicated that they valued the group and perceived it as improving their clinical practice and their self-awareness. Staff did not always perceive group sessions as having clear aims and did not perceive the group as enhancing their well-being or their awareness of gaps in their skills. RPGs may be most effective if they form part of a service-wide approach to staff support and development. Originality/value: To the best of the authors’ knowledge, this is the first evaluation of RPGs in inpatient ID services. The adapted CSEQ was found to be an easily implemented method of evaluating RPGs in an inpatient ID setting.

  • Spanish validation of the Glasgow depression scale for people with intellectual disabilities (GDS-LD) and of the Glasgow depression care supplement scale (GDS-CS)

    Purpose: This study aims to validate a Spanish version of the Glasgow Depression Scale for Learning Disability (GDS-LD) and of the Glasgow Depression Care Supplement Scale (GDS-CS). Design/methodology/approach: The GDS-LD was administered to 120 adults with mild and moderate intellectual disabilities and the GDS-CS to the staff from their occupational workshops (n = 120) to detect symptoms of depression. Internal consistency, inter-rater reliability, test-retest reliability, criterion validity, construct validity and the feasibility and applicability of both scales were analysed. Findings: Both scales showed an adequate internal consistency (GDS-LD, a = 0.86) (GDS-CS, a = 0.88). Exploratory factor analysis revealed four well-defined factors in GDS-LD and three in GDS-CS. Pearson correlation analysis data has also been carried out with both tools for test-retest and inter-rater, showing good correlations. Research limitations/implications: In terms, of limitations, the participants were recruited from the same centre, so this could be a problem in terms of generalisation. In addition, the GDS-LD and GDS-CS scales were developed for people with mild and moderate ID; it would be worth it to develop a version for people with severe and profound disabilities. Practical implications: From its clinical perspective, it will be possible to have a specific tool that assesses the symptoms of depression in the Spanish population with ID. Furthermore, as it is a user-friendly scale; it can be administrated by both mental health and other professionals working in the field of disability. Originality/value: The Spanish version of the GDS-LD and GDS-CS showed adequate rates of feasibility and reliability to assess symptoms depression among Spanish speaking adults with mild and moderate ID.

  • Evaluating workforce needs for higher specialist training for psychiatry of intellectual disability in Kent, Surrey and Sussex: a workforce scoping service evaluation

    Purpose: Whilst recruitment and retention of high-quality staff is vital to providing a good service, at the time of the evaluations, Kent, Surrey and Sussex (KSS) was the only area of the UK without a Higher Specialist Training (HST) scheme in intellectual disability (ID). The purpose of this project was to identify barriers to recruitment and support the need for change. Design/methodology/approach: This evaluation included conducting interviews with 16 practitioners in the region with links to ID to consider the gaps in training and find solutions. Findings: Four themes were identified, namely, good experiences are important to recruiting people into the ID field; bad experiences or lack of exposure to people with ID are likely to prevent engagement with this field; there is an ongoing need for specialist psychiatrists in ID services; and there is a developing need for specialists in neurodevelopmental disorders. Finally, the challenge means we need to think differently about developing a workforce. Seven recommendations to support workforce delivery in KSS were developed. Originality/value: This paper highlights an important rationale for ongoing need for HST in ID work and also reasons to engage people in this field. This has not been undertaken in the ID field in this way previously.

  • Caregivers experiences of caring for people with intellectual disability and dementia: a qualitative evidence synthesis

    Purpose: A systematic review of the literature was completed to examine the needs of those who provide care to people with intellectual disability and dementia. The purpose of this paper was to develop an understanding of the complexities, challenges and support available to meet the needs of an ageing population. Design/methodology/approach: A qualitative evidence synthesis was used to appraise 12 studies. An evidence synthesis approach was used to better understand the challenges caregivers experience in caring for a person with intellectual disability and dementia. Aggregating and integrating findings from multiple studies allowed to identify inconsistencies, quality, relationships and trends to enhance the awareness of gaps in care provision. Findings: There were six main domains identified from the available literature which included: gaps in knowledge and skills, early identification of dementia and associated difficulties, managing behaviour, coping, burden of care and Impact on confidence. Originality/value: To the best of the authors’ knowledge, this is the first paper to use qualitative evidence synthesis to understand the challenges of caring for a person with intellectual disability and dementia.

  • Investigating the experience of professional carers supporting individuals with intellectual disability who were at risk of admission – a qualitative study

    Purpose: This study aims to understand the experiences of professional paid carers providing community support to people with intellectual disability “at risk of admission”. This study explores factors that were helpful or lacking in terms of the support the carers received from NHS health services during this time. Design/methodology/approach: This study conducted semi-structured interview with eight participants. Thematic analysis was used to analyse the data. Findings: Three main themes and ten subthemes were identified. The first main theme was “support systems” that were available or lacking for the client and their carers. The second main theme was “training and supervision” available to the carers and their team when the individual they supported needed additional support. The third theme was “change” clients encountered which included changes in the environment as well as changes because of COVID-19 pandemic. Originality/value: To the best of the authors’ knowledge, this is the first study on experiences of carers during specifically high stress periods, such as when the clients they are supporting are at risk of hospital admission.

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