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This paper examines the process of assessing mental health needs for people with learning disabilities, considering questions of targeting, mental illness and challenging behaviour, diagnostic assessment and quality of life. It recommends comprehensive assessment within an integrated care approach.

Understanding the mental health problems of children who have learning disabilities presents huge challenges across many domains. This paper examines some of the assessment frameworks that may be used, offers clinical guidance on collecting information and suggests ways in which various theoretical approaches can be used to derive comprehensive case formulations. An emphasis is placed on the use of structured methods to improve reliability and validity.

Understanding the mental health problems of children who have learning disabilities presents huge challenges across many domains. This paper examines some of the assessment frameworks that may be used, offers clinical guidance on collecting information and suggests ways in which various theoretical approaches can be used to derive comprehensive case formulations. An emphasis is placed on the use of structured methods to improve reliability and validity.

The PAS‐ADD assessments (Psychiatric Assessment Schedules for Adults with Developmental Disabilities) have their origins in work that was being conducted over 20 years ago on the health status of older people with intellectual disability. Since that time, the assessments have undergone continuous development and refinement, and now encompass children as well as adults. This paper seeks to discuss some of these fundamental issues and how the PAS‐ADD instruments have attempted to meet these challenges.

The paper includes discussion of theoretical and practical issues that have shaped the development of the assessments.

The fundamental aim of the modern PAS‐ADD system is to improve case detection and assessment by supporting and enhancing the skills of clinical staff, rather than attempting to replace the need for those skills. The assessor makes the final judgement about diagnosis. The PAS‐ADD assessments are based on existing psychiatric classification rules for the general population and are conceptually different from instruments derived from psychometric principles. These factors have major implications, both for instrument design and for the evaluation of effectiveness.

The PAS‐ADD assessments have become widely used in the field of intellectual disability mental health. The theoretical issues discussed here are a central part of the ongoing effort to understand and improve the mental health of people with intellectual disabilities.

This case report provides a description of a simulation exercise as part of the induction programme for a staff team recruited to a specialist inpatient service for adults with intellectual disabilities and additional mental health problems. The rationale for this novel approach is described, along with details of its planning, implementation and outcomes.

In the last decade we have witnessed much debate and activity around the provision of mental health services for people with learning disabilities in England. This article looks not only at current initiatives to improve mental health care from around England, but also places them within a policy context. Unfortunately there are areas that still fail to provide a basic care standard, some of which has been reported throughout the media from recent investigations. Where this is the case, we outline the responses and actions that have been put in place to address these issues.To maintain a momentum for positive change for the mental health care of people with learning disabilities, there now needs to be cooperation between services that traditionally have not worked together for the benefit of this client group. Before an equality of mental health service provision, in line with national standards, can be realised the traditional views and values of service providers and commissioners will need to be challenged and tuned to the needs of this group of people.

While the right to life, ‘personhood’, and the educability of people with profound and multiple learning disabilities are still under‐debated, service providers and research workers continue to extend the boundaries of expectation with respect to what such people can achieve. In this paper the messages of recent research are summarised and key references for fuller information suggested. The need to bring together such specialised knowledge in the framework of an ordinary life aimed at enhancing competence and quality of life is urged.

This study examines the experiences of physical restraint procedures reported by in‐patients of a secure mental health service. Interview data were subjected to thematic content analysis in accordance with grounded theory methodology.Patients had differential experiences of similar physical procedures. Most reported some negative psychological experience of restraint. Anger and anxiety were two major themes. Some respondents held the perception that restraint was used to punish patients and several suggested that restraint incited further violence and aggression. Some female service users reported that restraint evoked flashbacks of previous sexual trauma.A subset of female respondents gave contrasting accounts of restraint, suggesting that they purposely brought about the restraint to gain a sense of containment or as a way to release feelings.Possible implications of these responses for clinical practice are discussed.

This article reviews the first volume of the Journal of Children's Services. In doing so, it discusses broader directions and challenges in research, policy and practice. The article focuses on discussion about outcomes, the ‘idea’ of children's services and the impact of interventions on children's health and development. It welcomes reflections on different approaches to outcome measurement, analyses of the practicalities of implementing policy reforms and rigorous evaluations of the impact of Early Years, parenting and other programmes. At the same time, it suggests specific areas in which more work would be valuable, including: socio‐political commentary on policy developments; methods of and results from need analyses; empirical research on inter‐agency initiatives; how to improve the processes and structures that underpin good outcomes; transitions; and understanding ‘what works’ in research dissemination and utilisation. The value of international perspectives (including intra‐UK comparisons) is stressed. Forthcoming special editions on randomised controlled trials (RCTs) (2007) and anti‐social behaviour by young people (2008) will help to address other points raised.