General psychiatric services for adults with intellectual disability and mental illness

BACKGROUND: Adults with intellectual disability (ID) and mental illness may use general or specialist psychiatric services. This review aims to assess if there is evidence for a difference in outcome between them. METHODS: A literature review was conducted using a variety of electronic databases and hand-search strategies to identify all studies evaluating the outcome of people with ID and mental illness using general psychiatric services. RESULTS: There is no conclusive evidence to favour the use of general or specialist psychiatric services. People with ID stay less time on general psychiatric than specialist inpatient units. People with severe ID appear not to be well served in general services. Older studies of inpatient samples suggest a worse outcome for people with ID. Novel specialist services generally improve upon pre-existing general services. Assertive outreach in general services may preferentially benefit those with ID. Recent studies suggest similar lengths of stay in general psychiatric beds for people with and without ID. CONCLUSIONS: Although 27 studies were located, only two were randomized controlled trials. The evidence is poor quality therefore further evaluation of services employing a variety of designs need to be employed to give more robust evidence as to which services are preferred.     

Health professionals' attitudes and emotions towards working with adults with intellectual disability (ID) and mental ill health

Objectives Mainstream mental health services are providing more care for individuals with an intellectual disability (ID); this has implications for staff and service users. Attitudes of staff towards people with ID in mental health services may be negative and negative staff attitudes may have a detrimental impact on service provision. Design A cross‐sectional design was used. Methods A questionnaire designed to investigate the attitudes and emotions of staff towards delivering mental health care to adults with ID was completed by 84 staff from mainstream and specialist ID services. Results Staff in both services experienced more positive emotions when working with clients whom they are currently employed to work with. When the frequency of contact with adults with ID, the number of individuals worked with and the amount of formal ID training received were considered, there was no significant difference between the attitudes of staff in both services. Positive correlations were found between attitude scores and positive emotional experiences in both services. Conclusions The research suggests that numerous factors, including the role of emotional experience and a number of environmental aspects, need to be considered in the context of providing mental health services to adults with ID to ensure the highest quality. Research limitations and clinical implications of the study are also considered.     

Lifestyle and health behaviours of adults with an intellectual disability

Background There is currently no published research in Ireland on the health behaviours of adults with an intellectual disability (ID). With an increasing age profile and similar patterns of morbidity to the general population, the ID population would benefit from baseline data from which to establish risk factors. Methods A questionnaire survey was carried out with 157 carers of people with an ID in the west of Ireland. Results The results of this survey were compared with results of a health survey for the general population in the same region. The present survey found that 68% of the ID sample was overweight or obese. Levels of smoking (2.6%) and regular alcohol consumption (10.3%) were relatively low in comparison with the general population. However, participation in exercise and adherence to a healthy diet were poor. The level of resident choice and decision‐making did not have any relationship to health behaviours nor did residential setting. Finally, there were no gender differences in health and lifestyle profiles. Conclusion The results of this study have important implications for health promotion interventions for people with an ID.     

Suicide amongst people with intellectual disability: An Australian online study of disability support staff experiences and perceptions

Background

Individuals with intellectual disability (ID) have a higher likelihood of exposure to identified risk factors for suicide when compared with the general community and have been recognised as being both capable of forming intent for suicide and acting on this intent. However, in spite of research outlining these concerns from the 1970s, there remains a dearth of studies that examine suicide amongst the population of people with ID.

Method

An online cross‐sectional survey was purposively developed, with questions aimed at identifying both the experiences and current practices of support staff who assist people with ID in relation to suicide, suicidal behaviour and suicide assessment. It was undertaken across both rural and metropolitan areas in Australia. The survey was open for a period of 12 months. A total of 139 respondents (109 female/30 male), with a mean age of 41 and an average 12 years of experience in supporting people with ID, completed the tool.

Results

A total of nine suicides by people with ID were reported. Seventy‐seven per cent of the respondents reported that they had individuals with ID display suicidal behaviours, and 76% noted that a person had specifically talked about wishing to end their life. Only four participants (3%) noted that they did not support individuals with a dual diagnosis of ID and mental health concern. Sixty per cent of participants reported that no one in their organisation had ever completed a suicide risk assessment, and only 28% reported that they would do a suicide risk assessment if an individual that they supported was diagnosed with a mental health issue.

