Enriching the process of "good science" through participation of people with psychiatric disabilities in all aspects of research

The purpose of this study is to describe the experiences of researchers with a psychiatric disability participating in a project evaluating the services of Community Mental Health Centers (CMHCs) and to identify strategies for researchers with a psychiatric disability in mental health. A project coordinator and four researchers who were people with psychiatric disabilities were interviewed. The rationale for researchers with a psychiatric disability is discussed, and the facilitators of and barriers to them are described. People with psychiatric disabilities should be involved in formulating research questions, data collection, interpreting the results, identifying implications, and presenting the results to stakeholders. People with psychiatric disabilities' participation in CMHC program evaluation can promote service innovation and enhance people with psychiatric disabilities'satisfaction.     

Psychiatric disorder and disability in a rural community

This study examined the relationship between psychiatric disorder and disability in a rural community and the use of formal and informal services in the management of such disabilities. It was found that of the 26% of the surveyed population who obtained a positive current psychiatric diagnosis, 48.3% had required assistance in managing at least one activity of daily living. The majority of those seeking assistance in managing these functional problems did so from family and friends rather than from formal agencies. Psychiatric disorder was found to lead to disability as frequently as did physical disorder, with almost 50% of those who had experienced mental health problems reporting that they were currently unable to carry out at least one activity of daily living. The finding that assistance was sought primarily from family and friends raises important questions about the nature of psychiatric disorder as a public health problem. Accepted: 6 November 1997     

Perspectives of people with psychiatric disabilities on employment disclosure

The Americans with Disabilities Act (ADA) of 1990 protects people with disabilities from employment discrimination. Under the ADA, employers must accommodate the known disabilities of a qualified employee or applicant. For persons with psychiatric disabilities, which are often invisible, the individual is required to make a conscious decision regarding disclosing their disability to an employer. The decision to disclose is very complex because the person needs to consider the possibility of confronting stigma and negative stereotypes. A qualitative study including a focus group and individual interviews was conducted to gather data from people with psychiatric disabilities/labels regarding employment disclosure. Major findings include the significant impact of disability identity (does the participant think they have a disability), and the importance of appropriate job matching as a disclosure strategy.     

Deficient health and social services for elderly people with learning disabilities

Elderly people with learning disabilities have greater psychiatric morbidity than younger individuals, but a previous report has suggested that themajorityoftheformerdonot receive treatment All people with leaming disabilities aged 65 years and over living in Leicestershire, England (n= 134), and a random sample of adults with learning disabilities aged between 20 and 64 years (n= 73) were assessed for psychiatric disorders and service use. Elderly people received less day care, less respite care, and were less likely to have a social worker and receive input from most health services than the younger group. Chiropody was an exception. Those receiving psychiatric services did so through the leaming disabilities specialist services only. Those with an additional psychiatric disorder were more likely to receive services, but results still favoured the younger group. Services were better accessed by those living in residential care. Failure to access services may relate to carers attitudes and beliefs: in leaming disability settings, morbidity was attributed to ‘it's just old age’ in the elderly settings, morbidity was attributed to ‘it's because s/he has leaming disabilities’. The specialist health and social services need to take the lead in health promotion and education.     

Experience with post-secondary education for individuals with severe mental illness

There is a need for increased understanding and support of students with severe and persistent psychiatric disabilities in post-secondary education. Advancements in the pharmacological treatment of psychiatric disabilities are permitting a broader range of mental health consumers to reach a level of recovery allowing these consumers to begin or restart college careers (Eudaly, 2002). A post-secondary education is now considered a mandatory investment in the future ("Higher Education," 2003). There are a growing number of people pursuing higher education including those with serious mental illness. I am working on a Master's degree in a Rehabilitation Counselor Education program and face many obstacles due to my psychiatric disability, Bipolar Disorder.     

Effect of benefits counseling services on employment outcomes for people with psychiatric disabilities

OBJECTIVE: This study examined the impact of specialized benefits counseling services on levels of competitive employment for people with psychiatric disabilities receiving Social Security Administration (SSA) disability benefits in Vermont. METHODS: Beneficiaries who had a psychiatric disability and who received specialized benefits counseling (N = 364) were compared with matched contemporaneous and historical control participants over four years, two years before and two years after the initiation of the intervention. Study participants were consumers of vocational rehabilitation services, and the outcome measure was quarterly earnings from state unemployment insurance program records. Benefits counseling included general education regarding SSA disability programs, the various work incentives available under those programs, and other federal and state public benefits; individualized research and counseling regarding enrollees' current benefits packages; assistance in managing benefits through the transition to employment; and provision of information to supporting professionals. RESULTS: Participants who received specialized benefits counseling achieved significantly greater improvements in earnings. The benefits counseling group increased its adjusted average earnings by 1,256 dollars per year in comparison with the two control groups. CONCLUSIONS: Specialized benefits counseling appears to be an important employment support for Social Security Administration disability beneficiaries who have psychiatric disabilities.     

