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Caregivers of people with intellectual disabilities may feel overburdened in their work and experience negative psychological consequences. The purpose of this instrumental study was to determine the evidence of internal structure and reliability of the Zarit Caregiver Burden Interview scale. A total of 398 family caregivers, including women and men, participated (M = 47.33, SD = 10.44). The structure of the scale was evaluated by factor analysis and the McDonald Omega coefficient was used to estimate reliability. Sixteen models of the scale were tested, differing in number of items and factor structures. A model of 15 items and 4 dimensions (overload, competence, social relationship, and interpersonal relationship) obtained acceptable fit (χ2 = 184.72; p < 0.001; CFI = 0.95; TLI = 0.94; RMSEA = 0.055; SRMR = 0.05) and reliability coefficients above 0.70 in their dimensions. It is concluded that the Zarit scale is valid and reliable for use in caregivers of people with intellectual disabilities.

Purpose This study provides further insight into the experiences of five men who have committed sexual offences, with intellectual disabilities and have been recalled back to prison. The purpose of this paper is to increase professional knowledge to assist with improving working practices that support the reintegration of individuals convicted of sexual offences and with intellectual disabilities, back into the community. Design/methodology/approach Interview data was analysed using interpretative phenomenological analysis, to identify the key issues associated with criminal justice services. Findings The following superordinate themes were identified: “The label that sticks” and “Probation officer dependency”. Research limitations/implications The key implications of the findings were the high level of dependency individuals had on their probation officers and the impact that this relationship had on the overall experience of recall. The stigma of the label “sex offender” was also found to have a profound impact on individuals’ feelings of safety and their future progression. Originality/value Research exploring the experiences of individuals convicted for sexual offences and with intellectual disabilities, being recalled back to prison, is limited. Future recommendations of how practice could be improved to better support responsivity needs of this group and to create a more positive self-identity are discussed.

BackgroundPersons with intellectual disabilities (ID) may have difficulties providing reliable and valid accounts of their personal experiences through self-report measures. The aim of the current study was to systematically review the peer-reviewed research literature on the adaptations needed to develop ‘ID-inclusive’ self-report measures. MethodA search of PsycINFO, PubMed, Web of Science and Google Scholar identified 49 studies that met inclusion criteria. A GRADE-CERQual assessment was performed to determine the level of confidence in the review findings. Results161 recommendations for the development of ‘ID-inclusive’ self-report measures were extracted from 49 included studies. Recommendations were presented in a GRADE-CERQual Summary of Findings table, according to a 5-stage model of instrument development. ConclusionsThis review offers much-needed practical guidance for clinicians and researchers on how to develop ‘ID-inclusive’ self-report measures. Recommendations for future research about self-report instrument development for use with people with ID are presented.

Purpose This narrative review aims to examine how trans people with intellectual disabilities are perceived and discussed in the academic literature. Design/methodology/approach A narrative review was carried out to better understand the positioning of people with intellectual disabilities who identify as trans. Findings There was a lack of clear terminology, an over medicalization of both people with intellectual disabilities and trans people and evidence that identifying with a non-conforming gender identity was seen as a problem by services. Services need to be better informed about issues around gender identity so that they are able to better support trans people with intellectual disabilities. Originality/value To the best of the authors’ knowledge, no previous literature review has focused only on trans people with intellectual disabilities.

Purpose As Clinical Psychologists working in a tertiary Intellectual Disability (ID) service in the UK, this paper aims to address the impact of Covid-19 – and the subsequent transition out of Covid-19 restrictions – on individuals with an ID, and the clinicians working alongside them. Additionally, the paper reflects upon how Covid-19 has shaped and manipulated therapeutic communities and environments. Design/methodology/approach This paper is reflective in nature and reviews current evidence associated with how people with an ID experienced the impact of Covid-19. Clinicians reflect upon their shared experience in line with this evidence. Findings This paper highlights perpetuating inequalities and injustices on people with an ID as a result of Covid-19. Further, it is indicated that that there should be consideration of how people with an intellectual disability experience transitions back to their day-to-day environments and encourages clinicians to widely consider how to shape therapeutic communities and environments. Originality/value Multiple themes have been addressed in this paper, and the reflections add to an understanding of how those individuals specifically working in, or using intellectual disability services, have experienced the Covid-19 pandemic, though a critical lens.