Conclusions

The current findings indicate that support staff recognise the capacity of people with ID to conceptualise suicide, note the existence of suicidal discussions and behaviours and report on actual suicides. This represents one of the few Australian studies that has specifically considered suicide amongst this cohort of people and reinforces the fact that suicide is not unknown in this population. The data indicate a possible divide between the reports of people with ID actively talking about and acting on suicidal thoughts and the lack of any proactive use of any tools to assess for this risk.     

Psychiatrists' knowledge,training and attitudes regarding the care of individuals with intellectual disability

Background Psychiatrists are responsible for providing proper care for people with intellectual disability who have psychiatric disorders. This study examined psychiatrists' perceptions of their own training, knowledge and therapeutic skills, as well as their attitudes towards this population. Methods Questionnaires were distributed to 679 psychiatrists working within the public sector in Israel. Results Completed questionnaires were returned from 256 psychiatrists (38% response rate). Most (90%) participants reported having had limited training in the diagnosis and treatment of people with intellectual disabilities, while between 34% and 72% reported having inadequate knowledge in specific areas. Conclusion The findings of limited training and self‐perceived inadequate knowledge are at least partially explained by the service model, wherein people with intellectual disabilities are cared for by general mental health services. The identified inadequacies could be overcome through the implementation of a model in which specially trained psychiatrists are deployed within generic services.     

Validation of the attitudes toward intellectual disability – ATTID questionnaire

Background Individuals with an intellectual disability (ID) continue to experience major obstacles towards social, educational and vocational integration. Negative attitudes toward persons with ID has remained relevant over time and has led to discrimination and stigma. Objective The present study describes the development of a new questionnaire for tapping into the general population's attitudes toward individuals with ID and addresses its psychometric properties. Methods Adopting a multidimensional perspective, the Attitudes Toward Intellectual Disability Questionnaire (ATTID) was developed from a series of previously validated instruments and principles from the Montreal Declaration on Intellectual Disability (2004). The ATTID was administered by phone to 1605 randomly selected adult men and women, stratified by region in the Province of Quebec, Canada. Results The ATTID yielded a five‐factor structure overlapping the tri‐partite model of attitudes. The cognitive component was represented by two factors: knowledge of capacity and rights and knowledge of causes of ID. The affective component tapped into two factors: discomfort and sensitivity/compassion. Finally, the behavioural component emerged as a single factor. The ATTID had good internal consistency with Cronbach's alpha coefficients ranging from 0.59 to 0.89 for the five factors and of 0.92 for the overall questionnaire. Test–retest reliability yielded correlations from 0.62 to 0.83 for the five factors. Conclusion The ATTID can be used to measure attitudes among different populations and allows comparisons over time within the same population as a function of various intervention strategies for de‐stigmatising ID.     

Clinical outcomes of a specialised inpatient unit for adults with mild to severe intellectual disability and mental illness

Background   Limitations of general psychiatric services have led to the development of specialised psychiatric programmes for patients with intellectual disability (ID) and mental health needs. Few studies have examined treatment outcomes of specialised inpatient units, and no studies have explored how the effects of intervention may differ for individuals at varying levels of cognitive ability. The present study examined clinical outcomes of inpatients with mild ID in contrast to inpatients with moderate to severe ID within the same service.
Method   Thirty-three patients (17 with mild ID and 16 with moderate to severe ID) discharged between 2006 and 2008 from a specialised inpatient unit in Canada for adults with ID and mental illness were studied. In addition to examining change in scores on clinical measures, outcomes with regard to length of stay, diagnostic change, residential change and re-admission to hospital were explored.
Results   Both groups demonstrated clinical improvement from admission to discharge. However, only patients with mild ID demonstrated improvements on the Global Assessment of Functioning.
Conclusions   This study is one of the first to consider outcomes of higher and lower functioning individuals with ID on a specialised inpatient unit. Results suggest that outcomes may be different for these groups, and some clinical measures may be more sensitive to changes in patients with more severe disabilities.     

