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Purpose Although it is recommended that reflective practice groups (RPGs) are used to support staff in inpatient intellectual disability (ID) services, there is to date no research on their effectiveness or how staff perceive RPGs in these settings. This paper aims to evaluate staff perceptions of the RPGs in an assessment and treatment unit for people with ID and to ascertain the nature of any barriers for staff in attending the group. Design/methodology/approach Thirteen staff completed questionnaires ascertaining their views on the purpose, process and impact of the RPG run within the service. Questionnaires included a version of the clinical supervision evaluation questionnaire (CSEQ; Horton et al., 2008) adapted for this context and a questionnaire designed by the authors examining barriers to attending the group. Findings Staff responses indicated that they valued the group and perceived it as improving their clinical practice and their self-awareness. Staff did not always perceive group sessions as having clear aims and did not perceive the group as enhancing their well-being or their awareness of gaps in their skills. RPGs may be most effective if they form part of a service-wide approach to staff support and development. Originality/value To the best of the authors’ knowledge, this is the first evaluation of RPGs in inpatient ID services. The adapted CSEQ was found to be an easily implemented method of evaluating RPGs in an inpatient ID setting.

Purpose The assessment for and diagnosis of personality disorder (PD) continue to be contentious, with many prominent practitioner psychologists arguing against this specific label and providing a credible alternative framework to psychiatric diagnosis more generally. This paper aims to summarise the literature and support practitioners identifying PD in people with intellectual disabilities (ID). Design/methodology/approach Relevant National Institute for Health and Care Excellence (NICE) guidance and literature were reviewed to provide a service position on the assessment and diagnosis of PD in people with ID. Findings For people with intellectual disabilities, the PD label can be even less robustly applied and may be even more pejorative and obstructive. That said, there are people for whom a PD diagnosis has clear clinical utility and opens access to suitable specialist services. Practical implications Evidence suggests that a diagnosis of PD can be both facilitative and obstructive, and the assessment and diagnosis process should, therefore, be undertaken with caution. Originality/value This paper presents an account of NICE guidance and evidence on the assessment and diagnosis of PD in people with intellectual disabilities.

Purpose The use of anti-dementia medication in people with intellectual disabilities has been controversial and requires additional research to assess the efficacy of such medications. An essential part of this treatment (both in terms of research and clinical practice) is having robust outcome measures to assess the efficacy of these medications for individuals. Currently there is no consensus in the UK regarding which outcome measures, in conjunction with clinical judgement, are effective in informing clinicians’ decision-making regarding anti-dementia medication management and this paper aims to present useful outcome measures. Design/methodology/approach A comprehensive literature search was conducted to identify relevant outcome measures. Outcome measures focused on aspects of patients’ presentation such as cognition, activities of daily living, neuropsychiatric presentation or the impact of their presentation (either on themselves, or on others). These outcome measures were critically appraised to ascertain their suitability in informing clinician’s decisions regarding management of anti-dementia medication. The focus of this appraisal was on good quality measures that are practical and accessible and can be easily used within clinical NHS services. Findings This paper provides advice for clinicians on using appropriate outcome measures, depending on patients’ presentations and the symptoms of dementia being targeted, that can be used alongside their clinical assessment to enhance their anti-dementia medication management. Two case studies are presented to illustrate the use of such outcome measures. Originality/value The case for using a range of assessments that are both broad in focus, and those specifically selected to measure the areas of functioning targeted by the anti-dementia medication, is presented.

Purpose The purpose of this study was to explore the views of psychologists working in community teams for people who have intellectual disabilities (ID) on the provision of psychological therapies to those with ID and autism spectrum disorder (ASD). Design/methodology/approach Semi-structured interviews were carried out with seven clinical psychologists working across a large geographical area. Interviews concerned the accessibility and effectiveness of psychological therapies. These were transcribed and analysed thematically. Findings Participants expressed concern about lack of access to mainstream services, the lack of visibility of their service and the suitability of the physical space to deliver therapy. They were positive about the effectiveness of therapy but emphasised the importance of adaptations and managing expectations. Research limitations/implications There is a lack of research in this area, and further research is needed with service users to develop a fuller understanding of their needs. Practical implications Consideration needs to be given on how to optimally deliver psychological therapies for this group. This will need services to become more flexible and focussed on the needs of this group of service users. Originality/value This paper provides insights into the views of psychologists on providing psychological therapy to people who have autism and ID.

Purpose This paper aims to systematically review the available evidence that explores adverse childhood experiences (ACEs) in people with intellectual disabilities (PwID). It is important to systematically review this literature as, to date, there is little known about the number of studies in this area, despite the World Health Organization declaring ACE prevention and support as a global public health priority. Design/methodology/approach Published studies were identified from electronic database searches. Key journals and reference lists were also hand searched. Findings Two studies met the inclusion criteria and the prevalence and frequency of ACEs experienced by participants of these studies analysed. Overall, due to the small number of studies meeting the inclusion criteria, it is difficult to establish any meaningful conclusions. Originality/value This appears to be the first systematic review to try and identify a research base looking at the prevalence of ACEs within a PwID population. Findings suggest that this is a highly neglected area of research, and the authors hope to have identified that further evidence is required to draw clearer conclusions about the impact of ACEs on PwID.

Purpose Recent guidelines from the National Institute of Health and Care Excellence highlight that service users (SUs) with intellectual disabilities and co-occurring mental health problems rarely get the opportunity to share their experiences of mental health services. Over the past 20 years, policy documents have stated that these individuals (SUs) must be included in decisions about their care. Research suggests that often this is not the case. Therefore, this paper aims to create a space for SUs to share their experiences of mental health services, and what they found helpful. Design/methodology/approach A focus group was held with five SUs, two psychologists and two researchers. The audio recording of the discussion was transcribed and analysed using thematic analysis. Findings Three main themes were identified, namely, “relationships with others”, “inclusion and communication” and “challenges”. This focus group highlighted that although some SUs felt supported, they reported having little control in their lives and wanted to be listened to. Research limitations/implications Including a SU in the planning and facilitation of the focus group would have made this research more inclusive. Practical implications The implications of this research suggest that by listening to and involving SUs and developing more person-centred services, recovery rates may increase as the services provided would be more targeted. Originality/value Very little research has previously been conducted to explore SUs’ experiences. This paper highlights the value of being heard and the knowledge that is often lost if the authors do not take the time to listen to the people for whom a service is designed.

