Learning disability psychiatry – the future of services

J. M. O'Dwyer

doi:10.1192/pb.24.7.247

Learning disability psychiatry – the future of services

Psychiatric Bulletin ◽

10.1192/pb.24.7.247 ◽

2000 ◽

Vol 24 (7) ◽

pp. 247-250 ◽

Cited By ~ 6

Author(s):

J. M. O'Dwyer

Keyword(s):

Mental Illness ◽

General Population ◽

Learning Disability ◽

Psychiatric Disorders ◽

The Future

Distinctions between mental illness and learning disability have existed since the last century (Pinel, 1801; Ireland, 1877). The conditions have been accepted as coexisting in the same individual since the beginning of this century (Kraepelin, 1902). More recent papers have investigated the frequency of their coexistence and concluded that most psychiatric disorders are more common in those with learning disability than the general population (Turner, 1989).

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The capacity of people with a ‘mental disability’ to make a health care decision

Psychological Medicine ◽

10.1017/s0033291700001768 ◽

2000 ◽

Vol 30 (2) ◽

pp. 295-306 ◽

Cited By ~ 98

Author(s):

J. G. WONG ◽

I. C. H. CLARE ◽

A. J. HOLLAND ◽

P. C. WATSON ◽

M. GUNN

Keyword(s):

Health Care ◽

Decision Making ◽

Mental Illness ◽

General Population ◽

Learning Disability ◽

Comparison Group ◽

Verbal Ability ◽

Population Group ◽

Chronic Schizophrenia ◽

Mental Disability

Background. Based on the developing clinical and legal literature, and using the framework adopted in draft legislation, capacity to make a valid decision about a clinically required blood test was investigated in three groups of people with a ‘mental disability’ (i.e. mental illness (chronic schizophrenia), ‘learning disability’ (‘mental retardation’, or intellectual or developmental disability), or, dementia) and a fourth, comparison group.Methods. The three ‘mental disability’ groups (N = 20 in the ‘learning disability’ group, N = 21 in each of the other two groups) were recruited through the relevant local clinical services; and through a phlebotomy clinic for the ‘general population’ comparison group (N = 20). The decision-making task was progressively simplified by presenting the relevant information as separate elements and modifying the assessment of capacity so that responding became gradually less dependent on expressive verbal ability.Results. Compared with the ‘general population’ group, capacity to make the particular decision was significantly more impaired in the ‘learning disability’ and ‘dementia’ groups. Importantly, however, it was not more impaired among the ‘mental illness’ group. All the groups benefited as the decision-making task was simplified, but at different stages. In each of the ‘mental disability’ groups, one participant benefited only when responding did not require any expensive verbal ability.Conclusions. Consistent with current views, capacity reflected an interaction between the decision-maker and the demands of the decision-making task. The findings have implications for the way in which decisions about health care interventions are sought from people with a ‘mental disability’. The methodology may be extended to assess capacity to make other legally-significant decisions.

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Developing local services for people with a learning disability and a psychiatric disorder

Psychiatric Bulletin ◽

10.1192/pb.17.4.215 ◽

1993 ◽

Vol 17 (4) ◽

pp. 215-217 ◽

Cited By ~ 7

Author(s):

Ashok Roy ◽

Stuart Cumella

Keyword(s):

Mental Illness ◽

Learning Disability ◽

Psychiatric Disorders ◽

Community Support ◽

Psychiatric Ward ◽

District Health ◽

Mental Handicap ◽

Department Of Health ◽

Health Report ◽

Support Team

Recent ministerial statements and health circulars have identified a key role for the NHS in providing services for people with a learning disability who have a mental illness or a severe behaviour disorder (NHS Management Executive, 1992). This is not an insignificant task, given that psychiatric disorders (including both mental illness and/or severe behaviour disorders) occur among approximately 30% of people with a moderate or severe learning disability (Corbett, 1979; Lund, 1985). Patients with psychiatric disorders have proved particularly difficult to resettle from mental handicap hospitals, and form a substantial proportion of the patients who become long-stay residents of mental handicap hospitals despite the development of community-based services. It is therefore essential that each district health authority defines the most appropriate pattern of services for this group of patients, as part of their purchasing strategy for mental health. The type of service required was discussed by the department of Health report Needs and Responses: Services for Adults with Mental Handicap who are Mentally Ill, who have Behaviour Problems, or who Offend. This noted that no consistent pattern of services has yet emerged, and that suitable alternatives included admission to a specialised mental illness unit in a mental handicap hospital, admission to a general psychiatric ward, admission to a small staffed house, or treatment by a community support team.

