Search results

The purpose of this paper is to provide information for non-specialists on identifying the characteristics, assessment and support needs of people with intellectual disabilities (ID) accessing mainstream services.

A review of relevant policy and research literature is supplemented with observations from the authors’ own experience of working in mental health services for people with ID.

With change in provision of services the likelihood of mainstream staff encountering someone with ID will increase. However, information on whether a person has ID or their level of ID is not always available to professionals in acute mental health services meeting an individual for the first time. Reliance on observational and interview-based assessments can leave people with ID vulnerable to a range of over- and under-diagnosis issues. This is as a result of difficulties with communication and emotional introspection, psychosocial masking, suggestibility, confabulation and acquiescence. For people with poor communication, carers will be the primary source of information and their contribution has to be taken into account.

Knowing or suspecting an individual has ID allows staff to take into account the various assessment, diagnosis and formulation issues that complicate a valid and reliable understanding of their mental health needs. Awareness about an individual’s ID also allows professionals to be vigilant to their own biases, where issues of diagnostic overshadowing or cognitive disintegration may be important considerations. However, understanding some of the practical and conceptual issues should ensure a cautious and critical approach to diagnosing, formulating and addressing this population’s mental health needs.

This synthesis of a review of the literature and observations from the authors’ experience of working in mental health services for people with ID provides an informed and practical briefing for those encountering people with ID accessing mainstream services.

Services for people with intellectual disabilities would be barely recognisable to clinicians working half a century ago. Two forces in particular stand out as driving the changes that we see today. The first accompanied the closure of the once popular institution‐like hospitals as part of a general reorientation within psychiatry as a whole from the asylum to the community. The second is the push towards incorporating people with intellectual disabilities in ‘mainstream’ services, the principle of ‘normalisation’ that sits at the heart of health and social policy in the UK for this group of people. This article is a reflection on the current status of mental health services for people with intellectual disabilities against this historical and philosophical backdrop and the arguments for their continued existence as a separate specialist entity within the field of psychiatry.

The article aims to discuss findings from a knowledge exchange review of financial inclusion in Britain and compare these to key features of financial exclusion evident from European analyses.

This paper is based on an innovative knowledge exchange project. Rapid research reviews analysed evidence on financial exclusion in Britain in relation to access to banking services; to credit; to household insurance; personal savings and assets; money advice provision; and financial capability. The findings from these reviews were discussed by stakeholders representing the private, government, community and civil society sectors in a series of evidence review forums. The results of these discussions were summarised and reconsidered at a national knowledge exchange conference. Throughout the project, stakeholders exchange opinions about the state of financial exclusion knowledge through an online discussion forum.

The research identified agreement among British stakeholders over several aspects of financial exclusion, in particular continuing problems of access to mainstream banking services for low income customers and a lack of appropriate and affordable credit provision. Areas of controversy included whether banks denied services to lower income customers or were withdrawing from deprived communities, and the necessity for further regulation of mainstream financial services.

Comparing these findings to research from other European countries raises questions about how financial inclusion should be defined, and whether existing indicators capture this adequately across contrasting social, institutional and regulatory contexts. The research raises challenges for policy transfer between countries.

This research aimed to investigate staff knowledge and attitudes towards working with adults with both a learning disability and a mental health difficulty. Government policy in the UK suggests a shift in service provision such that the treatment of people with a learning disability who have mental health problems should be undertaken by mainstream mental health services rather than specialist learning disability services.Staff members from both specialist and mainstream services took part in a series of focus groups to discuss their experiences and attitudes about working with this group of people. The transcriptions of the groups were analysed to identify common themes. Findings from the study suggest that staff within mainstream services currently feel that they are inadequately trained to deal with the often complex mental health needs of this group. Conversely, staff in learning disability services expressed concern about losing their specialist skills in generic services.The implications of the themes raised are discussed, particularly in relation to future service provision. Care will need to be taken if service redesign is to be achieved without detriment to service users.

Abstract High secure services treat patients who may have very complex clinical needs under conditions of security. Until very recently such services were run and managed on the periphery of the structures and accountability arrangements put in place for the rest of the NHS, becoming isolated from modern thinking and evidence‐based therapeutic practice. A high percentage of patients in the high secure system were assessed as no longer requiring that level of security.Following an inquiry at Ashworth hospital which reported in 1999, steps were taken to bring these services into the mainstream of the NHS, to decentralise further the commissioning and performance management and to develop the capacity and capability to enable discharge of patients to lower levels of security. New partnerships and new relationships have resulted in an NHS Plan target of 400 patients discharged from high security.The inclusion of high security services within Health & Offender Partnerships creates a framework for managing proposed and ongoing changes. High security services are a necessary part of our mental health system and should be valued and developed. This paper outlines how quality improvements will be enabled and embedded.

