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Diagnostic overshadowing (DO) may be contributing to the worsening physical health outcomes for people diagnosed with mental health (MH) conditions. DO is a phenomenon researched worldwide, but there has been no systematic review of the evidence for its prevalence in UK health care. This paper aims to add to this body of knowledge, expanding the understanding of what factors are contributing to the poor physical well-being of people with diagnosed MH conditions.

A systematic search of three databases was conducted and after evaluation, three studies were selected for the review.

DO was found to have a high prevalence with structural, staffing and patient issues identified through a thematic analysis. Contemporary evidence shows themes identified are still impacting UK health care. Collaborative working across mental and physical health teams, thorough and lengthy assessments, and improved education for physical health care staff have been cited as mitigating factors to this practice.

To the best of the author’s knowledge, this paper is the first review of the evidence for diagnostic overshadowing taking place in UK health care.

Three deaths at Cawston Park Hospital shed a bright light on Norfolk’s services for people with learning disabilities and autism, including those operated by the company that ran the hospital. The purpose of this paper is to review Norfolk County Council's current position from the unique aspect of a senior manager wihtin the system.

This paper reviews the unique perspective of a social worker from within the system.

The process of making change included engagement and action concerning such thorny challenges as the pressures on community services; the undervaluing of care-giving as a career; and the continuing admissions to specialist mental health services at a time when hospital discharges are being expedited.

Norfolk’s investment in improving its services involves the adoption of a human rights approach; a capital programme to facilitate new developments; nurturing care-giving as a career; and bringing a clearer evidence base to this work programme.

The author, who is Chair of Norfolk’s Safeguarding Adults’ Board (SAB) reflects on the impact of a Safeguarding Adults Review (SAR) and the actions that resulted. The purpose of the paper is to provide an insight into a significant SAR and the resulting actions desinged to change practice.

The actions illuminate the power of hospitals and politicians over people’s lives. It took the deaths of three young adults with learning disabilities, in a hospital, to move beyond the status quo and organise some very different service responses.

“Progress summits” have considered local and national actions. There have been important gains and setbacks, including the delayed reform of the Mental Health Act. Despite uncertainties, SAB can be detonators to listening and taking action.

This is a unique insight into the impact of a Safeguarding Adults Review and the actions that resulted from this.

The purpose of this paper is to provide a literature review on what is known about unpaid family carers who are at risk of or have experienced abuse from the people they provide care for and relevant policy/legal and practice responses for affected family carers.

A literature search was carried out to locate literature relating to unpaid family carers who are at risk of or have experienced abuse from the people they provide care for. This also incorporated grey literature, including policy guidance and law, to determine the existing knowledge base, gaps in practice and areas that might require further research.

The findings suggest that although carer harm is serious, it is under-researched. In addition, the unique needs of unpaid family carers who are at risk of or have experienced abuse, violence and harm from the people they provide care for are subsumed in safeguarding policy/law processes and practice under the auspices of the protection of “adults at risk” rather than the protection of “carers at risk”.

It is important that those who support unpaid family carers who are at risk of abuse and harm know about their unique safeguarding needs and concerns to offer appropriate support. It is also apparent that policy and law need to address the gap in provision relating to the unique safeguarding concerns involving the abuse of unpaid family carers by the people they provide care for. This paper is based on this literature review and not on other types of research.

The paper provides insights into what is known about the abuse of unpaid family carers by the people they provide care for, and the policy/legal and practice responses to affected unpaid family carers. It contributes to the body of knowledge on carer abuse and safeguarding carers from abuse and harm.

To ensure health, social and criminal justice services are suited to the complex and dynamic needs of people with learning/intellectual disabilities (LD) at risk of offending, it is important to systematically analyse the needs and characteristics of this population. This study aimed to analyse the patterns of referrals to a single community forensic LD service before and during the COVID-19 pandemic.

A structured audit was conducted on all referrals to the service (n = 37) across a three-year period (May 2019 – end of July 2022).

