Clinical needs and outcomes of adults with intellectual disabilities accessing an inpatient assessment and treatment service and the implication for development of community services

Sandhu, Daljit Kaur; Tomlins, Rose

doi:10.1177/1744629515615267

Cited by 10 publications

(13 citation statements)

References 25 publications

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“…Research has suggested that demographics such as poorer levels of functioning, rates of self‐harming and challenging behaviour are more prevalent in adults who are admitted to inpatient units than those managed within local community services (Pearce et al, 2011). This has correlated in adults with higher HoNOS‐LD scores being admitted compared to adults commencing community‐based psychiatric/behavioural intervention (Pearce et al, 2011; Sandhu & Tomlins, 2017). Future research could assess if community services are as effective as inpatient units in improving clinical outcomes of the demographic of patients, who often have higher baseline HoNOS‐LD scores, that are often referred to inpatient services.…”

Section: Discussionmentioning

confidence: 99%

An 8‐year study of admissions and discharges to a specialist intellectual disability inpatient unit

Abraham

Purandare²,

McCabe

et al. 2021

Research Intellect Disabil

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Background In the United Kingdom, policy change has led to specialist intellectual disability inpatient bed reduction. Little evidence exists assessing the results for patients admitted to such units. This study evaluates the outcomes of a specialist intellectual disability inpatient unit. Method Gender/age/ethnicity/intellectual disability severity/co‐morbid psychiatric/developmental disorders, treatment length and stay data were collected. The health of the nation outcome scales for people with learning disabilities (HoNOS‐LD) scores at admission, treatment completion and discharge were recorded. Analysis of these multiple variables and correlations within different patient groups was investigated using various statistical tests. Results Of 169/176 patients (2010–2018), admission to discharge, HoNOS‐LD global and all individual items score decreased significantly, for all patient categories. Treatment completion to discharge duration was significant for the whole cohort. Conclusions This is the largest study of intellectual disability inpatient outcomes. Discharge from the hospital appears not associated with duration of treatment. Using HoNOS‐LD to demonstrate treatment effectiveness is recommended.

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Section: Discussionmentioning

confidence: 99%

An 8‐year study of admissions and discharges to a specialist intellectual disability inpatient unit

Abraham

Purandare²,

McCabe

et al. 2021

Research Intellect Disabil

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“…Nine papers focused on measures of patient safety with adults with intellectual disabilities and/or autism. 52,56,71,73,74,78,104,112,117 Eligible papers for outcome domain synthesis = 103 Fig. 2 A frequency count of the number of studies categorised according to one of three outcome domains: measures of effectiveness, measures of patient safety or measures of patient experience.…”

Section: Measures Of Patient Safetymentioning

confidence: 99%

“…2,5 Within studies, GMH and specialist intellectual disability inpatient services were described using different language, such as acute assessment and treatment, 76 or services for 'longer-stay' patients. 77 Some authors described the purpose for admission and the expected duration of stay, such as admission for assessment and treatment, 78 or emergency care/admission with short stays. 26 Details of 'aftercare' following discharge, including collaborative working with community services, were absent from much of adult literature.…”

Section: Models Of Service Provisionmentioning

confidence: 99%

“…55,77,79,102,108 The remaining 15 papers reported data about in-patients with intellectual disability and/or autism in specialist intellectual disability services only (Table 3). 1,3,4,6,8,14,35,[73][74][75]78,104,[109][110][111] The mean and the average median length of stay within specialist in-patient intellectual disability services was longer compared with GMH inpatient services, but was shorter when those identified as long stay were removed (Table 4).…”

