Editorial

Citation

O'Hara, S.H.a.J. (2014), "Editorial", Advances in Mental Health and Intellectual Disabilities, Vol. 8 No. 4. https://doi.org/10.1108/AMHID-05-2014-0016

Editorial

Article Type: Editorial From: Advances in Mental Health and Intellectual Disabilities, Volume 8, Issue 4

Welcome to issue 8.4. We have an interesting mix of papers in this issue; the first two explore the development and evaluation of an enhanced community service for people whose behaviour is described as challenging. A paper then describes milieu interventions for people with Post-traumatic stress disorder (PTSD) and another which investigates the factors that predict support worker confidence and knowledge about mental health. We have a study examining the UKU Side Effect Rating Scale (UKU-SERS) for people with intellectual disabilities, a paper that explores the work of the Can You Understand Group, and we conclude with a study which examined the self-regulation and social interaction skills of children with Autism Spectrum Disorder as compared to children with intellectual disabilities across time.

In the UK the development of community-based services for people whose behaviour is described as challenging is an area which has gained much needed attention recently since the horrific events at Winterbourne View Hospital unfolded over two years ago (Department of Health, 2012). There has been a drive for commissioners and providers to develop local competent and capable services based on the principles of positive behaviour support, reducing the likelihood of people with complex needs to be placed in hospital environments away from their local area. Though we need to remind ourselves, this has been policy and best practice in the UK since the publication of the Mansell Report in 1993 and the need for its in revision in 2007, due to the lack of progress (Department of Health, 1993, 2007).

We are pleased to open this issue with two papers from Inchley-Mort and colleagues who describe how a locally based enhanced Complex Behaviour Service was developed and evaluated. The first paper explores clinical and service use outcomes associated with the delivery of Positive Behaviour Support. Outcomes measures including the Aberrant Behaviour Checklist (ABC) were utilised for 24 individuals, compared to 22 people receiving a usual service. At six month follow-up improvements were seen in all domains of the ABC. The second paper explores the experiences and opinions of the person using the enhanced service and their carers. Analysis of interviews indicated that the service was seen as acceptable and useful. Positive experiences of the service was linked to frequency and availability of the service; talking about behaviour and being listened to; understanding, and change in, the service user, carer and behaviour. Both these papers highlight a service development in light of government policy which have resulted in positive outcomes for a number of individuals presenting with complex needs who would previously be a risk of being placed out of their local area.

In recent issues we have a number of papers on PTSD, awareness of which is becoming more apparent in people with intellectual disabilities. Bakken and colleagues, through a series of case studies, discuss the use of milieu therapeutic interventions for the stabilisation of emotions and behaviour in PTSD in people with severe intellectual disabilities. The study identified a number of areas of stabilisation including validation, anxiety relief, treatment of depressed mood, increased mastering of daily activities, protection against anxiety triggers, and facilitated staff communication.

Over the last two decades there has been a drive to develop a skilled workforce to provide effective care and support to people with intellectual disabilities. One area of focus has been mental health needs with the publication of guidance materials, training manuals and formal qualifications. In light of these developments Kilanska and Priest explored the factors that can predict support workers’ knowledge and confidence in this respect. Eighty support staff from a range of services completed a questionnaire which enquired about their exposure to service users with additional mental health needs, training, general and specific mental health knowledge, and confidence in working with this client group. They found that the level of exposure to people with mental health needs could predict knowledge about schizophrenia, but not about depression, anxiety, or dementia. Length of experience could predict overall mental health knowledge and confidence.

The use of psychotropic medication for people with intellectual disabilities is well reported and the experience of possible side effects is an important aspect, considering the increased susceptibility of this population, especially those with epilepsy. Tveter and colleagues studied experienced side effects using the UKU-SERS to ascertain if it is a useful tool for this population. Following trials the original 48-item scale was revised to include 35 items designed for use in people with intellectual disabilities.

Being able to understand the information relating to your treatment is an essential component of any care pathway. This is especially important for those with intellectual disabilities, as we need to enhance their capacity to make their own decisions about their care and treatment. Our next paper describes an innovative group from the UK, the “Can you understand it” Group. The group supports a number of services in making sure that the information available to people with intellectual disabilities is accessible. The group has been in operation for five years and the members report it to be a positive experience and it has helped improve their self-esteem, make friends, build confidence and independence, all of which are protective factors for mental health.

Our final paper is from Barnard-Brak and colleagues who examined the self-regulation and social interaction skills of children with Autism Spectrum Disorder as compared to children with intellectual disabilities across time. They found that those children with Autism Spectrum Disorder have significantly worse self-regulation and social interaction skills as compared to children with intellectual disability across time. As always, we would welcome submissions from clinicians, service users and carers, who wish to share their clinical, research or lived experiences to enhance our understanding of mental disorders so prevalent in people with intellectual disabilities, so that we can develop the evidence base for new approaches and better mental health outcomes.

Steve Hardy and Jean O'Hara

References

Department of Health (1993), “Mansell report – services for people with learning disability and challenging behaviour or mental health needs”, HMSO, London

Department of Health (2007), “Mansell report – services for people with learning disability and challenging behaviour or mental health needs” (Revised), HMSO, London

Department of Health (2012), available at: www.gov.uk/government/publications/winterbourne-view-hospital-department-of-health-review-and-response (accessed 3 February 2014)