A computer-based interactive multimedia program to reduce HIV transmission for women with intellectual disability

Background Despite recent recognition of the need for preventive sexual health materials for people with intellectual disability (ID), there have been remarkably few health‐based interventions designed for people with mild to moderate ID. The purpose of this study was to evaluate the effects of a computer‐based interactive multimedia (CBIM) program to teach HIV/AIDS knowledge, skills and decision making. Methods Twenty‐five women with mild to moderate ID evaluated the program. The study used a quasi‐experimental within‐subjects design to assess the efficacy of the CBIM program. Research participants completed five qualitative and quantitative instruments that assessed HIV knowledge, and decision‐making skills regarding HIV prevention practices and condom application skills (i.e. demonstration of skills opening a condom and putting it on a model penis). In addition, 18 service providers who work with women with ID reviewed the program and completed a demographics questionnaire and a professional customer satisfaction survey. Results Women with ID showed statistically significant increases from pre‐test to post‐test in all knowledge and skill domains. Furthermore, the statistical gains were accompanied by medium to large effect sizes. Overall, service providers rated the program highly on several outcome measures (stimulation, relevance and usability). Conclusions The results of this study indicate the CBIM program was effective in increasing HIV/AIDS knowledge and skills among women with ID, who live both semi‐independently and independently, in a single‐session intervention. As the CBIM program is not dependent on staff for instructional delivery, it is a highly efficient teaching tool; and CBIM is an efficacious means to provide behavioural health content, compensating for the dearth of available health promotion materials for people with ID. As such, it has a potential for broad distribution and implementation by medical practitioners, and public health offices. People with ID are part of our society, yet continue to be overlooked, particularly in the area of health promotion. Special tools need to be developed in order to address the health disparities experienced by people with ID.     

Health status and use of medications by adults with intellectual disability in Western Australia

Background Evidence suggests that adults with intellectual disability (ID) are vulnerable to poor health outcomes. This paper describes the health status and medication use of adults with ID in Western Australia.

Method We conducted a cross-sectional survey by interview of 328 adults with ID (M age?=?37 years, range: 18–82) and their families/support persons (79% proxy or joint informants).

Results Although 90% of participants reported long-term health conditions (M?=?2.6, range: 0–10), including epilepsy, allergies, eczema, asthma, and mental health problems, three quarters of the participants (77%) described their health as good or very good. Younger participants (18–44 years) reported osteoporosis and stroke, conditions commonly associated with ageing, more often than the general population at those ages. Medication use was high, with 70% taking one or more medications (Mdn?=?3 medications, range: 0–21).

Conclusions Many participants reported that health problems affected their daily lives, yet the majority reported good health. Long-term health conditions were common and many people used several types of medications. Participants had poorer health than the Western Australian population overall. Careful monitoring of health conditions and regular review of medications are recommended to improve health outcomes for adults with ID.     

Parents of children with and without intellectual disability: couple relationship and individual well‐being

Background Research on parents of children with intellectual disability (ID) has identified a range of risk and protective factors for parental well‐being. In family research, the association between marital quality and depression is a vital field of investigation. Still little research has addressed how aspects of the couple relationship affect the adaptation of parents of children with ID. The present study examined predictive links between couple relationship factors (marital quality and coparenting quality) and individual well‐being. Methods Data were obtained through self‐report questionnaires completed by parents of children with ID (mothers, n = 58; and fathers, n = 46) and control children (mothers, n = 178; and fathers, n = 141). To test the hypothesis that couple relationship factors predicted individual well‐being, multiple regression analyses were performed controlling for the following risk factors identified by previous research: child self‐injury/stereotypic behaviour, parenting stress, and economic risk. Results Marital quality predicted concurrent well‐being, and coparenting quality predicted prospective well‐being. Mothers of children with ID reported lower well‐being than other parents. Conclusions There is a continued need for investigation of the details of the links between couple relationship and individual well‐being in parents of children with ID. Couple relationship factors should be given consideration in clinical interventions.     

The feasibility of psychomotor therapy in acute mental health services for adults with intellectual disability

Background Psychomotor therapy enables people to reflect on the relationship between experiences and feelings by starting from awareness of bodily responses rather than from awareness of emotion. In this study we examine PsyMot (ID), an assessment that directs this psychological therapy.

Method Twelve suitable consecutive admissions were recruited from a specialist intellectual disability (ID) assessment and treatment unit for adults. Video-recordings of PsyMot (ID) allowed assessment of interrater reliability (IRR). Treatment goals indicated by PsyMot (ID) were addressed using psychomotor therapy as part of a comprehensive program of interventions.

Results Psychomotor therapy was both feasible and popular with patients who participated without any adverse effects. Nine patients completed PsyMot (ID). IRR of the treatment goals identified by all 3 raters was good to excellent in 81% cases, but there were discrepancies for individual items.

Conclusions PsyMot (ID) and psychomotor therapy is feasible within this context, and enriched the clinical team's formulation. Further studies of reliability and efficacy should be undertaken.     

