Editorial

Citation

Hara, S.H.a.J.O. (2014), "Editorial", Advances in Mental Health and Intellectual Disabilities, Vol. 8 No. 3. https://doi.org/10.1108/AMHID-03-2014-0003

Editorial

Article Type: Editorial From: Advances in Mental Health and Intellectual Disabilities, Volume 8, Issue 3

Welcome to the latest issue of Advances in Mental Health and Intellectual Disabilities. This issue contains a mixture of papers including the exploration of staff understanding of trauma, the use of Dialectical Behaviour Therapy (DBT), the prevalence of aggressive behaviour and three case studies.

Our first paper is by Keesler, who explores how service co-ordinators understand trauma as experienced by people with intellectual disabilities. Over recent decades it has become strikingly apparent that individuals with intellectual disabilities are at risk of experiencing adverse life events, such as abuse and bullying. Exposure to these events result in vulnerability to the development of mental illness. Fifteen service co-ordinators were interviewed for this study. Three major themes emerged; experiencing adversity, responding to adversity and adapting to adversity - influenced by precipitating and perpetuating conditions. The study concluded that service co-ordinators (social workers/care managers in other parts of the world) can be an asset to service delivery and individual care when they are "trauma informed".

DBT is a psychological intervention which whilst still in its infancy can have a significant positive impact on people with a range of mental health problems. Its application to people with intellectual disabilities is relatively new. Baillie and colleagues examine the challenges of implementing a community DBT service for adults with intellectual disabilities through a series of case studies and describe practical lessons they learned about how to maximise the effectiveness of DBT with this client group.

Aggressive behaviours can have a detrimental effect on the care of the person with intellectual disabilities. It can increase the risk of restrictive interventions and reduce access to the community. In terms of staff support there is a risk of injury and stress which may result in work absence. Crotty and colleagues surveyed 119 Registered Nurses in intellectual disability working in residential services, using an adapted version of the Modified Overt Aggression Scale (MOAS). They found significant levels of all types of aggression ranging between 48.9 and 64 per cent. Individuals with mild intellectual disabilities were more likely to engage in verbal aggression and damage to the environment, whereas in those with more significant disabilities there was a higher rate of aggression to others. The study recommends a pragmatic view is adopted when considering the person with intellectual disability and aggressive behaviour and developing a range of positive and realistic interventions.

Low self esteem is often a problem for people with intellectual disabilities, especially considering the challenges and discrimination they are likely to encounter in their day to day lives, which can have a negative impact on their mental health. However, as society changes and more opportunities arise for this vulnerable group we are hearing more and more positive stories of people achieving goals that even a few years ago would have been unheard of. Goleniowska provides a thoughtful and practical paper on the importance of self-esteem in individuals with intellectual disabilities. She explores ways of developing self-esteem and confidence with simple techniques for parents and carers to try. As a mother of a child who has Down Syndrome she also reflects on her own experiences. She is also the author of the web site http://www.downssideup.com, which provides a wealth of valuable information for anyone caring for or supporting people with Down Syndrome.

This issue concludes with three insightful case studies. Richards and colleagues describe their work with an individual with mental health needs and complex medical conditions. A multi-disciplinary and multi-agency team approach is described through the application of a clinical pathway. Drury and Alim's case study explores the use of a combination of different psychological models and how this informs formulation and treatment, and the benefits for the client and the therapist of working in this way. Hopkins and colleagues case surrounds their work with a child with autism and intellectual disability and how genetic screening can inform and support the management of individuals with complex presentations.

We hope you enjoy reading these papers and that they help inform your practice. As ever we are always looking for papers from across the world to help improve the mental health care of people with intellectual disabilities.

Steve Hardy and Jean O'Hara