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Tobacco Use in Adults With Mental Illness: An Overview of One State-Wide Tobacco Cessation Program

The Journal of Smoking Cessation ◽

10.1017/jsc.2018.27 ◽

2018 ◽

Vol 14 (2) ◽

pp. 132-137

Author(s):

Noeen Sarfraz ◽

Yvon Fils-Aime ◽

Michael Brand ◽

Sara Vesely ◽

Laura Beebe

Keyword(s):

Mental Illness ◽

General Population ◽

Psychiatric Disorders ◽

Tobacco Use ◽

Tobacco Cessation ◽

Vital Signs ◽

The United States ◽

Tobacco Marketing ◽

Current Cigarette ◽

Adults With Mental Illness

Even though one of the public health's top achievements of the 20th century involves tobacco cessation, a disproportionate burden of tobacco-related comorbidity still affects those with mental illness (Centers for Disease Control and Prevention, 2017; Cook et al., 2014). There is evidence suggesting that psychiatric disorders are associated with an increased prevalence in cigarette smoking (Tsoi, Porwa, & Webster, 2013). One explanation for this is the potentiating effect of nicotine on dopamine receptors (Mao, Gallagher, & McGehee, 2011). Other explanations include poverty, educational advancement and industry bias in tobacco marketing (MMWR Vital Signs: Current Cigarette, 2016; CDC Morbidity and Mortality, 2013). We know that adults with mental illness smoke at rates twice that of the general population, and are nicotine-dependent at rates up to three times higher than the general population (Cook et al., 2014; Grant, Hasin, Chou, Stinson, & Dawson, 2004). Adults with mental illness comprise about 19% of the population, but smoke approximately one-third of all the cigarettes smoked (MMWR Vital Signs: Current Cigarette, 2016). In the United States, the national tobacco use prevalence is estimated at 19%; however, prevalence among those with bipolar disorder is 51%–70% and 36%–80% among those with major depressive disorder (Grant et al., 2004; King, Dube, & Tynan, 2012; Lasser et al., 2000). Despite these high rates, recent studies suggest that smokers with mental illness are highly motivated to quit (Cook et al., 2014). However, it remains rare for mental and behavioural health professionals to offer tobacco cessation pharmacotherapy and counselling to clients with psychiatric disorders.

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Sati

Crisis ◽

10.1027/0227-5910.26.2.73 ◽

2005 ◽

Vol 26 (2) ◽

pp. 73-77 ◽

Cited By ~ 15

Author(s):

Dinesh Bhugra

Keyword(s):

Mental Illness ◽

Psychiatric Disorders ◽

Indian Subcontinent ◽

Cultural Factors ◽

Role Expectations ◽

Prevention Strategies ◽

Social Causation ◽

Gender Role Expectations ◽

Good Wife ◽

And Gender

Abstract. Sati as an act of ritual suicide has been reported from the Indian subcontinent, especially among the Hindus, for several centuries. Although legally proscribed, these acts occur even now in modern India. The principle behind such acts has been put forward as the principle of good wife. There is little evidence to suggest that women who commit this act suffer from a formal mental illness. Cultural factors and gender role expectations play a significant role in the act and its consequences. Using recent examples, this paper illustrates the cultural factors, which may be seen as contributing to the act of suicide. Other factors embedded in the act also emphasize that not all suicides have underlying psychiatric disorders and clinicians must take social causation into account while preparing any prevention strategies.

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Attitudes and Perceptions of General Population towards mental illness; Drawing future mental health services

PsycEXTRA Dataset ◽

10.1037/e574202014-007 ◽

2014 ◽

Author(s):

C. Panayiotopoulos ◽

A. Pavlakis

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Health Services ◽

General Population ◽

Health Services ◽

Attitudes And Perceptions

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Overcoming the Complexities of Mental Illness and Homelessness

MacEwan University Student eJournal ◽

10.31542/j.muse.98 ◽

2014 ◽

Vol 1 (1) ◽

Author(s):

Chelsea Lee Dost

Keyword(s):

Mental Illness ◽

Social Work ◽

General Population ◽

Continuity Of Care ◽

Contributing Factors ◽

The Many

Mental illness and homelessness are inextricably tied together in a way that has created a costly problem which profoundly affects both individuals and society. To begin to eradicate this problem, the severity and complexity must be understood by considering the many contributing factors to both mental illness and homelessness. Care must be individualized to fit each person’s unique situation, and continuity of care is absolutely critical. This problem has ramifications for many disciplines such as healthcare, social work, corrections, and housing, but stigma in the general population must also be addressed if progress is to be made.

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Unfitness to Plead in England and Wales

10.1093/oso/9780198788478.003.0003 ◽

2018 ◽

Author(s):

Rudi Fortson

Keyword(s):

Mental Illness ◽

Learning Disability ◽

Developmental Disorder ◽

Criminal Offence ◽

Legal Process ◽

England And Wales ◽

Criminal Jurisdiction ◽

Communication Impairment ◽

The Law ◽

Law Commission

This chapter examines the legal and practical issues encountered by practitioners when dealing with unfitness to plead litigation. As the Law Commission for England and Wales has pointed out, defendants charged with a criminal offence may be unfit to plead or to stand trial for a variety of reasons, including difficulties resulting from mental illness, learning disability, developmental disorder, or communication impairment. Two issues are considered: (i) how might those defendants who are unfit be accurately identified; and (ii) what steps should be taken by legal practitioners and by the courts of criminal jurisdiction to cater for the interests of vulnerable defendants, victims, and society, and to maintain the integrity of the legal process as one that is fair and just? The chapter evaluates the reform proposals of the English Law Commission and assesses how the law could be improved for all those who are involved in dealing with the unfit to plead.

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