Psychiatry and neurodevelopmental disorders: experts by experience, clinical care and research.

People with neurodevelopmental disorders often present with challenging behaviours and psychiatric illnesses. Diagnosis and treatment require patients, families and healthcare professionals to work closely together in partnership, acknowledging their respective areas of expertise. Good treatment outcomes should also be underpinned by robust research evidence. Key research priorities are highlighted.

International medical graduates: how can UK psychiatry do better?

The National Health Service (NHS) was created 70 years ago to provide universal healthcare to the UK, and over the years it has relied upon international medical graduates (IMGs) to be able to meet its needs. Despite the benefits these professionals bring to the NHS, they often face barriers that hinder their well-being and performance. In this editorial, we discuss some of the most common challenges and the adverse effects these have on IMGs' lives and careers. However, we also propose practical measures to improve IMGs' experiences of working in psychiatry.

Attending to the health needs of people with intellectual disability: quality standards.

People with intellectual disabilities remain among the most vulnerable members of society and often face many barriers to healthcare. They experience major health problems and risks yet pay a disability penalty, the result of social exclusion, discrimination and isolation. If public health strategies are to address the physical and mental health needs of people with intellectual disabilities, attention needs to be given to their particular health profile. Health targets, quality standards and outcome measures must attend to their needs, for the measure of civilisation is how well we treat those who are deemed more vulnerable and less able in society. This article highlights how these issues are being addressed in westernised countries and some of the dilemmas and challenges faced by health care organisations.

Hospital admissions for respiratory system diseases in adults with intellectual disabilities in Southeast London: a register-based cohort study.

BACKGROUND: Intellectual disability (ID) carries a high impact on need for care, health status and premature mortality. Respiratory system diseases contribute a major part of mortality among people with ID, but remain underinvestigated as consequent morbidities. METHODS: Anonymised electronic mental health records from the South London and Maudsley Trust (SLaM) were linked to national acute medical care data. Using retrospective cohort and matched case-control study designs, adults with ID receiving SLaM care between 1 January 2008 and 31 March 2013 were identified and compared with local catchment residents for respiratory system disease admissions. Standardised admission ratios (SARs) were first calculated, followed by a comparison of duration of hospitalisation with respiratory system disease between people with ID and age-matched and gender-matched random counterparts modelled using linear regression. Finally, the risk of readmission for respiratory system disease was analysed using the Cox models. RESULTS: For the 3138 adults with ID identified in SLaM, the SAR for respiratory system disease admissions was 4.02 (95% CI 3.79 to 4.26). Compared with adults without ID, duration of hospitalisation was significantly longer by 2.34 days (95% CI 0.03 to 4.64) and respiratory system disease readmission was significantly elevated (HR=1.35; 95% CI 1.17 to 1.56) after confounding adjustment. CONCLUSIONS: Respiratory system disease admissions in adults with ID are more frequent, of longer duration and have a higher likelihood of recurring. Development and evaluation of potential interventions to the preventable causes of respiratory diseases should be prioritised.

Standards and quality measures for services for people with intellectual disabilities.

PURPOSE OF REVIEW: In our modern, performance managed National Health Service, quality has become a key target. Quality assurance has become a statutory duty and the National Health Service is inundated with policy documents and performance measures in most areas of mainstream healthcare. Performance against such measures will be monitored by powerful independent regulatory bodies. It is therefore timely to look at what specific quality measures there are for services for people with intellectual disability. RECENT FINDINGS: Tension exists as to the need for developing specific targets for the population with intellectual disabilities when the philosophy of care is for real social inclusion where 'all means all'. To what extent will existing quality standards for mental health services suffice when we know that often people with intellectual disabilities have real issues accessing these services? This paper highlights published quality measures and standards from primary care through mainstream secondary care and specialist mental health services. It also discusses the policy context and current development of regulatory standards as these continue to evolve. SUMMARY: Evidence for meeting quality standards will increasingly dominate the delivery and funding of healthcare in the National Health Service.

Ill-health and intellectual disabilities.