Purpose This paper aims to discuss the barriers that people with intellectual disabilities face to come out as transgender in the context of a paucity of research with or about this group. Design/methodology/approach The commentary and brief overview of trans participation in literature on people with intellectual disabilities presented in this paper is informed by a Queer Theory and Critical disabilities Studies approach. Findings Researchers in this area are correct that there is insufficient literature that addressed the experiences of trans people with intellectual disabilities; however, for trans people with intellectual disabilities to be involved in research they must first be safe to self-identify and come out in their communities and services. Existing research suggests that people with intellectual disabilities may face additional barriers to self-identifying as LGTBQ, and that for those who have claimed a trans identity, it is not safe to come out. Social implications There is a need for researchers and professional and lived experience experts to be engaged in policy and social research with the aim of creating safe spaces and communities for people with intellectual disabilities to explore and affirm their gender. Originality/value There are no published papers that redirect focus from a paucity of research into the experiences of trans people with intellectual disabilities towards addressing why trans people with intellectual disabilities may choose not to come out in a context of hostility towards transgender identity in disabilities services.

People with intellectual disabilities (PWID) are more likely to be survivors of sexual assault than people without intellectual disabilities (ID). Their cognitive, emotional, behavioral, and physical challenges increase their vulnerability and chances of being sexually assaulted. Despite this, individuals that disclose their sexual abuse face multiple barriers while seeking justice. This results in low prosecution and conviction rates of sexual offenders in cases involving complainants with ID. There is limited information available about specific factors that predict a court case outcome of sexual abuse cases involving PWID. This correlational study reviewed archival data of alleged survivors of sexual abuse with ID. The sample of 493 complainants had received assistance from Cape Mental Health (CMH) Sexual and Victim Empowered (SAVE) Program. This study showed that most of the complainants of sexual assault were female (86.8%), and 12.6% were male. Most complainants fell within the Mild ID range (54.6%), followed by Severe (20.3%) and Moderate ID (17%). More than half of the cases were withdrawn (58%), 22% of the perpetrators were found guilty, and 12% were acquitted of the charges. This study found that the ability to understand the consequences of sex and to refuse sexual advances increased the individual's ability to consent to sexual activity, while their ability to answer clarifying questions and take an oath significantly impacted their ability to testify in court. However, neither the ability to provide consent nor the ability to testify was significant in predicting the court case outcomes. This highlights the challenges complainants with ID face when seeking justice for sexual abuse. Sexuality education for PWID may mitigate their risk of sexual abuse and serve as a protective factor. Furthermore, the public's awareness regarding the rights of, and responsibilities towards, PWID may also decrease their vulnerability and protect PWID from injustice.

This paper is an introduction to adaptations to make cognitive behaviour therapy (CBT) more accessible to people with intellectual disabilities. It is intended to inform therapists who may work with people with intellectual disabilities in mainstream services. The paper describes adaptations that consider neuropsychological processes, such as memory, and executive functions, such as planning, problem solving and self-regulation, and identifies that these factors are not unique to people with intellectual disabilities. We describe adaptations based on a review of literature describing CBT for people with intellectual disabilities (Surley and Dagnan, 2019) and draw on clinical experience to give examples of adaptations where possible. The paper particularly emphasises the generalisability of adaptations used with people with intellectual disabilities to therapy with wider populations and suggests that CBT therapists working in mainstream services will have the skills to be able to adapt therapy for people with intellectual disabilities. Key learning aims (1) To overview the evidence base supporting the use of CBT with people with intellectual disabilities. (2) To describe the epidemiology of intellectual disability and discuss its implications for the generalisability of adaptations discussed in this paper. (3) To describe a range of adaptations to make CBT more accessible people with intellectual disabilities. (4) To consider whether such adaptations are part of the skill set of CBT therapists mainly working with people without intellectual disabilities.

Purpose. The research reveals the possibilities of psychological support and advisory support for young people with intellectual disabilities (ID) in the process of their employment and work activities in order to achieve positive dynamics in matters of their professional self–determination, painless integration into the professional community and development in the profession. Procedure and methods.The study involved young people with ID aged 18 to 32 years (N=123). The experimental technology of included employment, developed on the basis of a professional labor experiment, a case method, methods of resource and positive psychotherapy, SPT, involves differentiation of the levels of readiness for employment of persons with ID (minimum, medium, sufficient) and selection for each level of the route accompaniments, which includes the provision of psychological counseling and support: employment, protected employment and escorted employment in the open market. Results and conclusions. The introduction of the technology showed that the leverage that activates the personal resources of the readiness of young people with ID to perform work tasks is specially organized working conditions and psychological support in the experimental social enterprise "Special Assembly" in combination with group trainings and individual counseling. The results of the provision of counseling psychological assistance and psychological support was a significant increase in the number of people with a sufficient level of readiness for independent work (from 27.64% to 40.65%), the indicator of responsible attitude of employees with ID towards team members increased from 1.58% to 36.50% of respondents, anxiety about failures in work activity decreased from 2% to 33.50% of respondents, 47.61% of people with ID established communication with friends at a sufficient level. 51 people are employed in the open labor market.