Emotional and behavioural problems in adolescents with intellectual disability with and without chronic diseases

Background   Adolescents with intellectual disability (ID) (ID-adolescents) and adolescents with chronic diseases are both more likely to have emotional and behavioural problems. The aim of this study was to assess the association between chronic diseases in ID-adolescents and emotional and behavioural problems in a large school-based sample.
Methods   We obtained data on 1044 ID-adolescents, aged 12–18 years, attending secondary schools in the Netherlands. Parents of the adolescents completed the Dutch version of the Strengths and Difficulties Questionnaire and questions about chronic diseases in their child and about the background of the child.
Results   Prevalence rates of emotional and behavioural problems were generally high in ID-adolescents with chronic diseases (45%), compared with ID-adolescents without chronic diseases (17%). The likelihood of emotional and behavioural problems was high in ID-adolescents with two [odds ratios (OR) 4.47; 95% CI: 2.97–6.74] or more than two chronic diseases (OR 8.01; 95% CI: 5.18–12.39) and for ID-adolescents with mental chronic diseases (OR 4.56; 95% CI: 3.21–6.47). Also ID-adolescents with somatic chronic diseases had a high likelihood of emotional and behavioural problems (OR 1.99; 95% CI: 1.33–2.99), in particular in the combination of somatic and mental chronic diseases (OR 5.16; 95% CI: 3.46–7.71).
Conclusions   The current study showed that chronic diseases in ID-adolescents, in particular mental chronic diseases, largely increase the likelihood of emotional and behavioural problems. This should be taken in the provision and planning of care for ID-adolescents.     

Comparison of attitudes to the sexual health of men and women with intellectual disability among parents,professionals, and university students

Background This study investigates whether parents, professionals, and university students have different sexual attitudes towards men versus women with intellectual disability (ID) and which factors are related to such attitudes among these three groups.

Method A self-administered survey using the ASQ-ID questionnaire was implemented, and 130 parents, 173 professionals, and 645 university students completed it.

Results University students showed more positive attitudes than parents and professionals. Parents were more likely to have a positive perception of men with ID than of women with ID with regard to “parenting.” Whether they were parents, professionals, or university students was not correlated with their attitudes; instead, their attitudes were associated with participants' age, education, and religion.

Conclusions Awareness of sexual rights related to people with ID, especially women with ID, needs to be discussed among parents and professionals, particularly those in old age, with a low level of education, and those who follow the Buddhist religion.     

Physical education teachers' attitudes towards children with intellectual disability: the impact of time in service,gender, and previous acquaintance

Background This study investigated attitudes towards teaching students with intellectual disability (ID) within a representative sample of secondary school physical education (PE) teachers, and to determine the effects of age, gender, teaching experience, and having acquaintance with ID and students with ID on their attitudes. Methods Participants were 729 secondary school PE teachers who worked in 81 major cities of Turkey. The Teachers Attitudes towards Children with Intellectual Disability Scale was administered. Results The statistical analysis revealed that there was no significant effect on factors and total attitudes scores of gender and having students with ID. Significant effects on factors and total attitudes score were found in teaching experiences and having acquaintance with ID. Conclusions It is encouraged to maintain and further develop in‐service education programmes of adapted physical activity for PE teachers.     

Social support and intellectual disabilities: a comparison between social networks of adults with intellectual disability and those with physical disability

Background   Social support has been identified as a major protective factor in preventing mental health problems and also as a major contributor to quality of life. People with intellectual disabilities (ID) have been identified as having limited social support structures. Interventions have been focused on promoting their social presence and integration. However, previous studies have shown that this does not always lead to the formation of social relationships. To date few studies have looked at how having an ID leads to impoverished social networks. This study aimed to do this by contrasting the social relationships of people with physical disabilities (PD) and people with ID.
Methods   Two groups of participants were recruited; 30 people with mild ID and 17 people with PD. Social and functional support networks were assessed, in addition to life experiences. Between and within group differences were then explored statistically.
Results   Adults with ID had more restricted social networks than PD, despite being involved in more activities. Social support for adults with ID was mainly provided by family and carers and few relationships with non-disabled people were identified. In contrast adults with PD had larger social networks than had been reported in the mainstream literature and had a balance of relationships with disabled and non-disabled people.
Conclusions   The results suggest that there are additional processes attached to having an ID, which lead to continued impoverished lifestyles. The findings also endorse other work that suggests being physically integrated and engaged in a wide range of activities does not guarantee good social and emotional support.