Editorial
Article Type: Editorial From: Advances in Mental Health and Intellectual Disabilities, Volume 8, Issue 2.
Welcome to the second issue of 2014. We have an interesting mix of articles for you to read, including the attitude of generic mental health staff towards those with intellectual disabilities, a paper exploring the assessment of post-traumatic stress disorder (PTSD) and another exploring the potential of a pictorial system to measure adult attachment. We have two research papers from inpatient services, the first examining the experience and management of pain and the second evaluating the effectiveness of a Healthy Living Group. Our final paper is from Hong Kong and examines the physical activity of individuals employed within a sheltered workshop. Our readership from outside the UK has steadily been increasing over recent years and we would encourage authors from across the globe to submit papers.
Our first paper from Mesa and Tsakanikos is timely given the refocusing on people with intellectual disabilities in England accessing generic mental health services. In 2012 the National Development Team for Inclusion (NDTi) published a report that examined how mental health services were making reasonable adjustments to support access for people with intellectual disabilities and/or autism (National Development Team for Inclusion, 2012). More recently in December 2013 the NDTi on behalf of the Department of Health in England revised the Green Light Toolkit,a self-assessment framework for local areas to measure how good their mental health services are for people with intellectual disabilities (National Development Team for Inclusion, 2013). The paper investigates whether acute inpatient psychiatric staffs’ attitudes and self-efficacy towards adults with mild intellectual disability, were different than towards the general mental health population and whether their understanding of the policy for those with mental illness and intellectual disability differed. They found that the majority of staff were unaware of the current policy direction for adults with intellectual disability, such as wherever possible people should be accessing their services, but in the main participants did agree with the underpinning principle. It was encouraging to see that overall staff did not have more negative attitudes to those with intellectual disability, in contrast to previously published studies but staff consistently reported a lack of confidence and thought they required more training.
PSTD has steadily gained attention in services for people with intellectual disabilities over recent years. It can often be difficult to recognise in people with significant communication needs and maybe misinterpreted as challenging behaviour. Bakken presents a paper which describes the assessment of PTSD in adults with intellectual disabilities. They investigated symptom presentation and diagnosis in five people with moderate to severe intellectual disabilities. They found that previously, PSTD had not been considered with these individuals, although they had experienced traumatic life events. The paper highlights the need for further research and for clinicians to be mindful of PSTD following traumatic experiences.
Gallichan and George explore the potential of the Adult Attachment Projective Picture System (AAP) as a measure of attachment state of mind in adults with intellectual disabilities. They describe how this approach was adjusted and implemented with five people with intellectual disabilities. They report that AAP has the potential to assess attachment state of mind in adults with intellectual disabilities and is the first developmental measure of attachment status that has shown potential in this population.
Pain can often be difficult to recognise in people with intellectual disabilities, especially those with significant communication needs. Although this issue is included in the training of those specialising in the field of intellectual disabilities, you will still hear of cases where pain has not been identified. Chester and Henriksen provide an insightful research-informed audit into pain management in a forensic inpatient service for people with intellectual disabilities. In total, 64 patients and 12 nurses were interviewed and clinical documentation was accessed. They found that with this population the majority were able to communicate their pain and seek support, but a number of patients appeared to have insufficient knowledge about how to best manage pain.
The increased prevalence of the range of physical health needs of people with intellectual disabilities is well established and recent inquiries have highlighted the significantly different mortality rates. The argument for health promotion has never been stronger for this vulnerable group. Rose and colleagues provide a paper that evaluates the usefulness of a Healthy Living Group for individuals with intellectual disabilities and mental health problems in an inpatient setting. The course comprised of seven sessions, each with a different focus. The aim was to support the participants in developing an individualised healthy living plan and support them in developing practical skills. The group was found be successful and was enjoyed by the participants as well as increasing their skills to promote their own health.
Our final paper is from Hong Kong. Chan examined the lifestyles of adults with intellectual disabilities working in sheltered workshops to gain a better understanding on their physical activity. There is a growing awareness of the importance of physical activity and mental wellbeing. The study found that obesity was a serious issue among adults with intellectual disability in Hong Kong, especially for women and the majority of participants were found to have low levels of physical activity.
We hope you enjoy reading these informative articles and welcome your suggestions for themed journals in the future.
The Green Light Toolkit 2013 and Reasonably Adjusted report can be downloaded at: www.ndti.org.uk
Steve Hardy and Jean O' Hara
References
National Development Team for Inclusion (2012), Reasonably Adjusted? Mental Health Services and Support for People with Autism and People with Learning Disabilities, NDTi, BristolNational Development Team for Inclusion (2013), , NDTi, Bristol
Green Light Toolkit 2013: A Guide to Auditing and Improving Your Mental Health Services so that it is Effective in Supporting People with Autism and People with Learning Disabilities
