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Psychiatric assessment in adults with autism spectrum disorder (ASD) and intellectual disability (ID) is complex and challenging. With co-occurring congenital blindness, this complexity is increased. Systematic knowledge about psychiatric assessment in this combination of challenges is virtually non-existing, and there is little guidance available for clinicians faced with this task. The paper aims to discuss these issues.

Experiences from comprehensive psychiatric assessments in two adults with congenital blindness, ASD, and ID are explored and discussed.

Adaptation of assessment procedures usually employed for individuals with ASD and ID involved no major alteration, but co-operation between mental health and visual impairment professionals was important, as was the involvement of the families of the individuals in question. In both cases, the patient met criteria for an anxiety disorder, underlining the vulnerability and the challenges involved in living with this combination of challenges.

There is an urgent need for research into mental health issues for this group, including case studies describing successful treatment or intervention for these issues.

Psychiatric assessment in individuals with this combination of challenges may be feasible, but requires involvement of professionals specializing in mental health in developmental disabilities, and professionals in visual impairment. Assessments need to be individually adapted.

This is the first study systematically describing psychiatric assessment in this group involving the use of checklists and assessment tools. Strategies and tools that were useful are described and discussed to aid other clinicians faced with similar challenges.

The purpose of this paper is to explore the clinical implications of the case of AM and the ruling that the Mental Health Act no longer has primacy over other legislation in certain treatment situations.

Critical case analysis and discussion.

The Mental Capacity Act Deprivation of Liberty Safeguards could be used more widely, and in preference to the Mental Health Act, but this may cause problems to clinicians and other decision makers such as Mental Health Tribunals.

This case and its findings have not been widely discussed in academic or clinical practice literature.

In the UK, the mental health treatment requirement (MHTR) order for offenders on probation has been underused. A MHTR service was established to assess the effectiveness of a partnership between a probation service, a link worker charity and an independent mental healthcare provider. Short-term structured cognitive behavioural interventions were delivered by psychology graduates with relevant work experience and training. Training for the judiciary on the MHTR and the new service led to a significant increase in the use of MHTR orders. The paper aims to discuss these issues.

A total of 56 (of 76 MHTR offenders) completed treatment in the first 12 months. A single cohort pre-post follow-up design was used to evaluate change in the following domains: mental health and wellbeing; coping skills; social adjustment; and criminal justice outcomes. Mental health treatment interventions were delivered under supervision by two psychology graduates who had relevant work experience and who were trained in short term, structured, cognitive behavioural (CBT) interventions.

Clinically significant changes were obtained on measures of anxiety and depression, and on measures of social problem solving, emotional regulation and self-efficacy. Ratings of work and social adjustment and pre-post ratings of dynamic criminogenic risk factors also improved. This new initiative has addressed the moral argument for equality of access to mental health services for offenders given a community order.

While the current initiative represents one of a number of models designed to increase the collaboration between the criminal justice and the mental health systems, this is the first within the UK to deliver a therapeutic response at the point of sentencing for offenders with mental health problems. The significant increase in the provision of MHTR community orders in the first year of the project has been associated with a decrease in the number of psychiatric reports requested that are time consuming and do not lead to a rapid treatment.

The purpose of this paper is to identify approaches that mental health clinicians, working in intellectual disability services, can adopt to ensure the spiritual needs of their service users are met.

A narrative literature review examining original research, expert opinion pieces and book chapters was undertaken. To broaden the perspective of the paper, publications from different academic areas were reviewed including intellectual disabilities, mental health, neurodevelopmental disorders, general health and spirituality literature.

The main principles of spiritual assessment tools from the general health literature can be applied to this group. However, the literature would suggest that certain approaches are of particular importance in intellectual disabilities mental health including advocating for service users to attend the religious services they wish to and working collaboratively with families and carers when addressing spiritual issues.

The question of how to meet the spiritual needs of people with autism and severe intellectual disability is a neglected research area. Research examining the spiritual needs of service users with intellectual disabilities, on mental health inpatient units, is also needed as well as a review of whether spiritual needs are being met in current person-centred care plans.

No published literature review was identified that specifically addressed the question of how mental health clinicians should approach the spiritual needs of their service users.

Pre-registration mental health nursing courses are a mixture of clinical practice and university-based education completed over three years, culminating in a successful student entering the professional nursing register. During a student’s time at university they will encounter many different types of assessment, whether formative or summative. These are typically academic written assignments, academic exams, presentations, viva, assessed clinical practice by an approved mentor, and objective structured clinical exam (OSCE). The paper aims to discuss these issues.

An OSCE to assess second year mental health nursing students was determined to be a highly appropriate method of allowing students to demonstrate the skills associated with the nursing process, NMC standards and learning outcomes for the module.

It was recognised that preparation was essential in supporting the reduction of the student’s anxieties over the process, careful design and planning was needed to ensure reliability and validity of a logistically challenging assessment method.

OSCE have become a major contributor towards the assessment of student nurses and are regarded by some as the gold standard for assessment. However, this assessment has not been widely utilised within mental health nurse education and little research exists surrounding their use. This paper furthers the literature base on the use of OSCE by exploring the underpinning design rationale and the subjective experience of staff and students.

This study aims to improve the efficiency of the assessment process within a Step4 Psychological Therapies Service by identifying factors related to assessment non-attendance and service suitability for referred clients.

Referral and assessment information was accessed between October 2019 and March 2020 from Step4 routine service data, electronic client records where necessary and Step4 staff self-report questionnaires.

All clients offered an assessment during this time attended. Findings indicated several factors could influence service suitability in meeting client need. These included individual differences such as readiness to change, which was not necessarily identified at referral or prior to assessment, and potential systemic factors, such as the opt-in procedure, which possibly impeded access. Though the necessity for assessment in clarifying client needs and treatment was indicated, an assessment (from referral to assessment appointment) that led to discharge could take an excess of one working day of service time, associated with considerable opportunity cost to other clients awaiting assessment. Recommendations are made for improving assessment efficiency.

