Experiences with Involuntary Mental Health Admissions Among Service Users with Intellectual Disabilities: A Qualitative Study

Clear recommendations for how to best adapt mental health services for adolescents with a background as asylum seekers and refugees are lacking. This study therefore explored healthcare professionals' experiences and perspectives on mental health needs of these groups of youth in Norway. The objectives were to explore healthcare professionals' perspectives on what is needed for adolescents with status as asylum seekers or refugees to seek professional help for mental health problems and what is important for them to experience the offered help as beneficial. A qualitative interview study was carried out to explore the perspectives of healthcare professionals (n = 11) in primary and secondary healthcare settings. Systematic text condensation was used for data analysis. Four themes were developed through the study: (a) culturally sensitive and adapted services; (b) low threshold and outreach services; (c) building a trusting relationship; and (d) user involvement. The study provides a constructivist understanding of cultural competence including several suggestions for how to overcome barriers to service use among adolescents who have a background as asylum seekers or refugees. Some of the recommendations include an ongoing collaboration with youth and their families to better understand their culture; healthcare professionals who acquire cultural competence, practice cultural humility and are mindful of their own cultural backgrounds. There should be comprehensive education and training programmes for healthcare professionals. Services should be easily accessible with simplified referral procedures and arena flexibility. Skilled interpreters should be used, including cultural interpreters. Shared decision-making should be used to actively engage youth in their treatment.

Family presence during resuscitation (FPDR) is a growing hospital praxis despite lack of high-quality evidence. The aim of this qualitative evidence synthesis review was to synthesize current evidence regarding healthcare professionals (HCP) perspectives on barriers and facilitating factors of FPDR and the potential impact of FPDR on HCP performance. We conducted a systematic literature search May 17, 2023 including primary studies with qualitative study designs. We applied NVivo for data analysis. Data was coded with line-by-line coding and organized into themes and categories following the method for thematic synthesis described by Thomas and Harden to analyse data. The studies underwent quality appraisal by Critical Appraisal Skills Program. We used GRADE CERQual to assess the confidence in the evidence. We identified 8241 articles suitable for screening, 141 articles were full text screened, and nine studies included from Australia, UK and USA. In total, 134 HCP participated, between 2005 and 2019. Most studies lacked sufficiently rigorous data analysis and findings were appraised to have moderate GRADE CERQual confidence. We identified three analytical themes ("Facilitating factors for FPDR", "Barriers for FPDR" and "How staff are affected by FPDR") with eight descriptive subthemes. One finding was of high GRADE CERQual confidence: a belief that FPDR is "the right thing to do" which was a "Facilitating factor of FPDR." The evidence on HCP perspectives is of low to moderate confidence. The interviewed consent that FPDR is the "right thing to do", and an ethical principle of beneficence is dominant, especially regarding children.

The goal of this communication is to provide clinicians and behavioral scientists with a scoping perspective on the diverse array of impacts of the COVID-19 pandemic on individuals with intellectual and developmental disabilities (IDD) in the U.S. It is our hope that this will stimulate subsequent scientific and advocacy efforts to ameliorate the disproportionate burden of the pandemic on people with IDD.We begin with the assertion that among non-infected persons in the U.S. few are more adversely affected by COVID-19 than individuals with IDD, given that a vast proportion require in-person care or critical therapeutic support within their living environments, with little back-up or systematic coverage for prolonged interruption of services.Many have temporarily lost access to trained caregivers or community service providers, and now face evolving threats to the return of baseline service, given uncertainties in State and agency budgets.Therefore, a first priority relates to restoration of in-person support services or comparable alternatives.There have been emerging guidelines on the safe care and support of individuals with IDD during the COVID pandemic-see Supplementary Table (ST) 1 which lists resources and documentation of early success of such strategies, however guidance is still evolving, has not permeated all reaches of the community where the information is desperately needed, and is not always presented in ways that can be fully comprehended by those with IDD.It must be

Experiences of involuntary psychiatric admission decision-making: a systematic review and meta-synthesis of the perspectives of service users, informal carers, and professionals