Psychiatric disorder in Asian adults with learning disabilities: patterns of service use

Asian and white Caucasian adults with learning disabilities seen by the Department of the Psychiatry of Learning Disabilities, Frith Hospital, Leicester, England, in 1991 were studied, Asian adults with learning disabilities were under-represented with respect to the local population (as measured by learning disability register), but not the population of individuals with learning disabilities known to the psychiatric services. Asians were significantly more likely to receive a psychiatric diagnosis, in particular that of psychosis, but there were striking similarities in the routes of referral, the number of contacts with the service and the range of defined disabilities.     

A survey of mental disability among state prison inmates

To obtain a comprehensive picture of the levels of mental disability in the general state prison population in New York State, the authors gathered data on a random sample of inmates using a survey instrument adapted from the state's level-of-care surveys of the psychiatric population. The sample consisted of 3,332 inmates in the general prison population (9.4 percent) and 352 inmates in prison mental health units. The survey results showed that 8 percent of the state's prison inmates have severe psychiatric or functional disabilities that clearly warrant some type of mental health intervention, and another 16 percent have significant mental disabilities that require periodic services. The specific nature and extent of these disabilities need to be assessed before appropriate services can be developed.     

Psychiatrists and psychiatric rehabilitation

Interventions that focus directly on functional impairments related to mental illnesses are termed psychiatric rehabilitation. Research demonstrates that rehabilitation services are increasingly able to help adults with psychiatric disabilities achieve the functional outcomes they desire, particularly in the areas of housing and employment. To support the community lives of adults with severe mental illnesses, psychiatrists must stay current with advances in this field and know how to integrate psychiatric rehabilitation with other interventions. This article reviews the concept of psychiatric rehabilitation, current approaches in the field, the psychiatrist's role in these services, and implications for psychiatric training and continuing education.     

Vocational rehabilitation in psychiatry: a re-evaluation

OBJECTIVE: To highlight the vocational gap in the provision of psychiatric rehabilitation, to outline the goals and conceptual framework of psychiatric rehabilitation, and to discuss rehabilitation interventions with specific reference to vocational rehabilitation and the evidence base for supported employment. CONCLUSIONS AND SERVICE IMPLICATIONS: Vocational psychiatric rehabilitation has been a neglected area of practice in Australian psychiatry. Psychiatric treatment needs to adopt a more balanced approach in the provision of a range of services, including vocational rehabilitation, in order to improve long-term outcomes for people suffering from psychiatric disability. A vocational focus should be included in psychiatric rehabilitation and better integration between mental health services and vocational services needs to take place. Supported employment is an evidence-based practice that is designed to help people with psychiatric disabilities participate as much as possible in the competitive job market.     

The positive impact of including students with intellectual disabilities in schools: Children’s attitudes towards peers with disabilities in Saudi Arabia

BackgroundThe purpose of this study is to examine the attitudes of Saudi students towards peers with disabilities. It examines how these attitudes are related to age, attending a school that includes students with intellectual disabilities, and having a relative with a disability.Methods and procedureParticipants included 357 elementary school male students (grades 3–6) who completed the Arabic version of the CATCH scale.Outcomes and resultsThe students presented positive attitudes towards peers with disabilities. Students in schools that included students with intellectual disabilities had more positive attitudes than other students. Older students were more likely to hold positive attitudes than younger students. Having a relative with a disability had no effect.Conclusion and implications The findings suggest that students generally hold positive attitudes towards children with disabilities. Moreover, including students with intellectual disabilities in schools associated with other students’ awareness about students with differing levels of abilities. Expanding schools to include children with disabilities in society in general will probably help increase the likelihood that they will be accepted and diminish the stereotypes that follow them.     

Can SSDI and SSI beneficiaries with mental illness benefit from evidence-based supported employment?

OBJECTIVE: Individuals with psychiatric disabilities are the fastest-growing subgroup of Social Security Administration disability beneficiaries and have negligible rates of return to competitive employment. Nevertheless, a new approach to vocational rehabilitation, termed supported employment, has increased the optimism regarding employment for this population. METHODS: Aggregating data from four randomized controlled trials of evidence-based supported employment for persons with severe mental illness, the investigators compared 546 Social Security Administration disability beneficiaries with 131 nonbeneficiaries. Three employment measures were examined: job acquisition, weeks worked, and job tenure. RESULTS: Beneficiaries receiving supported employment had better employment outcomes than those receiving other vocational services. Similar results were found for nonbeneficiaries. Overall, nonbeneficiaries had better employment outcomes than beneficiaries. However, the effect sizes measuring the improved outcomes with supported employment were similar for beneficiaries (d=.52-1.10) and nonbeneficiaries (d=.78-.89). CONCLUSIONS: Evidence-based supported employment could enable many Social Security Administration beneficiaries with psychiatric disabilities to attain competitive employment even though receipt of disability benefits operates as a barrier to employment.     