Purpose People with intellectual disabilities are not routinely involved in the assessment of their behaviours that challenge, as this is often completed by a proxy respondent and the health-care professional. This is contrary to guidance stating that everyone should be involved in the planning of their care. This paper aims to show how health-care professionals can support people with intellectual disabilities to engage in the assessment of their behaviours that challenge and the subsequent development of their own positive behaviour support (PBS) plans. Design/methodology/approach A non-systematic review of the existing literature on improving the engagement of people with learning disabilities in health-care planning, and specifically PBS planning, was undertaken. Appropriate papers were included in this paper. Findings There are several evidence-based methods to improve people’s engagement in the assessment of their own behaviours that challenge and then the development of their PBS plans. These methods are discussed in terms of their application to supporting people to communicate and involving them in the process of developing a valid and meaningful PBS plan. This is a relatively new focus within the literature, and further research should focus on increasing engagement in the process, as well as monitoring how co-production affects PBS outcomes. Originality/value This paper summarises some of the approaches used to support people with intellectual disabilities to engage in the assessment of their behaviours that challenge and the development of their own PBS plans. This should encourage health-care professionals to consider how to use alternative and augmentative communication strategies to facilitate co-production in their own clinical practice.

Purpose This paper aims to describe three dementia assessment services for people with intellectual disabilities to provide professionals with insight into planning this type of service. Design/methodology/approach Three services in England were contacted via email and telephone to collect data on their service provision. They were asked about the average age of individuals when receiving a baseline assessment, frequency of follow-up assessment, assessment instruments used and descriptive aspects of their services. Findings All three services offered proactive dementia assessment services to people with Down's syndrome (DS), with one service providing systematic screening via the GP. None offered proactive screening to people with intellectual disabilities who did not have a diagnosis of DS. All offered reactive assessment to this population if they experienced a decline in function. Services differed in terms of age at which baseline assessments were offered, frequency of follow-up and instruments used. Originality/value To the best of the authors’ knowledge, this is the first paper to compare dementia assessment provision between different services in England.

Purpose The purpose of this paper is to provide a commentary on Banks et al. and sets the wider context. Design/methodology/approach It provides a brief narrative review of the literature on the factors that determine the quality of life of people with intellectual disabilities, including the impact of culture. Findings Key to ensuring good quality of life outcomes is support that is facilitative, enabling and empowering which can compensate for severity of disability and improve people’s experiences. This approach is called Active Support. Improving quality of life is a key part of preventing and responding to behaviours that challenge. Culture is an important factor in ensuring staff are motivated to work in such ways but is likely to be intertwined with many other factors. Originality/value This paper summarises the key literature on what is needed to improve outcomes for people with intellectual disabilities. It introduces the importance of exploring how the different dimensions of culture interact and how culture, practice, processes and structures might work in a much more complex and intertwined fashion than previously conceptualised.

Objectives: Mental imagery is important in the development and maintenance of psychological disorders and well- being but has been neglected in people with intellectual disabilities. A detailed idiographic analysis of the lived experience of mental imagery in this population is presented. \ud Design: This qualitative study uses interpretative phenomenological analysis (IPA). It involved inclusive research methods with people with intellectual disabilities and other stakeholders (including family members, advocates, support workers and intellectual disability service managers).\ud Methods: Ten individual semi-structured interviews were conducted with people with mild–moderate intellectual disabilities. Participants were opportunistically sampled through organisations providing community services to people with intellectual disabilities in the UK. Two men and eight women (mean age 43 years) participated. Interviews were audio-recorded and analysed using IPA.\ud Results: People with intellectual disabilities are able to experience a range of rich and detailed mental images across all sensory modalities. Participants reported changes in affect based on mental imagery, and an ability to experience both spontaneous and deliberate mental images. The emotional saliency of the object of mental imagery appeared to influence participants' ability to engage with imagery. A number of adaptations make mental imagery more accessible and easier to report. The ability of people with intellectual dis-abilities to experience vivid mental imagery has important clinical implications for the use of a range of mental imagery interventions with this population.\ud Conclusions: The need to consider mental imagery interventions for this population, and how these can be adapted to ensure accessibility is a priority for people with intellectual disabilities and psychological disorders\ud

