ABSTRACT
BACKGROUND: When adults with intellectual disabilities (ID) require a psychiatric admission, general adult mental health units are often used. Specialist units have emerged recently as a care option but there is only limited evidence of their effectiveness. Thus this study aims to describe and evaluate the effectiveness of a specialist inpatient unit and report on the utilization of generic and specialist inpatient services. METHOD: All patients admitted to a specialist ID psychiatric unit were evaluated on admission and immediately after discharge on a number of outcome measures. In addition, they were compared with those admitted to general adult mental health units covering the same catchment area. RESULTS: Significant improvements were demonstrated within the specialist unit cohort on measures including psychopathology, global level of functioning, behavioural impairment and severity of mental illness. The specialist unit patients had a longer length of inpatient stay but were less likely to be discharged to out-of-area residential placement. CONCLUSIONS: Specialist units are an effective care option for this group of people.
Subject(s)
Hospital Departments , Intellectual Disability/complications , Mental Disorders/complications , Mental Disorders/rehabilitation , Adult , Cohort Studies , Disability Evaluation , Female , Hospitalization , Humans , Length of Stay , Male , Prospective Studies , Surveys and QuestionnairesABSTRACT
The implementation of community care in the UK has led to the requirement that services should be able to meet the needs of adults with intellectual disability (ID) and additional needs in terms of challenging behaviour. However, the extent to which people with challenging behaviour are present in the community and the extent to which community services can support them effectively still requires significant research. The present study examines the prevalence of challenging behaviour amongst adults with ID residing in three London boroughs and the issues which arise from service delivery to this client group. All service providers and general practitioners in the area were contacted and asked to identify any individuals with ID and challenging behaviour. All responses were screened, and then key staff were interviewed for information on a range of demographic factors and on the Checklist of Challenging Behaviour. The reliability of the instrument was also assessed. Four hundred and forty-eight individuals were identified from a total borough population of 670 000. There was consistency in the types of behaviour which were frequently identified across the three boroughs. There were significant levels of self-injury as well as a range of behaviours of the 'hard to engage' type. Most individuals had more then one challenging behaviour and some individuals with seriously aggressive behaviour used local community services. Twenty-five per cent of the sample lived at home with their families and 50% were in community residential services. The boroughs differed in their ability to manage those with challenging behaviour in that one borough had many more people placed out-of-borough. Significant numbers of individuals with challenging behaviour were living in the community. The range and number of behaviours suggest that staff need to be very skilled in supporting such individuals, and that effective planning and support are essential if people with challenging behaviour are to be maintained in community settings.
Subject(s)
Community Mental Health Services , Intellectual Disability/psychology , Social Behavior Disorders/psychology , Activities of Daily Living/classification , Activities of Daily Living/psychology , Adult , Cross-Sectional Studies , Female , Humans , Incidence , Intellectual Disability/epidemiology , Intellectual Disability/rehabilitation , London/epidemiology , Male , Middle Aged , Needs Assessment , Patient Care Team , Social Behavior Disorders/epidemiology , Social Behavior Disorders/rehabilitation , Social Problems/psychology , Social Problems/statistics & numerical dataABSTRACT
The interhemispheric transfer of stereognostic information was investigated in four groups of subjects: paranoid schizophrenics, non-paranoid schizophrenics, non-schizophrenic psychiatric patients, and normals. Previous work has raised the possibility that schizophrenia is characterised by a dysfunction of the corpus callosum, but there are several methodological problems associated with this research. A comparison of inter-manual and same-hand conditions on the experimental task revealed no evidence for impaired transfer of information in the schizophrenic groups. However, the performance of the non-paranoid schizophrenic group was markedly inferior to all other groups on the right hand/right hand no transfer condition, consistent with a left hemisphere dysfunction. Possible reasons for the failure to replicate previous findings are discussed.