Predictors of Psychology Graduate Student Interest in the Field of Developmental Disabilities

This study examined predictors of interest in the future provision of clinical services to people with developmental disabilities by Canadian graduate students in psychology. Utilizing a cross-sectional survey, 458 psychology students from clinical, clinical neuropsychology, and counseling psychology programs from across Canada provided information on their interest in working with the population, their formal training experiences within the university, and their experiences outside the university. Formal training in school and informal experiences in the community were significant predictors of students' intention to work with clients with a developmental disability. The implications of these findings for training programs are discussed.     

Importance et enjeux du Double Diagnostic en milieu médicolégal

Among persons with an intellectual disability, several studies highlight the heterogeneity of psychiatric disorders. For years, Dual Diagnosis, the comorbidity between an intellectual disability and a psychiatric disorder is a key topic in the management of those persons. However, there are few studies on Dual Diagnosis among forensic inpatients. Those patients seem to present specificities in their psychopathological profiles. If forensic inpatients with intellectual disabilities are often seen as a homogeneous group, study results show differences of their profile between patients with intellectual disabilities with psychiatric comorbidity and those without comorbidity. In the light of these elements, different issues occur including an improved understanding of the specificities of patients with a Dual Diagnosis as well as for the care perspectives.     

Are primary health care staff aware of the role of community learning disability teams in relation to health promotion and health facilitation?

Research has identified that while people with learning disabilities often have greater health needs than the general population, they access primary care at the same rate or lower. Valuing People recommends that members of learning disability teams should take on a key role in supporting people with learning disabilities to access mainstream health services. They should be working with primary health care teams in a health facilitation and health promotion role. This study aimed to examine whether primary health care team members knew what services were provided by their local learning disability team, and in particular whether they used specialist learning disability workers to identify health care needs.     

Chinese cultural dynamics of unemployability of male adults with psychiatric disabilities in Hong Kong

Work and employment has long been regarded as crucial for the mental health of human beings. Unemployment may lead to deterioration of physical and mental health. Nevertheless, for adults with psychiatric disabilities, discontinuity of employment is common. They may have various reasons to discontinue their employment. In Hong Kong, only 2.5% of people with psychiatric disabilities discharged from sheltered workshops are able to seek open employment. By means of illustration, the authors will show that traditional Chinese work culture tends to reinforce the discontinuity of employment of adult males with psychiatric disabilities. In Chinese culture, work is a means to occupy time, control misbehavior, show consistency of words and deeds, and to glorify parents and ancestors. All these factors contribute to the fulfillment of an adult male role and identity in traditional Chinese culture. In this case history, instead of finding realistic employment, a male adult with psychiatric disability tried to indulge himself in what he felt was his ideal job to fulfill all requirement as an adult male in Chinese culture. The imaginative ideal job gave him excuses to discontinue open employment. Its implications to vocational rehabilitation with male adults with psychiatric disability are also discussed.     

Institutional affiliations of authors publishing research in Australian developmental disabilities journals

Research can contribute significantly to the improvement of services for persons with developmental disabilities. Therefore, it is important to document trends in the field of developmental disability research. Affiliations of authors publishing in Australian journals over several years were recorded to document the most productive centres of developmental disabilities research. Research on developmental disabilities emanated from a variety of centres in several countries. The 19 most productive centres were primarily universities in Australia, New Zealand, and the United States of America. This initial attempt to document trends in Australian developmental disability research may prove useful to granting agencies, service providers, and prospective graduate students.     

How central and connected am I in my family? Family-based social capital of individuals with intellectual disability

Using social network methods, this article explores the ways in which individuals with intellectual disability (ID) perceive their family contexts and the social capital that they provide. Based on a subsample of 24 individuals with ID, a subsample of 24 individuals with ID and psychiatric disorders, and a control sample of 24 pre-graduate and postgraduate students matched to the clinical respondents for age and sex, we found that family networks of clinical individuals are distinct both in terms of composition and in terms of social capital made available to them by their family ties. Individuals with ID perceive themselves as less central in their own family; their family networks are perceived as less dense, less centralized, and more disconnected. Individuals with intellectual disabilities and psychiatric disorders have less family-based social capital than individuals with intellectual disabilities only. The composition of their family is also distinct as spouses or partners and children are missing. We discuss the importance of those findings for research on family relationships of individuals with ID.     

Mental health services for people with intellectual disability in Israel--a review of options

Intellectual disability (ID) (often also referred to as "mental retardation," "development disability," "mental handicap," "learning disability" or as "generalized learning difficulties") is common in all countries. Many people with ID suffer from psychiatric/behavioral/emotional disturbances (known as "dual diagnosis"). Specialist psychiatric services are needed to address these problems effectively, but are not currently available in most countries, including Israel. This article sets out to describe the problems, current services in Israel, approaches in other countries and proposed solutions for Israel. We believe it important to enforce laws against discrimination based on disability, to raise the general awareness, knowledge and skills among generic mental health professionals on the topic of intellectual disability by inclusion in university, postgraduate and in-service training curricula, to work towards a form of subspecialty within psychiatry along the lines of the model in the United Kingdom and to establish specialized psychiatric services, possibly functioning as back-up to the generic psychiatric services.