The majority of the overall sample were male (36, 97%) and Caucasian (24, 65%) with a mean age of 32.9 years and mild LD. The most prevalent current offending type was sexual offending (17, 44%), whereas the most prevalent historical offending type was violence (17, 35%). The most common service/function offered by the service was advice and consultation to other professionals and agencies (10, 19%). The service user and forensic/legal characteristics measured did not differ significantly before and during COVID-19.

To the best of the authors’ knowledge, the project is the first to systematically analyse and compare community forensic LD service referral patterns before and during the COVID-19 pandemic. This study also provides an example of how a structured audit tool can be used to benefit individual services and the wider literature on assessing the needs and characteristics of adults with LD who live in the community and are at risk of [re]offending.

People with intellectual disability die prematurely and from avoidable causes. Innovative solutions and proactive strategies have been limited in addressing this disparity. This paper aims to detail the process of developing a risk stratification tool to identify those individuals who are higher risk of premature mortality.

This study used population health management principles to conceptualise a risk stratification tool for avoidable deaths in people with intellectual disability. A review of the literature examined the existing evidence of causes of death in people with intellectual disability. A qualitative methodology using focused groups of specialist clinicians was used to understand the factors that contributed towards avoidable deaths in people with intellectual disability. Delphi groups were used for consensus on the variables for inclusion in the risk stratification tool (Decision Support Tool for Physical Health).

A pilot of the Decision Support Tool for Physical Health within specialist intellectual disability service demonstrated effective utility and acceptability in clinical practice. The tool has also demonstrated good face and construct validity. A further study is currently being completed to examine concurrent and predictive validity of the tool.

To the best of the authors’ knowledge, this is the only study that has used a systematic approach to designing a risk stratification tool for identifying premature mortality in people with intellectual disability. The Decision Support Tool for Physical Health in clinical practice aims to guide clinical responses and prioritise those identified as at higher risk of avoidable deaths.

This study aims to examine whether country of residence, sex trafficking attitudes, complainant gender, juror gender and right-wing authoritarianism (RWA) influenced juror decision-making within a sex trafficking case.

Jury-eligible participants from the USA and the UK participated in an online juror experiment in which an independent group design was used to manipulate the complainant’s gender. Participants completed the juror decision scale, the sex trafficking attitudes scale and the RWA scale.

Sex trafficking attitudes predicted the believability of both the defendant and complainant. Greater negative beliefs about victims predicted greater defendant believability and lower complainant believability. US jurors reported greater believability of both the complainant and defendant, and RWA was associated with greater defendant believability. However, none of the other factors, including complainant and juror gender, predicted participants’ verdicts. The findings suggest juror verdicts in sex trafficking cases may be less influenced by extra-legal factors, although further research is needed, especially with a more ambiguous case.

This is one of the few cross-cultural comparison studies in the area of jury decision-making, specifically regarding sex trafficking cases. The findings indicated that US participants held more problematic attitudes about sex trafficking than their UK counterparts, although all participants held problematic attitudes about sex trafficking. However, those attitudes did not affect verdict formation about either a male or female complainant. Participants who were more knowledgeable about sex trafficking reported greater complainant believability, suggesting that educational interventions may provide greater support for victims in court.

An appreciative inquiry process was collaboratively undertaken with an inner city local authority and personal advisors where systemic social work practice was embedded. The purpose of this study is to explore how systemic social work principles could be integrated into the support of young adults leaving the care system, especially when safeguarding concerns exist.

Three fortnightly, reflecting team-style, appreciative inquiry workshops explored the integration into practice of systemic concepts under the themes of safeguarding, uncertainty and new possibilities.

Within the contexts of the organisation, other agencies and the relationship, six paired themes emerged: learning and navigating; positioning and risk-taking; and feeling and engaging. Core systemic concepts, such as self-reflexivity and mutual influence, can enable personal advisers to use themselves and their relationship with care leavers as a context for change. Considering responses to risk from different family member positions may support holding greater levels of uncertainty. Seeing resilience as a process rather than a personal attribute enabled personal advisors to think about how they connected with care leavers through shared life experiences, fostering narratives of hopes and dreams where new possibilities abound.