Section: Length Of Staymentioning

confidence: 99%

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A systematic review of in-patient psychiatric care for people with intellectual disabilities and/or autism: effectiveness, patient safety and experience

et al. 2022

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Background An increasing number of children, adolescents and adults with intellectual disabilities and/or autism are being admitted to general psychiatric wards and cared for by general psychiatrists. Aims The aim of this systematic review was to consider the likely effectiveness of in-patient treatment for this population, and compare and contrast differing models of in-patient care. Method A systematic search was completed to identify papers where authors had reported data about the effectiveness of in-patient admissions with reference to one of three domains: treatment effect (e.g. length of stay, clinical outcome, readmission), patient safety (e.g. restrictive practices) and patient experience (e.g. patient or family satisfaction). Where possible, outcomes associated with admission were considered further within the context of differing models of in-patient care (e.g. specialist in-patient services versus general mental health in-patient services). Results A total of 106 studies were included and there was evidence that improvements in mental health, social functioning, behaviour and forensic risk were associated with in-patient admission. There were two main models of in-patient psychiatric care described within the literature: admission to a specialist intellectual disability or general mental health in-patient service. Patients admitted to specialist intellectual disability in-patient services had greater complexity, but there were additional benefits, including fewer out-of-area discharges and lower seclusion rates. Conclusions There was evidence that admission to in-patient services was associated with improvements in mental health for this population. There was some evidence indicating better outcomes for those admitted to specialist services.

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“…After analysis of the existing evidence, we hypothesised that that lower intellectual functioning is associated with more severe illness, a poorer prognosis and worse functioning. We know from several intellectual disability studies 25 , 26 in patients with MID in the UK, the USA and Finland, that schizophrenia, psychotic disorders, aggression and alcohol and substance misuse are often reasons for hospital admission and long-term treatment. Looking at the distribution of diagnoses in the patients with an SCIL score of ≤19, schizophrenia (odds ratio 2.41), substance use disorder (odds ratio 1.84) and intellectual disability (odds ratio 7.11) are significantly more often diagnosed than in patients with an SCIL score of ≥20.…”

Section: Discussionmentioning

confidence: 99%

Increased prevalence of intellectual disabilities in higher-intensity mental healthcare settings

et al. 2021

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Background It has been suggested that people with intellectual disabilities have a higher likelihood to develop psychiatric disorders, and that their treatment prognosis is relatively poor. Aims We aimed to establish the prevalence of intellectual disability in different mental healthcare settings, and estimate percentage of cognitive decline. We hypothesised that the prevalence of intellectual disabilities increases with intensity of care. Method A cross-sectional study was conducted in different settings in a mental healthcare trust in the Netherlands. We used the Screener for Intelligence and Learning Disabilities (SCIL) to identify suspected mild intellectual disability (MID) or borderline intellectual functioning (BIF). We identified patients with a high level of education and low SCIL score to estimate which patients may have had cognitive decline. Results We included 1213 consecutive patients. Over all settings, 41.4% of participating patients were positive for MID/BIF and 20.2% were positive for MID only. Prevalence of suspected MID/BIF increased by setting, from 27.1% in out-patient settings to 41.9% in flexible assertive community treatment teams and admission wards, to 66.9% in long-stay wards. Only 85 (7.1%) of all patients were identified as possibly having cognitive decline. Of these, 25.9% were in long-stay wards and had a diagnosis of schizophrenia or substance use disorder. Conclusions Low intellectual functioning is common in Dutch mental healthcare settings. Only a modest number of patients were identified as suffering from cognitive decline rather than suspected MID/BIF from birth. Therefore, we recommend improved screening of psychiatric patients for intellectual functioning at the start of treatment.

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Clinical needs and outcomes of adults with intellectual disabilities accessing an inpatient assessment and treatment service and the implication for development of community services

Cited by 10 publications

References 25 publications

An 8‐year study of admissions and discharges to a specialist intellectual disability inpatient unit

An 8‐year study of admissions and discharges to a specialist intellectual disability inpatient unit

A systematic review of in-patient psychiatric care for people with intellectual disabilities and/or autism: effectiveness, patient safety and experience

Increased prevalence of intellectual disabilities in higher-intensity mental healthcare settings

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