Purpose The COVID-19 pandemic meant that it became impossible for many individuals with intellectual disability to access specialist mental health support. The purpose of this study was to evaluate a set of guided self-help resources adapted for delivery on an outreach basis. Design/methodology/approach The use and impact of the resources were evaluated through: data about downloads and requests for printed materials; interviews with individuals who used the resources; webinars with organisations; family members and support workers who had delivered the resources and an online survey with individuals who had delivered the resources. Findings The resources had considerable reach, with over 12,555 printed copies requested from across Scotland. The materials were perceived to be relevant and useful, helping individuals to talk about difficulties and to be aware that others were facing similar challenges. Originality/value The findings highlight the potential long-term value of guided self-help resources to help promote well-being that can be delivered on an outreach basis by family members and social care organisations.

Purpose The purpose of this paper is to broaden the discussion on some of the barriers and solutions for co-production in positive behaviour support (PBS) planning as identified in the paper “Including people with intellectual disabilities in the development of their own Positive Behaviour Support Plans”. Design/methodology/approach Drawing on the literature associated with co-production in PBS planning, this commentary will reflect on the wider systems and culture needed to enable successful implementation of this way of working. Findings Co-production in PBS planning is recommended as part of best practice guidelines. However, there is limited research in the area of co-production with regards to PBS and use of augmentative and alternative communication methods. Collaboration among speech and language therapy and PBS practitioners is an important factor for co-production to achieve the best outcomes for people with learning disabilities who display behaviours of concern. Along with identifying a range of communication tools/strategies needed for PBS assessment/planning, it also requires a whole systems approach and culture shift to ensure the necessary foundations are in place. Originality/value Co-production in PBS planning remains an under practiced way of working. This commentary builds on the barriers and solutions identified for co-production and provides further insight into what might be needed to achieve this in health and social care settings.

This narrative synthesis aims to review and collate what is known to date on the impact of culture on the experiences and identity of PWID and their families and carers. Despite findings in the general population that cultural identity affects personal identity (Schwartz et al., 2008), and that experiences of people from minoritised ethnic communities in accessing services differ from those from White communities (Moriarty, 2008) (Cabral & Smith, 2011), relatively little is known about how the identity and experiences of people from minority communities intersect with disability in both PWID and their family and carers. There is a potential ‘double discrimination’ experienced by PWID from non-White backgrounds, through the intersectionality of being non-White (Ajayi (Sotubo), 2021) (Randhawa, 2007) and potential marginalisation due to having an ID (Mencap, 2016). This may be important in terms of the direct impact on the wellbeing and identity of the PWID, but also more indirectly, where institutional racism may mean assumptions are made based on diagnostic overshadowing, with an individual’s ID considered by a professional, but not cultural adaptations; see, for example, Ali et al. (2013), who highlight how PWID may have communication difficulties when accessing physical health care due to both their need for accessible information, and a language barrier. At the time of writing, the researcher could not find a systematic review that summarised the literature on this topic to date.

Body image, defined as people’s body-related self-perceptions and self-attitudes, plays an important role in people’s eating, physical activity and weight management behaviour. Research shows that in the general population, there is a well-established relationship between increased social media usage and the negative body image. Body dissatisfaction has been found to be associated with unhealthy eating patterns and is higher with elevated body mass index yet, little is known about body image in people with intellectual disabilities (ID), despite the increased overweight and obesity prevalence rates in this population. Similarly, not much is known about how and why young people with ID use social media, even less about how this may relate to body image, despite recent data showing that young people with ID actively participate on social networking sites (SNSs). The inconclusiveness and limitedness of the literature calls for a direct exploration of social media usage and body dissatisfaction in young people with ID. The current study addresses this gap in the literature. The aims of the study are to: 1. Explore how much and what types of Social Media young people with ID use. 2. Explore the motivations for social media use in young people with ID. 3. Investigate whether social media use behaviours relate to body image and self-esteem in young people with ID, predicting those that use social media more and for social comparison-related reasons will have higher body dissatisfaction and lower self-esteem, based on the general population literature.

