Psychiatry of intellectual disabilities faculty special edition

Citation

McCarthy, J. and Devapriam, J. (2015), "Psychiatry of intellectual disabilities faculty special edition", Advances in Mental Health and Intellectual Disabilities, Vol. 9 No. 4. https://doi.org/10.1108/AMHID-05-2015-0022

Psychiatry of intellectual disabilities faculty special edition

Article Type: Guest editorial From: Advances in Mental Health and Intellectual Disabilities, Volume 9, Issue 4.

Current developments in mental health care for adults with intellectual disabilities

This special edition of the Journal was commissioned with the key aim of actively encouraging those early in their clinical career working in the field of intellectual disabilities to publish their work following presentation at the Royal College of Psychiatrists Intellectual Disabilities Faculty Residential meeting in October 2014. The presentations were either through oral communication or by poster. The papers in this edition cover a wide area of current developments in meeting the mental health needs of people with intellectual disabilities.

The first two papers are reviews of the literature looking at prevalence of mental health conditions in adults with intellectual disabilities. The observation as the editors is that both review papers included no more than eight papers each over a 15-20 year time span. The paper from Walton and Kerr (2015) is a systematic review of the prevalence and presentation of unipolar depression in Down syndrome. The review identified eight papers since 1990. The review indicates that individuals with Down syndrome are more at risk for depressive disorders than other individuals with intellectual disabilities. However, the review points to the need for more research in this field by using cohort studies following individuals over a longer period to increase our understanding on the natural history of depression in people with Down syndrome including exploring any link to dementia. The paper by Andersen (2015) is also a review paper identifying the prevalence of personality disorder in adults with intellectual disabilities which has been an ongoing debate in this field. The review identified six studies over 20 years. As with the systematic review on depression in Down syndrome, there were few papers in the literature indicating how little publishable research is undertaken on the mental health needs of adults with intellectual disabilities. The authors highlight the variation in methodology in the application of classification systems and discuss the adequacy of the current classification systems to capture the concept of personality disorder in those with intellectual disabilities. This paper highlights the ongoing need for research into the mental health needs of people with intellectual disabilities supported by the developments of adapted classification systems of mental and behaviour disorder such as DC-LD: Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/mental Retardation and Diagnostic Manual-Intellectual Disability (DM-ID) as described in the paper.

The next two papers cover issues relevant to people with intellectual disabilities who are in contact with services due to their forensic or offending behaviours. McKinnon et al. (2015) outline an approach to improve the detection of those with intellectual disabilities in police custody so very early on their entry into the Criminal Justice System which is in keeping with national guidance. McKinnon and colleagues describe the validity of a brief targeted screen for intellectual disabilities while in police custody so providing a practical solution to the issue of screening. The authors conclude that further work is required on the impact of early screening for mentally vulnerable offenders in the police station. The paper by Cheshire et al. (2015) is on the experiences of patients in secure services in maintaining contact with their families. The authors seek to set standards on good practice in home visits to support contact of the individual with intellectual disabilities with their family. The findings indicate that frequency of home visits is not related to demographic variables or distance from family home but the reasons are more complex than just geographical distance. The paper highlights how little work is published on the relationship between family contact for those in secure hospital care and their treatment outcomes including successful discharge.

The final two papers are on intervention and management approaches supporting people with intellectual disabilities in the community. The paper on Community Treatment Orders (CTOs) from Gupta et al. (2015) is very relevant to current national priorities in England and Wales specifically on discharging people with intellectual disabilities from hospital in the light of government policy to transform health care for people with intellectual disabilities from hospital to community care. This paper describes a national survey of services in England and Wales on their use of CTOs with people with intellectual disabilities as part of the Mental Health Act 1983 (Amended 2007). The authors note an increase in the use of CTOs in the wider adult mental health services in recent years probably due to the reduction of inpatient beds. Although a small sample size, the survey identified the situations when CTOs are being used such as when the patient engagement with professional was poor or patients were not compliant with medication. This is not an unexpected finding but indicates CTOs are being used in appropriate way for people with intellectual disabilities.

The paper by Shankland and Dagnan (2015) reports the views and experiences of Improving Access to Psychological Therapies (IAPT) therapists working with people with intellectual disabilities. The interesting finding is that the majority of therapists are of the view that therapy could be provided in mainstream services. However, the authors recognise there are challenges in providing therapy in mainstream services including the building up of confidence and skills of mainstream services. The paper highlights the need for services to develop pathways and training approaches to enable access to mainstream IAPT services for people with intellectual disabilities.

We hope you are inspired by the papers in this special edition in bringing together the hard work and commitment of those early in their career working with people who have both mental health needs and intellectual disabilities.

Jane McCarthy and John Devapriam

Dr Jane McCarthy is Vice Chair and Dr John Devapriam is Academic Secretary, both at Faculty of Psychiatry of Intellectual Disability, Royal College of Psychiatrists, UK

References

Andersen, H.K. (2015), “Personality disorder and intellectual disability – concept and prevalence”, Advances in Mental Health and Intellectual Disabilities, Vol. 9 No. 4, pp. 163-73

Cheshire, L., Chester, V., Graham, A., Gradce, J. and Alexander, R.T. (2015), “Home visits: a reflection on family contact in a specialist forensic intellectual disability service”, Advances in Mental Health and Intellectual Disabilities, Vol. 9 No. 4, pp. 186-95

Gupta, J., Hassiotis, A., Bohnen, I. and Thakker, Y. (2015), “Application of community treatment orders (CTOs) in adults with intellectual disability and mental disorders”, Advances in Mental Health and Intellectual Disabilities, Vol. 9 No. 4, pp. 196-205

McKinnon, I., Thorp, J. and Grubin, D. (2015), “Improving the detection of detainees with suspected ID in police custody”, Advances in Mental Health and Intellectual Disabilities, Vol. 9 No. 4, pp. 174-85

Shankland, J. and Dagnan, D. (2015), “IAPT practitioners’ experiences of providing therapy to people with intellectual disabilities”, Advances in Mental Health and Intellectual Disabilities, Vol. 9 No. 4, pp. 206-14

Walton, C. and Kerr, M. (2015), “Down syndrome: systematic review of the prevalence and nature of presentation of unipolar depression”, Advances in Mental Health and Intellectual Disabilities, Vol. 9 No. 4, pp. 151-62