Appreciative inquiry is generally seen as a defined model for implementing large organisational changes; this study comprised a small sample group, and the model’s application was less defined.

A gap exists in the extensive care leaver research, addressing safeguarding and working systemically. A conceptual model for practice is offered, with potential utility in developing further systemically informed training and supervision for practitioners. A less structured and more relationally engaged model for appreciative inquiry is presented.

Down syndrome is one of the common genetic causes of intellectual disability. Adult with Down syndrome may have many psychiatric comorbidities. Therefore, their mental health status should be considered in legal proceedings such as criminal responsibility and legal capacity where they are involved. This study aims to highlight that individuals with Down syndrome are often referred directly to forensic psychiatry without undergoing an interview, despite the fact that this is a group with varied mental statuses.

This study analysed the socio-demographic, clinical and forensic characteristics of eight adult individuals with Down syndrome for whom the Council of Forensic Medicine (CFM) requested an opinion on criminal liability and other legal situations between 2018 and 2022. The CFM is an authoritative institution to which cases from all areas of Türkiye are referred.

The mean age of the individuals with Down syndrome for whom a forensic psychiatric opinion was requested was 24.63 (±7.95) and the mean IQ level was 54.13 (±13.38). All cases were male, 6 / 8 were referred for assessment of criminal responsibility and 4 / 6 of those referred for assessment of criminal responsibility were referred for sexual offences. It was found that 5 / 8 of the cases had moderate intellectual disability and 3 / 8 of the cases had mild intellectual disability.

Regarding the limitations of this study, the first one is the small sample size. Nevertheless, due to the low prevalence of people with Down syndrome in society, it is plausible that their stigmatization may not be reflected in the judicial system, even in cases involving violent behaviour. The second limitation is that the reports lack all psychiatric medical documents, including forensic psychiatric evaluations of individuals with Down syndrome. Additionally, additional diseases were recorded based on familial anamnesis. The third limitation is that this study is the first publication to investigate Down syndrome from a forensic psychiatric perspective. Thus, there is a lack of literature to make direct comparisons and references in the discussion section.

This is the first study about forensic psychiatric aspects for people with Down syndrome. The aim of this study was to examine the forensic psychiatric approach in Down syndrome, one of the most common genetic causes of intellectual disability, the situations in which forensic psychiatric assessment is required and the issues that might be considered important in this regard. Although there are various publications in the literature on the psychiatric conditions of individuals with Down syndrome, to our knowledge, this is the first study to evaluate individuals with Down syndrome in terms of forensic psychiatric evaluation. People with Down syndrome are known to have varying degrees of intellectual disability and different types of psychiatric comorbidity.

People with Down syndrome are a heterogeneous group in terms of intellectual disability. The criminal responsibility and legal capacity of individuals may vary according to the legal situation. When requesting forensic psychiatric evaluation of these patients with psychiatric co-morbidity, patients should not be prejudged in terms of their level of mental competence and each case should be assessed individually.

The ever increasing prevalence of mental health disorders is subsequently resulting in an ever increasing burden on mental health services globally. Due to need outweighing capacity, many turn to, or are signposted to, online resources. Online mental health chatrooms are chat-based services that users can frequent to discuss their mental health, often with individuals experiencing similar issues. Most of these are moderated by volunteers. The purpose of this study was to explore the motivations for moderating, the positive and negative effects of the role and to identifying current and required pathways of support.

This study used an online questionnaire design, disseminated via the online mental health community, 18percent. An open ended interview schedule was disseminated to eight volunteer moderators. Qualitative data was analysed using NVivo software and reflexive thematic analysis.

Moderators were motivated to engage in this role due to past experiences and to help others. The positive effects of moderating were engaging in digital altruism and improving one’s personal mental health. The negative effects were personal triggers and role specific issues such as harassment and being unable to help people in crisis situations. For further support, moderators would benefit from refresher training sessions and further professional training in which they can proactively help when a user is experiencing suicidal ideation/behaviours.

The research highlighted the motivations for, positive and negative effects of and the current and further pathways of support required by volunteer moderators and proffers recommendations within the discussion.