Purpose Research into culture within intellectual disability services, has predominantly focussed on small group homes in Australia. The current investigation aimed to explore the transferability of the dimensions of culture identified in the literature, to a residential Intellectual Disability service in the UK. The purpose of this study was to better understand the impact of informal culture upon the behaviour of direct care staff, particularly around managing behaviour that challenges. Design/methodology/approach Semi-structured interviews were conducted with direct care staff. Interview transcripts were analysed thematically using template analysis. Findings Themes regarding leadership, perceptions of managers, team functioning, and relationships between direct care staff and service users, were identified, corroborating the existing literature. Additional themes relating to being aware of the risks posed by service users, and the emotional impact of behaviour that challenges, also emerged. Originality/value To the best of the authors’ knowledge, this is the first qualitative study to explore informal culture within a community residential Intellectual Disability service in the UK.

Background: Our STORM intervention was developed for people (16 +) with intellectual disabilities to enhance their capacity to manage and resist stigma. The current study describes the adaptation of STORM for (synchronous) on-line delivery in the context of the Covid-19 pandemic. Aims: To adapt the manualised face-to-face STORM group intervention for delivery via web-based meeting platforms and to conduct an initial pilot study to consider its acceptability and feasibility. Methods and procedures: The 5-session STORM intervention was carefully adapted for online delivery. In a pilot study with four community groups (N = 22), outcome, health economics and attendance data were collected, and fidelity of delivery assessed. Focus groups with participants, and interviews with facilitators provided data on acceptability and feasibility. Outcomes and results: The intervention was adapted with minimal changes to the content required. In the pilot study, 95% of participants were retained at follow-up, 91% attended at least three of the five sessions. Outcome measure completion and fidelity were excellent, and facilitators reported implementation to be feasible. The intervention was reported to be acceptable by participants. Conclusions and implications: When provided with the necessary resources and support, people with intellectual disabilities participate actively in web-delivered group interventions.

Background People with intellectual disabilities (ID) undertake extremely low levels of physical activity. Aims To enhance understanding concerning low levels of physical activity in people with ID, this study has three aims: (1) to identify barriers to and facilitators of physical activity in people with ID; (2) to examine differences in barriers and facilitators between levels of ID (mild, moderate, severe, and profound); (3) to examine differences in barriers and facilitators between various stakeholder groups. Methods and procedures A systematic search was performed using the following databases from the year 1990: MEDLINE, ERIC, and PsycINFO. The studies included were peer reviewed, available as full text, and written in English, addressing barriers to and facilitators of physical activity in people with ID. The quality of the studies was assessed using existing critical review forms. All studies were subjected to qualitative synthesis to identify and compare barriers and facilitators. Outcomes and results In all, 24 studies were retrieved, describing 14 personal and 23 environmental barriers and/or facilitators. The quality of the studies varied, particularly for qualitative studies. Only two studies included people with severe or profound ID. Stakeholder groups tend to identify barriers outside their own responsibility. Conclusions and implications Results reveal a broad range of barriers and facilitators, but not for people with more severe ID. Further research should also examine these factors among stakeholders responsible for providing support.

Stigma can hamper full inclusion of people with intellectual disabilities in society. For other minority groups, higher levels of familiarity with these groups have been shown to relate to lower levels of stigma, whereby emotions can play a mediating role. However, concerning people with intellectual disabilities, there is limited knowledge regarding the general public’s levels of familiarity, its relationship with stigma, and the role of emotions in this relationship. A cross-sectional survey was conducted among a nationally representative sample of the Dutch population (n = 892). The relationship between levels of familiarity and different measures of stigma representing cognitive, emotional, and behavioral aspects of stigma (i.e., attributions, emotions, discrimination) was examined. Emotions (fear, anger, and sympathy) were studied as a mediator in the relationship between familiarity and discrimination (i.e., social distance, and intention to help). Participants who reported no familiarity in real life with people with intellectual disabilities (30.6% of the population sample) demonstrated higher levels of stigma (attributions, emotions, discrimination) than participants who reported any form of real-life familiarity (69.4% of the sample). Fear was found to be the most important mediator of the relationship between familiarity and discrimination. The findings stress the continuing importance to advocate for people with intellectual disabilities to be recognized and become known within society. This increased familiarity might reduce stigma and increase positive experiences of inclusion. Support workers may have a vital role in this process. The importance of fear in the relationship between familiarity and discrimination may inform future research and antistigma interventions.