Purpose Fidelity data in clinical trials are not only necessary for appraising the internal and external validity, but also could provide useful insights how to improve the application of an intervention in everyday settings. The purpose of this paper is to understand the current literature of fidelity measurements in complex interventions for people with intellectual disabilities (ID) and behaviours that challenge. Design/methodology/approach The electronic databases MEDLINE, Embase, PsycINFO, Web of Science and CINAHL Plus were searched for studies published between 1990 to 2017 that have mentioned fidelity in randomised controlled trials of complex interventions for people with ID and behaviours that challenge based on positive behaviour support or applied behaviour analysis principles. The authors also searched the grey literature and reference lists. Findings Five randomised controlled trials were included in the review. The authors found variable and inconsistent fidelity measurements reported in the studies. The most frequently provided fidelity elements found in four out of five studies were adherence of implementation, dose and some aspects of quality of delivery. Research limitations/implications Research recommendations for a standardised approach of measuring fidelity in such studies are suggested. Originality/value The first review of such type that confirms the paucity of research measuring fidelity in complex interventions in this population.

Purpose Children and young people with comorbid intellectual disabilities (ID) and autism spectrum disorders (ASD) are more likely to exhibit comorbid mental health disorders (MHD) and other significant behaviours (SB) in addition to the core symptoms of ASD. The purpose of this paper is to identify the prevalence of comorbid MHD and behaviours in children and young people with ID and ASD in Egypt. Design/methodology/approach The Reiss scale for children’s dual diagnosis was administered by parents and teachers of 222 Egyptian children and young people with mild/moderate ID and ASD to screen for MHD and SB. The mean age of children and young people was 12.3 years (SD = 3.64), with 75.6 per cent male. Findings The results revealed that 62.2 per cent of children and young people with ID and ASD had high rates of comorbid MHD and behaviour disorders were shown in 64.4 per cent of the participated children and young people. The results identified anger, anxiety and psychosis being the most frequently diagnosed disorders while crying spells and pica were the most SB. No differences were found between the male and female with ID and ASD in the current study. Research limitations/implications Mental health assessment of children and young people with ID and ASD will help to highlight the needs of these vulnerable children and develop the appropriate services. Originality/value The findings highlight the prevalence of MHD in children and young people with ID and ASD in Egypt. This has implications on the assessment of comorbid disorders and services needed for children with ID and ASD in Egypt.

Purpose Elucidating where antisocial or violent behaviour arises within the life course of individuals with intellectual disability (ID) could improve outcomes within this population, through informing services and interventions which prevent behaviours reaching a forensic threshold. The paper aims to discuss this issue. Design/methodology/approach The Historical Clinical Risk Management-20, Version 3 assessments of a cohort of 84 inpatients within a forensic ID service were analysed for this study, with a particular emphasis on items concerned with the age at which antisocial or violence first emerged. Findings For most participants, violent or antisocial behaviour was first observed in childhood or adolescence. The study also highlighted a smaller subgroup, whose problems with violence or antisocial behaviour were first observed in adulthood. Originality/value The study findings suggest that targeted services in childhood and adolescence may have a role in reducing the offending behaviour and forensic involvement of people with ID. This has implications for the service models provided for children and adolescents with ID with challenging or offending behaviour.

Purpose The purpose of this paper is to describe the mental healthcare system for people with intellectual disabilities (ID) in Switzerland. It covers the current provision of mental healthcare services as well as educational and research aspects, and summarises both the historical development and the current data on demography, health economics, legislation and national policy. Design/methodology/approach The authors performed an extensive literature research and evaluated the (very sparse) literature, conducted some interviews with recognised experts and carried out extensive internet-based research on the topic. Findings There are numerous, well-funded, well-staffed and well-equipped facilities for people with ID. These facilities have highly trained special education teachers and social education workers. Legislation, the insurance system as well as the policies and strategies on a national level are basically in line with people’s with ID needs. On the other hand, there are too few specialist physicians and psychologists, not enough training centres and too few specialist psychiatric services, both inpatient and outpatient. Medical and psychological research in this field is also insufficient. Practical implications In Switzerland, the development of treatment facilities typically does not start with a decision by a central authority to implement a policy in a top-down process. Usually, these organisations develop on the basis of some local initiatives and spread throughout the country. The process is likely to be similar in the case of services for people with mental health and intellectual disabilities (MHID), and the situation can be expected to be much better throughout the country within a few years. Furthermore, specific training programmes are expected to be created for physicians and psychologists of various disciplines, to promote an interdisciplinary approach. Originality/value This review fills a gap in that there are very few published reviews on the provision of MHID services in Switzerland.

Purpose The purpose of this paper is to explore the importance of equal access to Improving Access to Psychological Therapies (IAPT) for people with intellectual disabilities. Design/methodology/approach The paper identifies barriers to access and shows how a reference group can work to solve the barriers and increase access. Findings The paper evaluates the authors’ progress to date and how the authors plan to continue to take the work forward. Practical implications The paper highlights some of the factors responsible for the authors’ success and gives information that will be helpful to other areas who are interested in facilitating equal access. Originality/value The paper demonstrates how the focus of a reference group can drive improvements across services to improve access for people with intellectual disabilities to IAPT services.

Purpose The purpose of this paper is to assess the effects of compassion-focussed therapy (CFT) on anxiety in a small sample of adults with intellectual disability. Design/methodology/approach A mixed-methods design was employed. Participants (n=3) completed questionnaire measures of anxiety and self-compassion on three occasions: pre-intervention, post-intervention and, at three months follow-up. Post-intervention, they also took part in recorded interviews that were analysed using interpretive phenomenological analysis. Findings were then synthesised to develop a comprehensive understanding of their overall experience. Findings Final data synthesis revealed five themes: participant anxiety decreased (reliable for all participants); the faulty self; improved positive compassionate attitudes; increased sense of common humanity; and mindful distraction techniques. Research limitations/implications This research paper offers in-depth analysis of three participants’ experiences rather than reporting in less detail about a larger number of participants. The self-compassion scale required considerable support and reasonable adaptation to be used with these clients. Originality/value Only two other studies have explored the use of CFT with people with intellectual disabilities.

