Editorial

Citation

Hardy, S. and O’Hara, J. (2012), "Editorial", Advances in Mental Health and Intellectual Disabilities, Vol. 6 No. 5. https://doi.org/10.1108/amhid.2012.54206eaa.001

Editorial

Article Type: Editorial From: Advances in Mental Health and Intellectual Disabilities, Volume 6, Issue 5

Welcome to the fifth issue of 2012. By the time this issue goes to print it will have been several months since the sad passing of Jim Mansell OBE. We would like to recognise his enormous contribution to improving the lives of people with intellectual disabilities; in particular his tireless work in the 1980s in returning people from long stay institutions back to their local communities and for his research, teaching and campaigning for a positive, ethically sound and evidence-based approach to supporting people whose behaviour is described as challenging.

This issue begins with a paper from Cooper, who founded the Challenging Behaviour Foundation, a charity that works to improve the quality of life for people whose behaviour is described as challenging and their families. They do this by providing a wide range of information, support, resources and training and by influencing national policy. Visit their web site at: www.challengingbehaviour.org.uk. The paper provides an overview of the exposure of abusive practices in services for people with intellectual disabilities, and the resulting inquiries and reports. Her account provides a shocking reminder that over a significant period of time a series of inquiries have reported on similar if not identical concerns, including fitting people into services, services not being person centred, restrictive practices and people being placed far from home. One wonders what needs to change to make best practice become reality for people with intellectual disabilities. The paper concludes with suggestions for what needs to happen to ensure that recommendations translate into action on the ground, to improve the quality of life for individuals and their families.

Our next paper by Koritsas and Iacono is the second in a two part series examining the risks associated with and causes of challenging behaviour. The literature was reviewed and three dominant approaches were found that attempted to explain the causes of challenging behaviour:

1. 1.

   applied behaviour analysis;

2. 2.

   biological factors; and

3. 3.

   psychiatric disorders.

The paper suggests that approaches so far have focussed on singular explanations for challenging behaviour and proposes an approach that explores the possible interactions between them, given that the causes of challenging behaviour are complex and likely to involve multiple factors.

Following on from our paper on the causes of challenging behaviour, Thakker and colleagues explore the current evidence base to better understand the complex relationship between mental health and challenging behaviour. They begin by examining prevalence rates of both and their co-existence in people with intellectual disabilities and discuss common aetiological factors including behavioural phenotypes, neurodevelopmental disorders and epilepsy. An overview of the assessment and management of challenging behaviour within the context of mental health is provided and they conclude that a range of therapeutic interventions is required.

We divert from the challenging behaviour theme with a paper from Tully and colleagues who investigated the usefulness of the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LD) (RCPysch, 2003) in a population of people with intellectual disabilities. The DC-LD was introduced in 2003 to provide a comprehensive and systematic approach to assessment and to improve accuracy of diagnosis in people with intellectual disabilities. The study included 50 individuals from the local intellectual disability service who were interviewed in the presence of a carer and cases notes were reviewed and psychiatric symptoms and behaviour difficulties were identified against the DC-LD criteria. They found considerable discrepancy between the rates of psychiatric diagnoses after application of DC-LD and rates of previously documented diagnoses within the sample. Use of DC-LD led to the reclassification of many previously documented diagnoses, mainly as behavioural disorders. The authors concluded that DC-LD was a useful tool and would be applied to all their service users in the future.

The environment in which anyone is living, and especially those receiving treatment for psychiatric disorders is of paramount importance and likely to have a significant influence on treatment outcome. Our final paper is from Bakken and colleagues at the Oslo University Hospital in Norway, They examined the psychosocial factors within psychiatric units for people with intellectual disabilities. The aim of their study was to examine whether adults with intellectual disabilities can reliably rate the Ward Atmosphere Scale-Real Ward (WAS-R), a well established tool in mainstream mental health settings. They found that those with mild intellectual disabilities were able to use the WAS-R with some help from staff whereas people with moderate intellectual disabilities required a significant amount of help with over half of the WAS-R items. They recommend that a shorter adapted version should be used to encourage more research on treatment milieu for individuals with intellectual disability and mental illness.

Steve Hardy, Jean O’Hara