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This paper aims to assess the quality of systematic reviews on the effectiveness of psychological therapy for adults with intellectual disabilities (ID) and mental health difficulties.

Four electronic databases were used: Cochrane, PsycINFO, PubMed and Scopus. Studies were included if they were a systematic review focused primarily on psychological therapy for adults with ID and mental health difficulties. Systematic reviews focused on anger were also considered for inclusion. These reviews were rated for quality on the Amstar-2, a quality rating tool designed to evaluate systematic reviews.

Twelve relevant systematic reviews were identified, which included seven reviews focused primarily on cognitive behavioural therapy, two on psychodynamic therapy and three on third-wave therapies. The AMSTAR-2 indicated that all 12 reviews were of “critically low” quality. Thus, there are significant problems with the evidence base.

To the best of the authors’ knowledge, this is the first systematic review of systematic reviews of the effectiveness of psychological therapies for people who have ID. It provides an overview of the quality of the evidence base into one place.

Over a decade ago “Psychotherapy and learning disabilities” was published by the UK Royal College of Psychiatrists. It was decided by the Royal College and British Psychological Society’s faculties for people who have ID to revise and update this report. The paper aims to discuss these issues.

Experts in the field were invited to make a contribution on their approach covering method, adaptations, service user views and outcomes.

A great deal has changed in the last decade in terms of service development and research resulting in a much wider range of therapies being made available and there being a growing evidence base.

Further work needs to be carried out to make such information accessible to carers and service users.

The report is a useful resource for professionals involved in the support of the mental health and emotional needs of people who have ID.

The report should help expand the range of therapies available to people who have ID who need then so they can live more fulfilling lives.

The report provide extensive coverage of the range of psychological therapies available to people who have ID along with their evidence base.

Measures introduced to mitigate the spread of coronavirus-19 (COVID-19) may have contributed to an increase in waiting times for face-to-face psychological treatments. As adults with intellectual disabilities (ID) are more likely to encounter barriers when accessing remote therapies, it is important they receive appropriate support while waiting. To understand what care is needed, this service evaluation [aimed to] explored the experiences of service users with ID who have waited for treatment during the pandemic.

Seven individuals who had been waiting for psychological therapy during the COVID-19 pandemic, which included those waiting longer than the national health service target of 18 weeks, were interviewed. Data were analysed using framework analysis.

The following four key themes were identified: waiting has been “painful”, related to how service users continued to experience difficulties whilst they waited; tolerating the wait, highlighted that individuals understood the reasons for waiting; use of coping strategies where service users identified both internal and external strategies they had used to cope; and support and contact from the learning disability team, related to how individuals experienced the support they received from the service.

To the best of the authors’ knowledge, this service evaluation is the first to explore the experiences of service users with ID waiting for psychological therapy during the Covid-19 pandemic. Results guide suggestions on improving support whilst they are waiting to help prevent further decline.

The novel coronavirus and associated restrictions have resulted in mental health services across the UK having to adapt how they deliver psychological assessments and interventions. The purpose of this paper is to explore the accessibility and prospective acceptability of providing telephone and videoconference-mediated psychological interventions in individuals with intellectual disabilities.

As part of a service evaluation, a mixed-methods questionnaire was developed and completed by clients who had been referred for psychological therapy at an adult intellectual disabilities’ community health service in the north of England. All clients were assessed using the Red/Amber/Green (RAG) system by a consultant clinical psychologist for risk and potential suitability for indirect service delivery given their ability and needs.

Overall, 22 clients were invited to take part, of which, only seven (32%) were accepting of telephone or videoconference-mediated psychological therapy. Most of the clients were unable to engage in video-conference therapy and therefore, only suitable for phone therapy. This paper presents the remaining findings and discusses the clinical implications and unique considerations for intellectual disability services drawing on the existing literature.

This is the first paper that the authors are aware of, examining videoconference-mediated psychological therapy in this population. It is hoped the data will be used to help inform practice or policy when using such therapeutic approaches in adults with an intellectual disability.

There has been little empirical investigation into the theoretical relationship between moral reasoning and offending in people with intellectual disabilities (ID). The purpose of this paper is to compare offending and non-offending ID groups on a new measure of social-moral awareness, and on theory of mind (ToM).

A between groups design was used. The scores of 21 male offenders and 21 male non-offenders, all with ID and matched for IQ, were compared on the Social-Moral Awareness Test (SMAT) and on two ToM tasks.

There was no significant difference in SMAT scores or on first- or second-order ToM tasks between offending and non-offending groups. Better ToM performance significantly predicted higher SMAT scores and non-offending groups. Better ToM performance significantly predicted higher SMAT scores.