PurposeThe purpose of this paper is to examine guided self-help (GSH), and some of the barriers as to why it is not routinely available for people with intellectual disabilities (IDs).Design/methodology/approachThis paper offers an overview of GSH and the potential benefits of it as an intervention for people with ID with mild depression and/or anxiety.FindingsThe current literature reports the successful use and effectiveness of GSH in the general population. However, despite this there is little evidence that it is being used in practice for people with ID.Originality/valueThis paper offers an overview of GSH and advocates for its increasing use for people with ID to help bring about equality in mental healthcare.

Purpose The purpose of this paper is to determine the relation between quality of life (QoL), mental illness, challenging behaviour and institutionalisation in an adult population with intellectual disabilities (ID). Design/methodology/approach The study assessed the QoL and its conditioning factors in 142 subjects with different degrees of ID. The GENCAT and Quality of Life in Late Stage Dementia scale were used to evaluate QoL, the Psychiatric Assessment Schedule for Adults with Developmental Disability and Diagnostic Assessment for the Severely Handicapped-II scale to assess mental illness and the Inventory for Client and aetiology Planning scale to assess challenging behaviour. Findings Individuals who live in residential care homes were found to have significantly impaired QoL ( Originality/value This paper provides new insight into the importance of challenging behaviour and psychiatric disorders in the QoL of individuals with ID.

PurposeTo develop and implement an educational programme to improve medical students’ attitudes towards intellectual disabilities. The purpose of this paper is to improve the healthcare outcomes for individuals with intellectual disability.Design/methodology/approachThe development of an educational programme involving actors with an intellectual disability as simulated patients. Scenarios were developed involving basic healthcare interactions. The programme was piloted in three sessions with 45 students. A qualitative analysis of student feedback was then used to develop a student attitude questionnaire for completion pre- and post-educational intervention.FindingsThe student attitude questionnaire was completed by 23 different medical students. Two domains were analysed: affect and understanding domain scores, mean difference (95% CI) 3.17(2.41-3.94)ppSocial implicationsStudent feedback reveals significant positive changes in affect and understanding, and an improvement in knowledge and skill levels when interacting with people with an intellectual disability following the educational intervention. Some major institutions now offer comprehensive programmes involving people with intellectual disabilities as tutors, and in the role of simulated patients. However, more needs to be done to encourage the increased participation and good practice for all of tomorrow’s doctors to benefit.Originality/valueFollowing the publication of recent enquiries into the deaths of people with intellectual disabilities. We know that many of these deaths are premature and potentially preventable. The main failing identified repeatedly is that healthcare staff lack of awareness of the needs of people with intellectual disabilities. This emanates from poor quality and limited curricula time dedicated to intellectual disabilities. There is a need to drastically change the approach to teaching about intellectual disabilities to medical students. All the evidence promotes the involvement of people with intellectual disabilities and their careers in designing and delivering this teaching.

Purpose The purpose of this paper is to discuss the role of education and training in addressing health inequalities in intellectual disabilities, before examining innovative approaches to healthcare education. Preliminary findings of a simulation training course to support healthcare professionals to work with people with intellectual disability are then presented. Design/methodology/approach This study employed a mixed methods design to assess the impact of the simulation course. Quantitative data were collected using the Healthcare Skills Questionnaire and a self-report confidence measure; qualitative data were collected using post-course survey with free text responses to open questions. Findings Healthcare skills and confidence showed statistical improvements from pre- to post-course. Qualitative analyses demonstrated that participants perceived improvements to: attitudes, communication skills, reasonable adjustments, interprofessional and multi-disciplinary working, knowledge of key issues in working with people with intellectual disabilities. Practical implications Encouraging findings imply that simulation training to address health inequalities in intellectual disabilities is a valuable resource that merits further development. This training should be rolled out more widely, along with ongoing longitudinal evaluation via robust methods to gauge the impact on participants, their workplaces, and people with intellectual disabilities. Originality/value The authors believe this paper to be the first to assess an interprofessional, high-fidelity simulation course, using actors as simulated patients to address the mental and physical health needs of people with intellectual disabilities. The rigorous use of co-production and co-delivery, alongside promising findings for this training method, represent a useful contribution to the literature.

Purpose– The purpose of this paper is to present the development and evaluation of an original training package for staff members on fire-setting in people with intellectual disabilities. It also included training on functional analysis as a model of formulating the fire-setting behaviour. The quality and effectiveness of the training was assessed and is reported in this paper.Design/methodology/approach– The training was delivered on a ward for people with intellectual disabilities in a UK NHS Trust Low Secure Hospital and was attended by various members of the multidisciplinary team for the ward. The workshop consisted of four modules: theoretical background of fire-setting, the functional analysis model of fire-setting formulation, offence-paralleling behaviours in secure settings and a case study practice. Level of self-reported understanding of the various aspects of the training was measured by an evaluation questionnaire completed pre and post training.Findings– The results of this study showed that following the training there was a significant increase in self-reported understanding of staff members. The participants reported an increase in understanding of fire-setting, functional analysis and formulation of individuals with an intellectual disability and history of fire-setting.Originality/value– This study highlights the potential for staff training to increase awareness of fire-setting behaviours by people with intellectual disabilities. The staff training in formulation would encourage their involvement in development of team formulations and may subsequently increase their understanding of such individuals.