This paper reports drinking patterns among minority ethnic groups from the UK literature over the past 15 years, and considers the evidence for service provision and support. Findings show that drinking remains low among minority ethnic groups, though with evidence of increases in consumption, particularly among Indian women and Chinese men. South Asian men, particularly Sikh men, are over‐represented for liver cirrhosis, and some ethnic groups have higher than national average alcohol‐related deaths. People from black and minority ethnic backgrounds have similar rates of alcohol dependency as the white population; however services do not appear to be responsive enough to the needs of minority ethnic groups as they are under‐represented in seeking treatment and advice for drinking problems. Help‐seeking preferences vary for drinking problems between and within groups suggesting that drinking problems need to be addressed within both mainstream and specialist services. Greater understanding of cultural issues is needed in the development of alcohol services in mainstream and specialist settings.

Researchers often debate health service structure. Understanding of the practical implications of this debate is often limited by researchers' neglect to integrate participants' views on structural options with discourses those views represent. As a case study, this paper aims to discern the extent to which and how conceptual underpinnings of stakeholder views on women's health contextualize different positions in the debate over the ideal structure of health services.

The researchers chose a self-standing, comprehensive women's health service facing the prospect of being dispersed into “mainstream” health services. The researchers gathered perspectives of 53 professional and consumer stakeholders in ten focus groups and seven semi-structured interviews, analyzed through inductive thematic analysis.

“Women's marginalization” was the core theme of the debate over structure. The authors found clear patterns between views on the function of women's health services, women's health needs, ideal client group, ideal health service structure and particular feminist discourses. The desire to re-organize services into separate mainstream units reflected a liberal feminist discourse, conceiving marginalization as explicit demonstration of its effects, such as domestic abuse. The desire to maintain a comprehensive women's health service variously reflected post-structural feminism's emphasis on plurality of identities, and a radical feminist discourse, holding that womanhood itself constituted a category of marginalization – that is, merely being at risk of unmet health needs.

As a contribution to health organizational theory, the paper shows that the discernment of discursive underpinnings of particular stakeholder views can clarify options for the structure of health services.

Evidence from Australia and worldwide has highlighted the ongoing marginalisation, discrimination, abuse, violence and neglect of people with disability. One of the main areas of concern is that despite such evidence there remain fundamental barriers for people with disability to report violence and/or access supports. Significantly few studies have canvased the perspectives of people with intellectual disability (ID), family members or disability service providers. Accordingly as a first step, the purpose of this paper is to explore the perceptions of disability and violence-response professionals’ regarding the barriers and facilitators of effective support for people with ID reporting sexual violence and accessing mainstream supports.

A qualitative research design informed the basis of this study. Semi-structured interviews were conducted with seven participants who held roles within disability services and mainstream violence response. Interviews were recorded and transcribed. These transcripts were then analysed individually using a combination of thematic analysis and discourse analysis to bring to light the social and material structures within service systems in terms of how they disempower or empower supports for people with ID.

Participants from both services reported that professionals (particularly those outside the disability sector) lacked awareness of practical ways in which they could support people with ID to report and access services outside of disability-specific services. Participants also felt the capacity for people with ID to have a voice about what happens in the “aftermath” of reporting sexual violence was rarely acknowledged. Participants called for education and development of resources which could guide professional practice across disability and wider violence-response services. Participants saw investment in building interagency relationships across sectors as key to supporting the citizenship of people with ID.

This study suggests that there is a strong need for better community engagement and understanding of the multi-faceted issues surrounding responses to violence concerning people with ID. The findings of this study also outline implications for practice and policy which may be of interest to professionals both within disability and wider violence-response sectors in Australia and internationally.

The National Disability Insurance Scheme (NDIS) is a new program for the provision of support to people with disabilities in Australia. The purpose of this paper is to explore the early implementation experience of this scheme, with a particular focus on the implications of this scheme for issues of care integration.

Semi-structured interviews were conducted with 26 policymakers in the Commonwealth government charged with the design and implementation of the NDIS.

The authors find somewhat of a lack of clarity concerning the boundaries of the NDIS and how it will work with a range of different services in the provision of seamless and consumer-directed care. Many of the same kinds of debates about interfaces with services were detected in this study as have been highlighted in relation to UK individual funding schemes. If the NDIS is truly to support individuals with disabilities to achieve choice and control, important work will need to be undertaken in to overcome organizational and institutional boundaries.

There is little empirical data relating to the implementation of the NDIS to date. This is the first study to explore boundary issues in relation to care integration.

Findings and good practice are reported from a project promoting engagement of PCTs with the health experiences of people with learning disabilities. Project work was most successful where it linked into mainstream NHS priorities, using good information and specialists' expertise to support mainstream practitioners.