PURPOSE OF REVIEW: Adults with intellectual disabilities are recognized globally as a group of individuals with poorer access to appropriate healthcare and have worse health outcomes than the general population, including significantly reduced life expectancy. This article reviews the evidence base published over the past 12-24 months, highlighting how public health policy is influencing the literature on the health needs of people with intellectual disabilities. RECENT FINDINGS: Recent studies looking at information from death certificates found people with intellectual disabilities died 15 years younger than people without intellectual disabilities. Using standardized mortality rates, the overall mortality for people with intellectual disabilities is three times higher than for the general population. People with intellectual disabilities have higher rates of asthma and oral disease, but similar rates of hypertension. There is limited high-quality evidence on drugs used to treat epilepsy in this population, despite epilepsy being one of the leading causes of premature deaths. SUMMARY: Recent evidence continues to show that people with intellectual disabilities have poorer health outcomes than the general population. However, the quality of evidence available on the wider health needs remains limited, but, with the move to a public health approach through health surveillance, this may increase the quality of evidence available, so influencing health outcomes for people with intellectual disabilities.

Mental ill-health and care pathways in adults with intellectual disability across different residential types.

The aim of this study was to investigate co-morbid psychopathology and clinical characteristics of adults with ID living across different types of residential settings. All participants were first time referrals to specialist services in South-East London who lived either with their family (N=375) or in supported residence (N=280) or independently (N=95). Psychiatric diagnoses were based on ICD 10 criteria following clinical interviews with key informants and patients. Logistic regression analyses showed that personality disorders were more likely to be diagnosed in people who lived independently or in supported residence, while anxiety disorders were more likely in those living with their family. Overall, those who lived in independent residence had higher rates of co-morbid psychopathology. These effects were independent of ID level and age differences. Younger adults were more likely to live with their families while those with higher ID level were about 17 times more likely to live independently. The largest proportion of referrals to outpatients lived in independent residence although there were no significant differences in other care pathways. The findings are discussed in terms of implications for service planning and development.

Mental health needs of parents with intellectual disabilities.

PURPOSE OF REVIEW: Parents with intellectual disabilities are more susceptible to psychological distress, isolation and abuse, but little is known about their mental health. A significant proportion risk losing custody of their children and current services are inadequate to meet their needs. It is timely to review this in the light of current reforms and good practice guidance. RECENT FINDINGS: Parents with intellectual disabilities have a right to specialist support to enable them to enjoy a normal family life; however, this is not always the case in practice. Access to appropriate services can be challenging owing to a combination of factors including a lack of expertise, funding and different eligibility criteria. Recent studies indicate these parents have an increased risk of psychopathology and mental health problems which impact on their ability to parent. Recent guidelines, however, have failed to address this area of need and services continue to be crisis driven. SUMMARY: This review highlights the high prevalence of mental health needs in parents with intellectual disabilities. A 'continuum of prevention' is a key principle of good practice, demonstrating the need for collaborative multi-agency working. This must include mental health services if the social inclusion and human rights agenda of families with an intellectually disabled parent are to be realized.

Attending to the health needs of people with intellectual disability: quality standards: [review]

People with intellectual disabilities remain among the most vulnerable members of society and often face many barriers to healthcare. They experience major health problems and risks yet pay a ‘disability penalty’, the result of social exclusion, discrimination and isolation. If public health strategies are to address the physical and mental health needs of people with intellectual disabilities, attention needs to be given to their particular health profile. Health targets, quality standards and outcome measures must attend to their needs, for the measure of civilisation is how well we treat those who are deemed more vulnerable and less able in society. This article highlights how these issues are being addressed in ‘westernised’ countries and some of the dilemmas and challenges faced by health care organisations.

Las personas con discapacidad intelectual permanecen entre los miembros más vulnerables de la sociedad y con frecuencia experimentan múltiples obstáculos para el cuidado de la salud. Padecen importantes riesgos y problemas de salud y sin embargo pagan una "penalización" por su discapacidad, resultado de la exclusión social, discriminación y aislamiento. Si las estrategias de salud pública han de enfrentar las necesidades de salud física y mental de las personas con discapacidad intelectual, deberán prestar atención a sus necesidades de salud peculiares. Los objetivos de salud, normas de calidad y mediciones de resultados deben prestar atención a sus necesidades, ya que la medida de la civilización es qué tan bien tratamos a los considerados como más vulnerables y menos capaces en la sociedad. Este artículo subraya cómo se están afrontando estos problemas en los países "occidentalizados" así como algunos de los dilemas y desafíos que encuentran las organizaciones para el cuidado de la salud.