Purpose – The purpose of this paper is to describe the views and experiences of Improving Access to Psychological Therapies (IAPT) practitioners in providing therapy to patients who have an intellectual disability in order to support IAPT services in increasing their capability in this area. Design/methodology/approach – An online survey was conducted of IAPT practitioners in four IAPT services in the north of England. The survey collected respondents demographic information and their experience, confidence and attitudes to working with people with intellectual disabilities. Qualitative responses regarding respondents attitudes, views of barriers, problems, successes and possible solutions to the delivery of therapy to people with intellectual disabilities within IAPT services were collected. The survey results were interpreted by thematic and statistical analysis. Findings – The majority of respondents report having worked with people with intellectual disabilities and identify the need to adapt therapy, but also believe that such therapy should be offered within mainstream services. Thematic analysis identifies the needs for support in training, therapy adaptation and adjustment to pathways. However, the majority of respondents could identify positive outcomes and experiences. Research limitations/implications – This data supports the further development of pathways and offers some broad frameworks for the focus of training and development work for people with intellectual disabilities within IAPT. Social implications – This project has identified a positive attitude and willingness to consider adaptation of therapy for people with intellectual disabilities in practitioners working within IAPT services. Originality/value – Until now the views and experiences of IAPT practitioners in working with this patient group were relatively unknown.

Purpose– The Real Opportunities project set out to implement a number of the approaches identified through research that can assist transition to adulthood in nine local authority areas in Wales. Supported work experience was delivered by small job coaching teams in each area. The purpose of this paper is to establish the impact of the work experience and employment teams by describing the placements provided, any change in the skills of young people, and the responses to the placements by employers, young people and their families.Design/methodology/approach– Data were collected over 24 months by participating employment services. Questionnaires were administered to employers. Interviews were carried out with a sub-sample of young people (24) participating and a family member (25).Findings– Over a 24-month period 297 young people received supported work experience. In total, 262 young people had an intellectual disability, 35 an autistic spectrum disorder. Up to three placements were delivered to each person, averaging five weeks per placement, with 405 placements in total. In total, 62 per cent of those with two placements had a different category of second work placement to their first. These numbers demonstrated that work experience in community placements is possible with support. Young people improved work skills significantly between first and second placements. Employers reported high satisfaction rates with the young person’s work in a range of key performance areas and company benefits from participation for other staff, company image and customer relations. Interviews with 24 young people and 25 of their family members reported satisfaction with support and placements. Six young people had paid work now, and 33 per cent said they would get a job at some future time. Families reported changes in young person’s outlook but their view of prospects of employment remained pessimistic due to the external environment.Research limitations/implications– Implications for future research are discussed.Practical implications– Implications for transition are discussed.Originality/value– The paper provides new insight into the impact of a large number of supported work experience placements.

Purpose– Attention disorders in people with intellectual disabilities (ID) is common. Current drug treatments are based on the literature in people without ID. The purpose of this paper is to present a review of the drug treatment of Attention Deficit Hyperactivity Disorder (ADHD) in people with ID in the German and English languages literature with the aim of exploring the current evidence base.Design/methodology/approach– The paper provides a general review of the evidence base on drug treatment of ADHD in people with ID from the German and English language literature.Findings– Studies and practice guidance on ADHD in both languages are similar with more information published in English. Much of the evidence on drug therapy to treat ADHD in people with ID is based on studies in children. The literature on ADHD in children without ID is helpful but not specific to all people with ID who have ADHD. The response rates to medication to treat ADHD in people with ID are lower than in people without ID. The occurrence of side effects from medication is more common in people with ID. Co-morbid disorders are often present in people with ADHD that could affect study findings.Practical implications– Medication used to treat ADHD is effective when treating ADHD in people with ID. Prescribers should be aware of guidelines on medication and their potential drug interactions and side effects. Newer drugs could offer more effective treatments because of fewer adverse effects than current medications.Originality/value– The general review offers an insight in to the literature in German and English on ADHD in ID comparing what is published in both languages.

Purpose – Despite the longstanding use of music therapy with people with intellectual disabilities and the growing evidence base for using music therapy as a tool to aid behavioural and psychological symptoms of dementia in the general population, there is little work published which details the use of music therapy groups for people with intellectual disabilities who have a diagnosis of dementia. The purpose of this paper is to report a qualitative evaluation of staff views of a music therapy group for people with intellectual disabilities and dementia. Design/methodology/approach – Carers of service users attending the group were interviewed either individually or through a focus group in order to ascertain their views about the music therapy group. The interview transcripts were then analysed using thematic analysis. Findings – Two core themes and eight sub themes emerged from the data. These themes show that the group was felt to be pleasurable and enjoyable for the service users and that some tangible benefits of attending the group were observed by staff members. Notwithstanding the positive feedback, the results also suggested that more work is needed to inform carers of the goals and purpose of such groups. Further psycho-education for carers is suggested as a strategy to support future groups to run successfully. Originality/value – There is little published research into the use of music therapy for people with intellectual disabilities who also have dementia. The current paper provides a starting point for future work in the area and further recommendations for future practice and research are considered.

Purpose – It is widely recognised that people with intellectual disabilities receive a poorer quality of healthcare than their non-disabled counterparts. Training for healthcare professionals in intellectual disability is often scant or non-existent. The purpose of this paper is to explore the usefulness of employing actors with intellectual disabilities as simulated patients in the assessment of trainee psychiatrists. Design/methodology/approach – The development of a structured clinical exam “station” designed to assess the ability of trainee psychiatrists to communicate with a simulated patient played by an actor with an intellectual disability is described. The paper also assesses the potential benefits of this kind of assessment and the experience of actors and examiners taking part in this process. Findings – The station was found to perform well in discriminating between candidates of various abilities and was well received by actors, examiners and observers. The station is now routinely used in the formal assessment of trainee psychiatrists. Practical implications – The use of people with intellectual disabilities in training and assessment appears to be advantageous in terms of improving knowledge, attitudes and skills amongst healthcare professionals and gives increased opportunities for people with intellectual disabilities to undertake valued social roles. Originality/value – Few institutions currently employ actors with intellectual disabilities as simulated patients as part of their training programmes and as a result there is little in the way of literature on this subject. This paper describes an alternative approach to teaching and assessment which falls in line with recommendations from the Department of Health to involve service users in the training of healthcare professionals.

