Learning disabilities within mental health services: are we adequately preparing nurses for the future?

Reducing restrictive practice in adult services: not only an issue for mental health professionals

Reducing 'restrictive practices' is an issue of national importance, pertinent to all NHS sectors, yet there is poor awareness of the issue in mainstream adult services. Such practices potentially restrict a person's rights to choice, self-determination, privacy and freedom. Challenging behaviour is often the result of unmet needs, communication difficulties or diagnostic overshadowing, but there is a common misconception that patients exhibit such behaviours because of their impaired intellectual abilities or mental health problems. This article seeks to raise awareness of restrictive practices and suggest the way forward. It highlights the importance of good de-escalation skills, which, if adopted early in therapeutic relationships, may help reduce the occurrence of challenging behaviours and situations. Behavioural support plans that adopt a biopsychopharmacosocial approach (BPPS) detail a range of interventions for managing challenging behaviours. Tailored support that follows a BPPS approach could reduce incidents of challenging behaviour, reduce costly observation, improve the patient experience and protect the patient's liberty.

Perceptions of learning disability nurses and support staff towards people with a diagnosis of schizophrenia

WHAT IS KNOWN ABOUT THE SUBJECT?: People with learning disability are more likely than the general population to develop schizophrenia. Personal recovery philosophies are based on positive attitudes and an optimism that recognizes and values people and their strengths and capacity to achieve goals. Little is known from previous studies about the illness perceptions of learning disability practitioners who work with people that experience both a learning disability and schizophrenia. The illness beliefs of learning disability practitioners about schizophrenia may mediate the potential for social exclusion and limit recovery outcomes. WHAT THIS STUDY/PAPER ADDS TO EXISTING KNOWLEDGE?: The findings show that the illness beliefs of learning disability practitioners and support workers regarding schizophrenia are pessimistic in terms of the consequences for people with schizophrenia and learning disability and their relatives as well as the chronic course of the illness. WHAT ARE THE IMPLICATIONS FOR CLINICAL PRACTICE?: This study identifies the nature of LD practitioner perceptions about schizophrenia and provides guidance about how personal recovery philosophies can be applied to the management of LD and schizophrenia. The beliefs of learning disability practitioners and support workers regarding schizophrenia need to be reframed to support better recovery outcomes and social inclusion for this group. The findings from this study can inform the development of training in bio-psycho-social models of schizophrenia, recovery approaches, family/carer interventions, clinical supervision, mentorship and reflection on clinical practice, which could be potentially useful strategies to help facilitate a reframing of beliefs.

ABSTRACT

Background and purpose of study The prevalence of schizophrenia in people with learning disability is 3-4%. This is the first study to investigate the illness perceptions of learning disability (LD) practitioners towards people with schizophrenia. Methods Learning disability practitioners (n = 210) that work with people with LD and schizophrenia completed a modified version of the Illness Perception Questionnaire Schizophrenia Carers Version (IPQ-SCV). Descriptive and correlational analyses were conducted for all of the IPQ-SCV subscales. Results A significant positive correlation was found between consequences relative and consequences patient (0.495, P < 0.001), and a negative correlation was found between timeline episodic and timeline chronic (-0.243, P < 0.001) subscales. Discussion Consistent with previous evidence found regarding negative staff attitudes to schizophrenia recovery outcomes, course and chronicity, the current investigation has extended and confirmed these observations to staff working with individuals with comorbid schizophrenia and learning disability. Implications for practice This study identifies the nature of LD practitioner perceptions about schizophrenia and contributes to the development of the recovery philosophy in relation to the management of LD and schizophrenia. The findings inform the design of training modules in bio-psycho-social models of schizophrenia, recovery approaches, family intervention, clinical supervision and reflection. These can help LD practitioners to reframe their schizophrenia/LD illness beliefs.

Diagnostic Masking and Overshadowing in Intellectual Disability-How Structured Evaluation Helps

PROBLEM

Comorbid psychiatric diagnoses tend to be underdiagnosed in patients with intellectual disability. Diagnosing anxiety disorders in such patients can pose challenges, in particular with regard to obsessive and compulsive disorder (OCD).

METHODS

We present the case of an adolescent diagnosed with intellectual disability with poor expressive language skills who presented with nonspecific mood and behavioral symptoms, not improving with routine clinical evaluations and treatment. A structured assessment was done to decipher the psychopathology.

FINDINGS

The structured evaluation was able to diagnose OCD, and the treatment response was accentuated, bringing about a significant reduction in patient and caregiver distress. Psychosocial interventions through nurses played a significant role.

CONCLUSIONS

The case highlights the need for a systematic assessment of patients with intellectual disability to arrive at reliable diagnoses and to plan appropriate treatment strategies.

A literature review exploring the preparation of mental health nurses for working with people with learning disability and mental illness

The aim of this literature review is to explore whether mental health nurses are being appropriately prepared to care for learning disabled patients who also suffer from mental ill health. A systematic approach was adopted in order to identify relevant literature for review on the topic. Five electronic databases were searched; CINAHL, Medline, ERIC, PubMed and Scopus. Searches were limited to the years 2001-2013. A total of 13 articles were identified as relevant to the topic area for review. Three main themes were identified relating to (a) attitudes (b) practice and (c) education. There appears to be a lack of research that directly addresses this issue and the existing literature suggests that there are considerable deficits in the ability of mental health nurses to be able to provide appropriate care for those with both a learning disability and mental ill health. The findings of this review would suggest that this topic area is in urgent need of further investigation and research. Further research into this area of practice could possibly help to inform education regarding this subject at pre-registration and post qualifying levels, which could therefore in turn, improve the delivery of mental health nursing care to this particular client group.

Meeting the needs of people with intellectual impairment in primary care

People with intellectual impairments are treated within the mainstream NHS including primary care with little support from specialist services. There are communication issues for primary care staff in relation to access of services and the assessment of health needs for this vulnerable group of individuals. Primary care staff do not always feel equipped to support people with intellectual impairment and need training in order to do so.