Results were inconsistent with previous research. Further work is required to establish the validity and theoretical underpinnings of the SMAT. Development in the measurement of ToM for people with ID is also required.

This is the first use of the SMAT with a population of offenders who have ID. The findings suggest caution in its use in clinical settings.

Services are increasingly exploring the use of remote conferencing to deliver psychological interventions, which have become particularly important given the COVID-19 pandemic and infection control guidelines. This paper aims to explore the feasibility, acceptability and preliminary effectiveness of delivering psychological therapy remotely to adults with intellectual disabilities (ID).

As part of routine practice within an adult ID community health service, this paper develops a six-session programme based on compassion-focused therapy (CFT) and delivered it to six clients. Clients completed the psychological therapy outcome scale for ID 2nd edition, at assessment, pre- and post-therapy, as well as a feasibility and acceptability measure.

Six clients engaged in telephone therapy; four clients individually, while the remaining two were supported by their caregiver. Most clients found the intervention helpful, enjoyable and were pleased that they received telephone-delivered psychological therapy. A reduction was observed at post-therapy in distress (g = 0.33) and risk (g = 0.69). No difference was reported in psychological well-being. Five clients were subsequently discharged from psychological therapy.

To the knowledge, this is the first study examining the use of telephone therapy (including CFT) for individuals with ID. Findings add to the growing evidence suggesting individuals with ID can benefit from receiving adapted psychological therapies. Research is required to further explore the effectiveness of remote-therapies, who would most likely benefit from this approach and how remote treatments could be used within existing pathways.

There is little consensus regarding what constitutes an effective therapist when working with adults with intellectual disabilities (ID) who have a mental health problem. This study aims to explore whether clusters of clinical psychologists (CPs) could be differentiated with regards to beliefs as to what defines an effective therapist for adults with ID experiencing psychological distress and seeking treatment.

Four interviews with CPs and an associated thematic analysis created the 49-item Q-set. These items were then sorted into a forced quasi-normal distribution by N = 27 CPs via an online Q-sorting task.

Three participant clusters were identified in the principal components analysis that accounted for 49% of the variance. These clusters were labelled the creative collaborator, the reflective expert and the system integrator.

Differences exist regarding beliefs as to what the psychotherapeutic approaches effective therapists working with ID and comorbid mental health problems should take. These differences approximated to preferred psychological therapy models. This study is critiqued to enable future research on this topic to progress.

To the best of the authors’ knowledge, this is the first study to explore what constitutes an effective psychological therapist for people who have ID.

This study aims to investigate whether factors previously shown to influence attendance rates for appointments in general practice and general mental health services also influence attendance rates in services for people with intellectual disabilities (ID).

Post hoc data from 452 psychology appointments, ID diagnostic and initial screening (triage) appointments were collected from the health-care files of a community adult ID psychology service. Demographic factors (age, sex) and clinical factors (waiting time, time between appointment invitation being sent and appointment being held, presence of prior telephone call or letter, type of appointment, weekday, month) were recorded along with the attendance outcome (attended/did not attend [DNA]). The impact of the COVID-19 pandemic was also explored by documenting whether the appointment predated March 2020.

No significant associations were found between any variable investigated and attendance outcome when analysing appointment data as a whole and when splitting the data between appointment type. Weekday was found to significantly be associated with attendance outcome for appointments held during COVID-19, in which more DNA appointments occurred on a Wednesday compared to the other days of the week. No other associations were found for appointments held during the COVID-19 pandemic or for appointments held prior to the COVID-19 pandemic. These results suggest that factors which influence attendance rates in general health-care settings do not necessarily generalise to ID services.

To the best of the authors’ knowledge, this study is the first to examine whether certain demographic and clinical factors influenced attendance rates in an adult intellectual disability service.

The novel coronavirus and associated mitigation efforts have produced barriers to accessing services for adults with intellectual disabilities. This paper aims to evaluate the impact of Covid-19 on access to psychological services. The paper evaluates monthly referral rates and psychological distress scores for service users awaiting therapy.

A quantitative service evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. A single case experimental design was used to examine the impact of events in March 2020 on referral rates. Descriptive statistics and effect size calculations were used to examine the impact of prolonged waiting times on psychological distress scores.

Referral rates were examined comparing a 5-year rolling average monthly referral rate for the 12 months prior to March 2020 with the 12 months following. Findings demonstrate that events starting in March 2020 have had a considerable impact on referral rates and rates have not recovered. Eight service users were contacted to determine the impact of prolonged waiting times with results demonstrating increases in psychological distress of large effect size.

This is the only paper the authors are aware of examining the impact of the coronavirus on access to services and psychological distress for adults with intellectual disabilities. It is hoped that these findings will be able to inform both policy and practice as services continue to navigate the pandemic.