Purpose – Diagnosing psychiatric disorders (PD) in adults with Intellectual Disability (ID) presents several issues and need specific skills and tools. The purpose of this paper is to provide a detailed description of the current status of art through a systematic mapping of the literature. Design/methodology/approach – The authors reviewed the international literature on the basis of the following questions: what are the issues in the psychiatric diagnostic process for adults with ID? What methods and procedures have been used for psychiatric assessment in ID? To date, is it possible to identify some most effective procedures? Findings – The analysis of the literature indicates that main issues of the psychiatric diagnostic process in adults with ID are the following: identification of psychiatric symptoms, behavioural equivalents, diagnostic criteria, setting, source of information, screening, and diagnostic tools. The evidence base is only emerging and although many relevant achievements have been reached in the last two decades, no definitive guideline has been produced. Most recent acquisition also allowed to identify some assessment procedures that are currently considered the most effective. Individualised assessment remains the best way to meet the needs of this heterogeneous and variable patient group. Originality/value – This paper offers a comprehensive and updated description of current achievements and issues towards the assessment of PD in people with ID.

Purpose– The purpose of this paper is to assess the behavioural and psychological effects on people with intellectual disabilities of transferring to an environment influenced by patient choice and low secure standards.Design/methodology/approach– Patients and staff transferring from a non-optimal environment to one driven by low secure standards compared the homeliness, ward climate and satisfaction with the two wards. Comparisons were made between the occurrences of risk behaviours on the two wards.Findings– The new environment was rated by staff as more homely while patients’ increased satisfaction with the new ward was reflected in social climate ratings of patient cohesion and experienced safety. The latter findings were reinforced by an objective reduction in risk behaviours in the new environment.Practical implications– Treatment interventions need to optimise research findings that attest to the influence of the environment on the behaviour of patients with intellectual disabilities.Originality/value– Findings highlight need to increase the focus on aspects of the built environment in planning the treatment of women in secure care.

Purpose – Carers play a vital role in looking after people with intellectual disabilities (ID). Caring role can be stressful and challenging in nature. Carers use various coping strategies to deal with stressors. The purpose of this paper is to explore coping strategies of carers looking after people with ID and dementia. Design/methodology/approach – Qualitative methodology was used to explore coping strategies. Focus groups and face-to-face interviews were carried out. These interviews were transcribed and analysed using thematic analysis. Findings – Nine interviews with carers (six paid carers and three family carers) and two focus groups with nursing staff looking after people with ID were carried out. Three key themes of “Narrative”, “Strategy toolbox” and “Compartmentalisation” emerged from analysis. Narrative and strategy took box were further subthemed. Carers had narratives about them and the person they look after. These “narratives” helped them to deal with day to day stressors. They also carried a “strategy toolbox”, which they used when they were in stressful situations. Compartmentalisation helped them to separate their personal life from work life as a carer. Originality/value – Understanding carers’ coping strategies is important when planning services to help carers who play an important role in our society. Professionals can support carers to understand and improve their existing coping skills and help them to thrive in their role as carers.

Purpose – There is a move to make primary care models of mental health care more accessible to people with intellectual disabilities (IAPT, 2009) but little evidence of their ability of services to make the necessary reasonable adjustments or their effectiveness (Dodd et al., 2011). The purpose of this paper is to describe a pilot project to evaluate an anxiety management group co-facilitated by Least Intervention First Time (LIFT) Psychology and Community Team for People with Learning Disabilities (CTPLD) services. Design/methodology/approach – Five people attended a nine-week anxiety management group, adapted from a course offered by LIFT services. The Glasgow Anxiety Scale (GAS-ID) and a skills and knowledge assessment were completed pre-group, post-group and follow-up to evaluate outcome and consider the ability of LIFT to make reasonable adjustments to deliver effective services for people with intellectual disabilities. Findings – Participants showed no significant reduction in anxiety levels but improvements in their skills and knowledge. An evaluation of the adjustments to make the group accessible for people with intellectual disabilities identified that some were feasible if offering the group on a long-term basis, and others were not. The viability of future groups is considered. Originality/value – The paper looks at the viability of making reasonable adjustments to psychoeducational groups within Improving Access to Psychological Therapies services to better meet the needs of people with intellectual disabilities, an area of limited research. It raises dilemmas and considerations for the future development of such services.

Purpose – There is little research addressing the delivery of training for health professionals who are interested in using cognitive-behaviour therapy (CBT) techniques as an adjunct to their current role. This paper describes the establishment and evaluation of a CBT training course to develop CBT skills in staff working with people with intellectual disabilities in Trust healthcare settings. The course would enable staff to learn how they could incorporate these skills into their daily practice to help them understand and work more effectively with people with intellectual disabilities. Design/methodology/approach – A CBT training course was designed to teach staff the use of a number of basic and specific CBT techniques and principles that staff could use within their current roles. Specific issues in relation to people with intellectual disabilities were included, e.g. understanding cognitive deficits as well as cognitive distortions. The course ran for six sessions on a fortnightly basis, followed by a two-month follow-up session. Participants completed a pre- and post-assessment questionnaire and kept a reflective diary. Findings – The training clearly focused on teaching skills that were feasible for staff to use in their own work settings. The evaluations, especially from the reflective diaries and the post-course questionnaires clearly demonstrated that this aim was achieved. Originality/value – This was a pilot study as there has been no previously published evidence of using this approach within intellectual disabilities services. A further training course has been planned to continue evaluating the effectiveness of this approach.

PurposeThe use of accessible, portable, mental health crisis information in people with intellectual disabilities has not been previously reported. The purpose of this paper is to explore whether crisis information could be modified to be made accessible and meaningful for people with intellectual disabilities.Design/methodology/approachPersonalized information to help in a mental health crisis was recorded on folded A4 sized sheets that could be carried in a conveniently sized wallet.FindingsThree quarters of the participants carried their crisis information wallets on a daily basis for six months before evaluation. They and their carers expressed positive feedback about them carrying the crisis information. No one carrying the information actually experienced a mental health crisis in the six months follow up period so their usefulness in such crises could not be evaluated. However, they were unexpectedly used in other non‐mental health settings and reported to have been helpful.Originality/valueThe sample size in this was small but the findings suggested that the carrying of crisis information might be a helpful measure for some people with intellectual disabilities. A further, larger scale trial is warranted.

