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Thirty-one participants engaged in this oral history research study aimed at exploring the lived experience of intellectual disability nurses and healthcare assistants' knowledge of the trajectory of intellectual disability nursing over the last 30 years in the Republic of Ireland and England. This paper documents some of these experiences offering perspectives on intellectual disability nursing and what is important for the future. Findings from Ireland consider the nature of intellectual disability services and the registered nurse in intellectual disability. Findings from England focus on opportunities and restrictions in intellectual disability nursing, shared visions, the changing context within which work took place and also the internal and external supports that impacted their roles. It is evident that intellectual disability nurses must be responsive to the changing landscape of service provision and also the requirements for contemporary new roles to meet the changing needs of people with intellectual disabilities.

Aim: This Quality Improvement Project sought to improve communication between patients with intellectual disabilities and their psychiatrists by sharing medical information using an easy read letter format following psychiatric review. Background: Writing directly to patients is in keeping with good medical practice. Previous studies have shown patients with intellectual disabilities prefer letters tailored to meet their needs. Method: An easy read letter was used by nine psychiatrists who handed them to 100 consecutive patients after review. Feedback of acceptability to patients was obtained using a three-item facial rating scale and the use of free text. Feedback of acceptability was obtained from participating psychiatrists. Results: Patients found the easy read letter helpful and felt it should be used routinely. Psychiatrists felt this approach was beneficial as well as aiding patient understanding of review. Conclusions: The easy read letter was reported to improve communication following psychiatric review. Limitations are acknowledged but it is concluded that an easy read letter should be adopted as routine practice following psychiatric review, for people with intellectual disabilities.

Background: Historically, the emotional lives and mental health needs of adults with learning disabilities received scant attention, especially when the policy of institutionalisation was at its zenith in the UK. Materials and Methods: This case study employed biographical narrative interviews based on a psychosocial approach. The main sources of data production were two loosely structured, audio-taped, interviews with a man with learning disabilities. This approach uses free association to elicit an individual's stories about his lived experiences. Additional information was acquired from consultations with key care staff and clinical records maintained by the man's service provider. Results: Data revealed insights into the biography of this man who had a diagnosed mental health disorder. These data recall his personal journey through the care system which took place during an important historical period encompassing both long-term institutionalisation in segregated settings, and the subsequent implementation of the policy of community care in the UK. He recalls positive and negative experiences while residing in a long-stay hospital, and the related thoughts and feelings about his life in a community setting in more recent years. Conclusion: This case study contributes to an increasing body of studies that perceive the use of in-depth interviewing of individuals with learning disabilities as having high ecological validity in the development of authentic knowledge, not readily available through other methods used in the co-production of data.

Background: It is well established that valproate, and its valproic acid, sodium valproate, and valproate semisodium forms is a highly teratogenic drug and evidence suggests that use in pregnancy leads to physical birth defects in 10% of children born compared with a background rate of 2% to 3%. Congenital malformations associated with valproate are predominantly neural tube defects, clefting abnormalities, cardiovascular defects, genitourinary defects in males, and musculoskeletal defects. There is also increased risk of developmental delays and this includes delays in walking, talking, poor language skills, memory problems, and low intellectual ability in approximately 30 to 40% children born to mothers taking valproate. Furthermore, developing foetuses, if exposed to valproate in-utero, are at increased risk of autistic spectrum disorder (approximately three-fold), and also more likely to develop symptoms of attention-deficit/hyperactivity disorder. Subsequently valproate preparations prescribed to treat epilepsy are now contraindicated in pregnancy unless there is no suitable alternative treatment. In addition, valproate preparations prescribed for bipolar disorder have an absolute contraindication in pregnancy. Implications for practice: In order for valproate containing medicines to be prescribed for women of child bearing potential a risk acknowledgment form must be completed annually. For people without capacity to consent the form may be completed by a relative or other appropriate person. However, for people with intellectual disabilities, even with capacity, healthcare professionals need to ensure that the information on the form is accessible in order that they can understand it. They may not choose to give consent for a third party to complete the form on their behalf. Often intellectual disability nurses have a pivotal role, on behalf of the interdisciplinary team (IDT), in identifying women of child bearing potential who are currently prescribed valproate. Notwithstanding the IDT also has a role in engaging with patients during discussions to ensure they understand the conditions of prescribing. It is important that the IDT understand their role in patient engagement to facilitate shared decision making. Therefore, for women with intellectual disabilities with capacity, consent to treatment must be 'informed', and all risks will need to be communicated to the woman, exploring alternatives in order to comply with the Montgomery Judgement. Specialist intellectual disability nurses have a pivotal role in discussing appropriate contraceptive advice, and sign-posting women to local services. Conclusion: Valproate preparations prescribed to treat epilepsy are contraindicated in pregnancy unless there is no suitable alternative treatment; in addition, valproate preparations prescribed for bipolar disorder have an absolute contraindication in pregnancy. It is imperative that specialist intellectual disability services are able to advise the wider primary health care team on best practice. Additionally, those with prescribing responsibilities, and particularly specialist intellectual disability epilepsy nurses, along with the wider IDT, must be aware of these new regulations.

The aim of this study was to explore how public health policy in the United Kingdom was reflected in community intellectual disability nurses' (CIDNs)' job descriptions and person's specifications. The role of CIDNs has evolved due to policy changes. As these roles evolve, job descriptions and person specifications are important in highlighting employer's expectations staff, priorities, and professional values of their employees. This study involved an exploratory documentary analysis of n = 203 CIDNs' job descriptions and person specifications in the context of role theory. The CIDNs' public health roles identified in this study are health education, health protection, health prevention, health surveillance, and health promotion. Key policies themes were intellectual disability health access, public health strategies, policy evaluation/redesign, and public health policy. There is a lack of public health role clarity and inconsistency in role expectations across organizational boundaries in the United Kingdom.

In the UK, the Mental Health Tribunal is a long-established safeguard for patients detained under the Mental Health Act. This gives such patients an effective appeal mechanism to ensure legal protection of their liberty. This act contains sections that allow for civil detention in the case of mental disorder. The right to apply to the tribunal against such detention is underpinned by the right to liberty under Article 5 of the European Convention of Human Rights (ECHR). Some patients with learning disabilities may lack capacity and the ability to challenge their detention. Method: This article presents a case study of a woman with Down's syndrome and severe learning disabilities. Whilst this woman was detained under the Mental Health Act, she could have applied for a review of her detention to the Mental Health Tribunal within 14 days. She did not do so because she lacked capacity to instruct solicitors. Subsequently, as a result of appeal, the case proceeded through English and European judicial review. Results: The European Court of Human Rights, in the case of "MH v UK" (2013), has ruled that the appeals procedure for patients without capacity detained under Section 2 of the Mental Health Act is not compatible with Article 5(4) of the European Convention of Human Rights. The European Court has ruled that special procedural safeguards are required to enable this cohort of patients to exercise their rights guaranteed by Article 5(4). Conclusions: Responsible clinicians [treating consultant psychiatrists] need to ensure that all patients detained under section 2 of the Mental Health Act have an assessment of their capacity to apply to the tribunal. There need to be systems in place to alert hospital managers when a patient lacks capacity to apply for a tribunal. Hospital managers should request the Secretary of State to apply for a tribunal in these instances. Knowledge of this ruling is relevant to informing the practice of other interdisciplinary healthcare professionals working with such patients.