Purpose This commentary aims to define STOMP and STAMP, describes its history and evolution and the authors’ thoughts about future directions given the lack of clear evidence base for prescribing and deprescribing psychotropic medication given for behaviour thought to be challenging. Design/methodology/approach This commentary defines the authors’ clinical experience and personal thoughts about STOMP achievements and challenges for the future delivery. Findings This commentary details STOMP development to date and highlights the potential areas for further study and research to grow understanding, professional confidence and delivery. Research limitations/implications This commentary highlights much of the currently accepted research and areas that have poor quality evidence or are of interest for future study. STOMP definition, especially of inappropriate prescribing, is key to redefining the work. Practical implications This commentary highlights the potential impact of STOMP and STAMP on prescribing rates and the need for better definition, processes and education for workforce development. There is a major need to understand the benefit of behavioural intervention to support the optimisation of medication. Originality/value This commentary builds on personal experience and current understanding to postulate considerations to further the delivery of STOMP and STAMP.

© 2020, Springer Nature Switzerland AG. This review paper reflects on the existing literature on cognitive behaviour therapy for adults, adolescents and children with intellectual disabilities. People with intellectual disabilities have high rates of comorbid mental health disorders, but low rates of accessing treatments with limited treatment options available to them. Historically, they have been excluded from cognitive-based therapies such as cognitive behaviour therapy. However, recent research has shown that people with mild to moderate intellectual disabilities do have the capacity to engage in cognitive-based interventions. The review highlights the progress that has been made in the field of adapting CBT for people with intellectual disabilities, as well as the current gaps in the literature and suggestions for future research.

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Purpose Care pathways are being increasingly used in the national health service to outline an anticipated programme of care in relation to a particular illness, condition or set of symptoms. The purpose of this paper is to inform those using the service of what they might expect within what time frame. They are designed to reduce variation in practice and allow optimal quality of care across a variety of care settings. Care pathways map out a patient’s journey, providing coordination of services for users. They aim to have: “the right people, doing the right things, in the right order, at the right time, in the right place, with the right outcome”. Design/methodology/approach This paper outlines care pathways in relation to people with intellectual disabilities who present with behaviour that challenges. Findings It is likely that many people will have a lifelong need for support, so discharge from clinical services should only be considered if it is genuinely appropriate. Reductions in a person’s behaviours that challenge are likely to be a consequence of changes that have been made to the person’s environment and supports. Therefore, any reductions in the level or type of support that the person receives may lead to an escalation of the behaviour again. Originality/value Standards in relation to care pathways are presented.

This article hopes to offer some guidance regarding remote working with people with Intellectual Disabilities (ID) during the Covid-19 pandemic. This includes offering individual therapy, managing risk, working indirectly and in consultative capacities.

Background Diagnostic manuals provide a strict definition of the PTSD gate criterion. Research on the adequacy of this definition in people with intellectual disabilities is lacking. This study aims to test the adequacy of the gate criterion for this population. Method Fourty nine adults with mild to moderate intellectual disabilities and 43 caregivers were questioned. Traumatic events included in the gate criterion definition and adverse events going beyond it were assessed. It was tested whether adverse events affect symptoms of PTSD additionally to traumatic events. Results The current data showed ambiguous findings in self‐ and informant report. Informant data suggested an additional impact of adverse events on PTSD symptoms. Self‐report data suggested the contrary. Conclusion Adverse events seem to have an impact on externalizing behavioural symptoms, such as hyperarousal. Self‐report assessment of more specific, intrapsychic PTSD symptoms, such as intrusions and avoidance, should be addressed in future studies.

Therapeutic services for people with intellectual disabilities (ID) often follow a medicalized narrative, focusing on treatment of the individual without attending to social and political factors. ...

Purpose Mental health courts (MHCs) may enable better support for people with intellectual disabilities (ID) within the criminal justice system (CJS) but little evaluative empirical evidence is available regarding their operation. The purpose of this paper is to explore professional perceptions of the challenges of including people with ID in a targeted services court (TSC) designed for people with mental health issues and ID. Design/methodology/approach Information was gathered, via interviews and focus groups, from 46 professionals working with people with mental health issues and ID within the TSC. Data were analysed by using thematic network analysis. Findings Findings highlight the neglect and lack of inclusion of people with ID within the TSC processes, with challenges in identifying people with ID, stakeholder awareness, inconsistent adapting of practices for people with ID and information transfer underpinned by the involvement of numerous organisations with differing agendas. Research limitations/implications Although valued, development of a TSC, including people with ID, was a challenging endeavour and may reflect societal and institutional neglect of people with ID, recommendations are provided. Originality/value This study adds to the few investigations that have considered the process of including people with ID in a TSC from the perspective of those working in the CJS.