PurposeThe aim of this paper is to review the current literature on working with young people with intellectual disabilities who commit arson.Design/methodology/approachA review of assessment methods and interventions involving young people with intellectual disabilities who start fires was completed. It explores the trends across the population of firesetters as a whole and also compares how treatment implications may differ for young people with and without an intellectual disability.FindingsThe paper outlines the core risk factors to be investigated within an assessment of a young firesetter with intellectual disabilities. In terms of treatment, the best current approach appears to be a combination of education and cognitive behavioural approaches including social skills training. Other treatment modalities, e.g. joint interventions provided by fire services and mental health services, are also discussed.Originality/valueGiven the lack of available literature on young firesetters with intellectual disabilities it is hoped that this paper will be useful in guiding clinicians working in this area and also prompt future research regarding treatment with this client group.

PurposeIt is increasingly recognised that people with intellectual disabilities have poorer access to health care. One of the recommendations from the independent report, Healthcare for All is compulsory undergraduate medical teaching about people with intellectual disabilities. The purpose of this paper is to investigate the attitudes of medical students towards people with intellectual disabilities. The authors hypothesised that knowledge and attitude will change over the course of a 14‐week Neurosciences block, which included a taught intellectual disabilities module and opportunity to undertake a clinical placement.Design/methodology/approachThe authors conducted a naturalistic prospective study in a London university. Data were collected at the beginning and the end of each of the three 14‐week Neurosciences blocks during the year. Attitude was measured using a self‐report questionnaire, including an amended short form of the Community Living Attitudes Scale (CLAS), administered in hard and e‐copy.FindingsIn total 136 medical students (35 per cent response rate) completed the questionnaire at the beginning and 133 (34 per cent response rate) at the end of the block. By the end of the block, students had increased knowledge of the definition of intellectual disability. Medical students showed generally favourable attitudes towards people with intellectual disabilities but there was no significant change in attitude between the start and end of the block.Originality/valueThis study shows that didactic teaching and limited exposure to people with intellectual disabilities, although it increases knowledge, is not enough to affect the kind of changes required to improve attitude. Increased face to face contact with people with intellectual disabilities and other innovative teaching methods are more likely to influence attitude in future medical practitioners. These will require further evaluation.

Purpose – Children and young people with co‐morbid intellectual disabilities and autism are more prone to experience mental health problems compared to people with intellectual disabilities but without autism. Children and young people with intellectual disabilities and autism may experience symptoms of anxiety at a greater level than the general population; however, this is not supported with research evidence in relation to the prevalence of anxiety in people with intellectual disabilities and autism. The aim of this study is to identify the prevalence of anxiety disorders in children and young people with intellectual disabilities and autism.Design/methodology/approach – In total, 150 children and young people (age range of 5‐18 years) from a metropolitan district in the North of England were screened for anxiety using the Reiss Scales for Children's Dual Diagnosis and the Glasgow Anxiety Scale.Findings – The results indicate that the prevalence of anxiety was 32.6 per cent for children and young peopl...

PurposeThe purpose of this paper is to ascertain the training status of staff in care homes for people with intellectual disabilities managed by the non‐health sector in High Wycombe, with regard to administering emergency antiepileptic medication and to identify training needs.Design/methodology/approachManagement of seizures in people with intellectual disabilities and epilepsy comes with its challenges. Although there are clear guidelines for the same, implementing them in the community, especially in the non‐health sector setting, raises the issue of training staff in the administration of emergency antiepileptic medication. A survey was undertaken in response to the varying staff training needs. A short semi‐structured questionnaire was designed and administered over the telephone to the managers of these care homes.FindingsLess than half of the care homes had staff trained to administer emergency antiepileptic medication. The commonest reason cited was their policy of admitting only patients with well controlled seizures. This paper identified the need for staff training and raising awareness amongst relevant healthcare professionals.Practical implicationsThe survey highlights the practical difficulties arising in the implementation of national and trust level healthcare policies in the community.Originality/valueThis paper is of value to clinicians working with people with intellectual disabilities and epilepsy, GPs, and staff and management in the care homes in the health and non‐health sectors. It raises questions around delineation of responsibility and communication between various professionals in various levels of care involved in managing people with intellectual disabilities and epilepsy to ensure provision of safe and effective care for this population.

PurposeAn earlier study of health and social services professionals in community teams for people with intellectual disabilities (CTIDs) identified a number of significant gaps in their knowledge of mental capacity issues. The present study aims to ascertain the knowledge of staff working in residential services for people with intellectual disabilities.Design/methodology/approachParticipants were staff working in three specialist residential settings catering to people with intellectual disabilities: qualified nurses working in the UK National Health Service (NHS) and in independent‐sector continuing health care settings; and senior staff in residential houses. They were administered the same structured interview as in the earlier study, which was constructed around three scenarios concerning a financial/legal issue, a health issue, and a relationships issue, as well as a set of ten “true/false” statements. Their performance was compared with that of two reference groups, the earlier CTID participants, and a group of staff working in generic (i.e. other than specialist intellectual disability) NHS services.FindingsNo differences in interview performance were found between the three groups of residential carers, who performed better than generic NHS staff but worse than CTID professionals. However, the three residential groups did differ in their self‐ratings of how well‐informed and confident they felt in relation to mental capacity issues.Originality/valueThe study shows that staff working in residential services for people with intellectual disabilities have only a limited understanding of mental capacity issues and their confidence in their own knowledge may not be a good guide to their ability to deal with such issues when they arise in practice.

The Improving Access to Psychological Therapies (IAPT) programme was established to treat people with mild to moderate depression and anxiety and bring them to recovery. Although the Positive Practice Guide for people with intellectual disabilities was published in 2009, no geographical areas are listed as having a special interest in specifically rolling out IAPT to people with intellectual disabilities. Issues related to whether current IAPT services can meet the needs of people with intellectual disabilities are considered, along with adaptations that would be needed to ensure the service is accessible and meets the needs of people with intellectual disabilities.