With a high prevalence of poor mental health in the UK, efforts must be made to identify and reduce additional demand upon service time and resources within mental health services to effectively meet people’s needs. Recommendations to improve assessment process efficiency include the use of a standardised referral form, offer of follow-up support procedures, increased client involvement, a streamlined opt-in battery and ongoing monitoring to ensure shared practice between clinicians. These are transferable to other mental health services, with implications for subsequent quality and timeliness of care.

Over the last 12 years there have been substantial developments in UK law and policy relevant to mental health social work practice. The previous legal frameworks across the jurisdictions were very similar but the new laws have developed in different ways and provide greater opportunities for comparison. Across all the jurisdictions policy developments, especially in the areas of recovery and risk assessment, have influenced the way that mental health social workers practice.

This exploratory study used case study vignettes with 28 respondents to examine how these major legal and policy developments impact on social work practice.

There were variations in how levels of risk are defined and often a lack of clarity about how this informs decisions. There was a consensus that recovery is important but difficulties in understanding how this might apply in crises. Predictably, differences in legal and policy contexts meant that there were a variety of perspectives on how mental health social workers applied the laws in their jurisdictions.

The limited focus on research informed practice and the lack of transparency in decision making across areas of risk assessment and intervention, use of recovery approaches and the use of mental health laws suggest the need for a more evidence-based approach to training, education and practice.

There is very limited previous research on practitioner experiences of the complexities involved in implementing mental health law. This paper provides some insights into the issues involved and for the need for more detailed examination of the decision-making processes involved.

The purpose of this paper is to consider the impact of mental capacity legislation when applied to parents with learning difficulties who lack capacity within childcare and family law proceedings in England and Wales.

The paper relies on a range of material including reports published by independent mental health foundations, official inquiries and other public bodies. It also refers to academic and practitioner material in journals and government guidance.

The paper critically reviews the application of the guidance when assessing mental capacity legislation as applied in England and Wales and offers by way of illustration several case examples where psychological assessments, and the enhancement of capacity, have assisted parents who were involved in childcare and family law proceedings.

There has been little published research or governmental reports on the number of cases when parents involved in childcare and family law proceedings have been found to lack capacity. No published prevalence data are available on the times when enhancing capacity has resulted in a change of outcome in childcare and family law proceedings.

The duty is on the mental health practitioners assessing mental capacity that they do so in a structured and supportive role adhering to good practice guidance and follow the guiding principles of mental capacity legislation assuming that the individual has capacity unless it is established that they lack capacity. Guidance and training is needed to ensure that the interpretation of the Mental Capacity Act (MCA) and its application is applied consistently.

For those who are considered to lack mental capacity to make specific decisions, particularly within childcare and family law proceedings, safeguards are in place to better support such individuals and enhance their capacity in order that they can participate more fully in proceedings.

While the MCA legislation has now been enacted for over ten years, there is very little analysis of the implications of capacity assessments on parents involved in childcare and family law proceedings. This paper presents an overview and, in places, a critical analysis of the new safeguarding duties of mental health practitioners when assessing for, and enhancing capacity in parents.

The purpose of this paper is to measure the levels of psychological distress in adults entering Western Australia (WA) as refugees through the Australian Humanitarian Programme. To determine if the introduction of mental health screening instruments impacts on the level of referrals for further psychological/psychiatric assessment and treatment.

Participants were 300 consecutive consenting refugee adults attending the Humanitarian Entrant Health Service in Perth, WA. This service is government funded for the general health screening of refugees. The Kessler-10 (K10) and the World Health Organisation’s post-traumatic stress disorder (PTSD) screener were the principal outcome measures used.

Refugees had a high rate of current probable PTSD (17.2 per cent) as measured with the PTSD screener and mean K10 scores were significantly higher than general population norms. The K10 showed high accuracy for discriminating those with or without probable PTSD. Being married and having more children increased the risk of probable PTSD. In regard to region of origin, refugees from Western and Southern Asia had significantly higher scores on both screeners followed by those from Africa with those from South-Eastern Asia having the lowest scores. Referral rate for psychiatric/psychological treatment was 18 per cent compared to 4.2 per cent in the year prior to the study.

This study demonstrates increased psychological distress including a high rate of probable PTSD in a recently arrived multi-ethnic refugee population and also demonstrates significant variations based on region of origin. In addition, it supports the feasibility of using brief screening instruments to improve identification and referral of refugees with significant psychological distress in the context of a comprehensive general medical review.

This was an Australian study conducted in a non-psychiatric setting. The outcomes of this study pertain to refugee mental health assessed in a general health setting. The implications of the study findings are of far reaching relevance, inclusive of primary care doctors and general physicians as well as mental health clinicians. In particular the authors note that the findings of this study are to the authors’ knowledge unique in the refugee mental health literature as the participants are recently arrived refugees from diverse ethnic groups.

In the last decade we have witnessed much debate and activity around the provision of mental health services for people with learning disabilities in England. This article looks not only at current initiatives to improve mental health care from around England, but also places them within a policy context. Unfortunately there are areas that still fail to provide a basic care standard, some of which has been reported throughout the media from recent investigations. Where this is the case, we outline the responses and actions that have been put in place to address these issues.To maintain a momentum for positive change for the mental health care of people with learning disabilities, there now needs to be cooperation between services that traditionally have not worked together for the benefit of this client group. Before an equality of mental health service provision, in line with national standards, can be realised the traditional views and values of service providers and commissioners will need to be challenged and tuned to the needs of this group of people.