Transitions for young people with intellectual disabilities have received much attention from researchers. Little is known, however, about how mental health services link with existing transition partnerships and what the potential service gaps are for young people with intellectual disabilities. Eight mental health professionals in three local authorities in Wales were interviewed to sketch potential research themes in this area. Our findings revealed a remarkable lack of engagement of mental health professionals with transition partnerships for young people with intellectual disabilities, and significant service gaps. The insufficient integration of mental health services in transition planning may contribute to disruptive transitions for young people with intellectual disabilities and their carers. Further research should examine how best to involve mental health services in transition partnerships for young people.

Purpose – The purpose of this paper is to identify psychotropic medication being prescribed for people with intellectual disability “as and when required” (PRN); the indications, frequency of use, rate of poly-pharmacy and contribution of PRN medication towards this. The paper also aimed to identify individual and environmental factors associated with PRN medication prescribing. Design/methodology/approach – Data were collected from nursing and medical records for the 119 service users in the acute assessment and treatment unit and NHS residential care settings managed by specialist intellectual disability services covering Leicester, Leicestershire and Rutland over a month period. Data were analysed using descriptive statistics and logistic regression to calculate adjusted odds ratios for predictor variables. Findings – In total, 72 per cent of the service users were prescribed and 25 per cent were administered PRN medication over the study period. The most common indications for PRN prescribing were aggression and agitation. Lorazepam and chlorpromazine were the most frequently prescribed PRN medications. The rate of poly-pharmacy was 41 and 38 per cent of this was attributable to PRN medication. Male gender and history of challenging behaviour were found to be significant factors associated with PRN medication prescribing. Originality/value – PRN medications are commonly prescribed in people with intellectual disabilities and contribute to poly-pharmacy. Whilst PRN medication continues to remain an effective therapeutic option in situations where environmental and behavioural approaches are proving insufficient, their use should always be in conjunction with effective review mechanisms.

Purpose – Psychological therapies are increasingly being made available to adults with intellectual disabilities. However, little is known about service user satisfaction with this type of intervention. The aim was to ascertain quantitative and qualitative data on user satisfaction with the psychological therapy they had received. Design/methodology/approach – In total, 20 recipients of psychological therapy completed the Satisfaction with Therapy and Therapist Scale – Revised (STTS-R; Oei and Shuttleword, 1999) and the Experience of Service Questionnaire (Commission for Health Improvement, 2002). The scales were adapted for language and administered in an assisted completion format by an independent researcher after a course of psychological therapy had been completed. Descriptive statistics were used to analyse the quantitative data and thematic analysis was used to analyse the qualitative data. Findings – Generally, recipients were highly satisfied with their therapist and the therapy they received. Originality/value – The results confirm previous findings from two small-scale qualitative studies. Service user satisfaction is a key quality outcome measure and can be collated in routine practice for people with intellectual disabilities. The collation of qualitative responses in addition to quantitative measures is important to enable the expression of dissatisfaction and greater detail in order to inform service improvement.

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.

PurposeWhilst there is a growing evidence base for the use of cognitive behavioural therapies (CBT) for people with intellectual disabilities, there may be challenges to using an approach that locates problems within people rather than as being generated and maintained through social relations and social discourses. The purpose of this paper is to present a cautionary case that demonstrates some of the potential dilemmas and challenges that can be experienced in therapy when applying this way of working to a client with intellectual disabilities.Design/methodology/approachThe authors present a case example of work with Mark, a young man with intellectual disabilities who accessed services for support with his low mood and outline the challenges faced when using CBT in understanding his presenting problem.FindingsThere is evidence from the case example that there is the potential for therapeutic techniques used in CBT to promote questions that invite, generate and reinforce feelings of incompetence and inability in people with intellectual disabilities.Originality/valueThe use of narrative techniques is discussed as a means of avoiding locating the problem as being within clients with intellectual disabilities; the implications that this has for the use of CBT with this client group are considered.

PurposeThe purpose of this paper is to provide a viewpoint on what needs to be done to develop competent residential services for people with intellectual disabilities and challenging behaviour.Design/methodology/approachThis article draws on previous accounts of the actions required. Whilst these have been available for decades and are still valid, they have not been fully implemented, hence the theme of “Back to the future”.FindingsThe need to continue developing small‐scale, community‐based services that have a clear value base and are committed to taking person‐centred action is highlighted. The paper focuses on the need to enhance service quality through the dissemination and implementation of Positive Behavioural Support and discusses some key issues regarding this with reference to recent work in Wales.Originality/valueThis paper makes a timely contribution to the current debate and highlights some practical actions and tools developed in Wales that may be of wider interest.

PurposeThe purpose of this paper is to discuss a model of couple intervention that has been specifically developed for helping people with intellectual disabilities who are experiencing relationship problems.Design/methodology/approachAmong other suggestions, the model recommends assessing and working not only with the couple, but also with extended family and the service system. An agency staff, familiar with the couple, is frequently asked to act as co‐therapist.FindingsPrivate couple therapy sessions have proven extremely valuable, along with specific strategies that focus on management of issues such as anger and jealousy, sexuality issues, ways partners can complement and compensate for each other's weaknesses, healthy boundary‐setting, having fun, and utilizing psychiatric consultation if necessary.Originality/valueThere is almost no other clinical literature on this topic. This paper offers practical suggestions and is quite unique in the field.

PurposeThe current qualitative study aims to investigate service users’, support staff's and community team members’ views of gender differences in cause and presentation of mental health problems, whether current services respond differently to men and women with mental health problems and areas in which services can become more gender sensitive.Design/methodology/approachTwo focus groups were conducted with service users with intellectual disabilities and mental health problems in addition to two focus groups with a variety of staff. Subsequently, individual interviews were conducted with both male and female staff members employed in residential and community intellectual disability services. The number of participants totalled 54 (16 service users and 38 staff). Thematic analysis was adopted in order to identify dominant themes in the discourse of these stakeholder groups.FindingsThe analysis produced a number of themes which include: compliance versus challenge; vulnerability; expression of emotion; gender equality; same sex support; caring qualities; and boundaries.Originality/valueA number of suggestions for improving services are discussed in the context of the current findings.

PurposeThere has been limited evidence on which to base services in the community for people who have intellectual disabilities and coexisting mental health problems. Recent research involving service users, carers and professionals has identified a number of key service components that community services should provide. More detail is needed to explore how best these components could be implemented and delivered. This paper aims to discuss these issues.Design/methodology/approachA total of 14 multidisciplinary professionals from specialist intellectual disabilities services in the UK were interviewed about their opinions on four key areas of community service provision. These included the review and monitoring of service users, their access to social, leisure and occupational activities, the support, advice and training around mental health for a person's family or carers and “out of hours” and crisis responses. The interview data was used for coding using the NVivo 7 software package and then analyzed using thematic analysis.FindingsAnalysis of participants' views on these key essential service components produced wider themes of importance. The ten major emergent themes for services were: their configuration/structure, their clarity of purpose/care pathways, their joint working, their training, their flexibility, their resources, their evidence‐base, being holistic/multidisciplinary, being needs‐led/personalised and providing accessible information.Originality/valueThese views of experts can help inform further research for the development and the evaluation of services.

Purpose – Great controversy surrounds the prescribing of antipsychotics for people with an intellectual disability. This stems from a lack of research to support their use in this specific population together with their “off label” use to treat behaviour problems. This paper aims to review prescribing practice of antipsychotics by the Salford Intellectual Disability Psychiatry Department in accordance with standards adapted from nationally recognised guidelines.Design/methodology/approach – Data was collected from all 178 patients under this department including patient demographics, severity of intellectual disability, co‐morbid diagnoses and details of any antipsychotic drug use. Main standards of prescribing measured: indication of antipsychotic prescribing; documented review of medications; documentation of side effects; documentation of physical health parameters including weight, blood pressure, blood glucose, lipids.Findings – In total, 126 (72 per cent) were prescribed antipsychotics. 42 (33 per c...

PurposeThe aim of the present study is to explore the psychometric properties of the EssenCES measure (patient report) of social climate in a secure service for people with intellectual disabilities.Design/methodology/approachPatients (37 men, 14 women, Mean age=33.24 years, SD=11.29, age range: 18‐71 years) residing in a secure intellectual disabilities service completed the EssenCES as part of routine clinical practice.FindingsReliability analysis revealed acceptable reliability for all three subscales (α=0.76‐0.88). In order to consider one aspect of the construct validity of this measure, a predicted group difference regarding the impact of security level on ratings of social climate was investigated. Analysis revealed that social climate ratings were more positive on low secure wards than medium secure wards as measured by the combined EssenCES subscales F(3, 31)=4.71, p=0.008; Λ=0.69; η2=0.31, and the Experienced Safety subscale, F(1, 33)=7.41, p=0.01.Research limitations/implicationsFuture research should consider the link between social climate and treatment outcome within forensic secure intellectual disability services.Originality/valueResults provide preliminary evidence to suggest that the EssenCES subscales (patient report) are reliable in this previously unconsidered population. However the validity of the measure is still unclear and requires further investigation.

PurposeThe purpose of this paper is to share and report on practice development.Design/methodology/approachA description of a joint neuropsychiatric clinic, including demographics of patients seen, is provided.FindingsThe paper expresses the opinion that the experience of running a joint clinic for complex cases with neurological and psychiatric pathology was professionally rewarding and that clinicians found it a more effective way of delivering care.Originality/valueThis is the first description of such a clinic to the authors' knowledge. Development of similar services may be of value.

PurposeThe purpose of this paper is threefold: to summarize data on rates of sexual abuse and interpersonal trauma in people with intellectual disability (ID); to demonstrate the relationship between such trauma and psychological distress; and to describe a promising treatment technique for such exposed individuals.Design/methodology/approachA review of the literature on rates of abuse and trauma among people with ID is presented with particular attention paid to the role of developmental level in both the experience and impact of trauma. Drawing from this understanding of the phenomenology of traumatic exposure in people with ID, the authors present a theoretical framework for psychotherapeutic intervention.FindingsThis paper establishes the inverse relationship between the higher‐than‐average rates of trauma and interpersonal violence in the ID population, co‐occurring with lower‐than‐average access to treatment, and lower‐than‐average treatment model development for this population. Further, this paper provides a description of a theoretically based therapeutic intervention with preliminary research efficacy.Practical implicationsThis paper documents three key areas in need of attention in order to reduce the suffering of people with ID: the need to address the high rates of exposure to abuse; the importance of taking into account developmental level when assessing the impact of potentially traumatic experiences; and the efficacy of the interactive‐behavioral model of group psychotherapy for people with ID who have trauma‐related distress.Originality/valueThis paper points to the need for systematic efforts to reduce the rate of traumatic exposure to which people with ID are disproportionately exposed. Moreover, it establishes how important the role of developmental level is in understanding how exposure to abuse may result in the development of psychological disorders. Finally, this paper provides a clear understanding of a targeted therapeutic approach and the need for a system of accessible care so that afflicted individuals may have the benefit of such therapy.

The aim of this study was to seek the opinions of people with an intellectual disability who have additional mental health needs about the mental health services they receive. A semi‐structured focus group methodology was used to ask participants about all aspects of the mental health services they receive. Overall, it was found that participants valued staff who listened to them and actively tried to help with their difficulties. They also wanted choice and control over their lives, particularly with regard to meaningful day activities. Limitations of the study are highlighted.

Purpose Nursing teams supporting people with intellectual disabilities in inpatient settings are known to be vulnerable to burnout, compassion fatigue and vicarious trauma. Aspects such as resourcing, support, training and the fundamental challenges of supporting this patient group are known risk factors for these difficulties. The aim of this paper is to synthesise the literature on these issues and provide suggestions for operationalising solutions. Design/methodology/approach Literature on the experiences of nursing teams supporting people with intellectual disabilities in inpatient settings was considered, alongside the established offer of clinical psychologists working into these services. Findings There are common themes of staff’s emotional health and the impact this can have on patient care and the steps that managers and organisations can take to support their teams to remain emotionally healthy, compassionate and effective practitioners. Clinical psychology can play a role in offering this support only where services and teams are aware of the contribution they can make. Originality/value Clinical psychology has been undersold and under-represented in inpatient settings for people with intellectual disabilities, and this practice paper outlines the important contributions that they can make to the psychological well-being of all within the system, not just patients.