ObjectivesWe conducted a meta-synthesis of qualitative studies to synthesize the views of psychiatric patients on second-generation antipsychotics (SGAs) and the healthcare providers about the metabolic monitoring of adult-prescribed SGAs.MethodsA systematic search was conducted in four databases through SCOPUS, PubMed, EMBASE, and CINAHL to identify qualitative studies of patients’ and healthcare professionals’ perspectives on the metabolic monitoring of SGAs. Initially, titles and abstracts were screened to exclude articles that were not relevant followed by full-text reading. Study quality was assessed by using Critical Appraisal Skills Program (CASP) criteria. Themes were synthesized and presented as per the Interpretive data synthesis process (Evans D, 2002).ResultsA total of 15 studies met the inclusion criteria and were analyzed in meta-synthesis. Four themes were identified: 1. Barriers to metabolic monitoring; 2. Patient related concerns to metabolic monitoring; 3. Support system by mental health services to promote metabolic monitoring; and 4. Integrating physical health with mental health services. From the participants’ perspectives, barriers to metabolic monitoring were accessibility of services, lack of education and awareness, time/resource constraints, financial hardship, lack of interest on metabolic monitoring, patient capacity and motivation to maintain physical health and role confusion and impact on communication. Education and training on monitoring practices as well as integrated mental health services for metabolic monitoring to promote quality and safe use of SGAs are the most likely approaches to promote adherence to best practices and minimize treatment-related metabolic syndrome in this highly vulnerable cohort.ConclusionThis meta-synthesis highlights key barriers from the perspectives of patients and healthcare professionals regarding the metabolic monitoring of SGAs. These barriers and suggested remedial strategies are important to pilot in the clinical setting and to assess the impact of the implementation of such strategies as a component of pharmacovigilance to promote the quality use of SGAs as well as to prevent and/or manage SGAs-induced metabolic syndrome in severe and complex mental health disorders.

Back to table of contents Previous article Next article Legal NewsFull AccessAPA Joins Amicus Brief in Capital Case Before U.S. Supreme CourtMark MoranMark MoranSearch for more papers by this authorPublished Online:3 Jan 2017https://doi.org/10.1176/appi.pn.2017.1a3AbstractDeterminations of intellectual disability in capital cases should rely upon a comprehensive assessment of intellectual and adaptive functioning using contemporary standards.APA joined four other mental health groups in urging the U.S. Supreme Court to reject criteria used by the state of Texas to determine that a defendant in a capital case is not intellectually disabled and therefore can be executed without violating the Eighth Amendment ban on cruel and unusual punishment. iStock/uschoolsAPA and the other mental health groups filed an amicus brief in support of Bobby James Moore, the petitioner in the case Moore v. Texas. They cited previous case law establishing that the diagnosis of intellectual disability in capital cases should be based on the diagnostic consensus of mental health professionals, including comprehensive assessment of intellectual and adaptive functioning using contemporary standards. They argued that the criteria used by Texas in assessing Moore for intellectual disability does not meet that standard and thereby endangers Moore, who might warrant exemption from execution if he were properly assessed. The other groups are the American Psychological Association, the American Academy of Psychiatry and the Law, and the National Association of Social Workers and its Texas chapter.In an interview with Psychiatric News, past APA President Paul Appelbaum, M.D., a member of the Committee on Judicial Action and a corresponding member of the Council on Psychiatry and the Law, explained the case law preceding Moore v. Texas that is relevant in the amicus. In a 2002 case before the Supreme Court (Atkins v. Virginia), the Court held that the Eighth Amendment prohibits the execution of individuals with intellectual disability. “However, the Court declined to specify the criteria or procedures by which determinations of intellectual disability would be made [for the purposes of capital cases],” Appelbaum said. “So the question remained—how do we know when someone is intellectually disabled and therefore warrants an exemption from the death penalty? What process should states follow to make that determination? The lower courts and states have been trying to work out the answer to that question.”A second case reaching the Supreme Court in 2004 (Hall v. Florida) established a precedent that became relevant to answering those questions, Appelbaum said. “The issue in Hall was whether the state of Florida was justified in having a set of criteria for determining intellectual disability that differed from the consensus of relevant professional organizations,” he said. (Those relevant professional organizations included APA, which filed an amicus brief in that case as well.)Appelbaum noted that there are two dominant sets of criteria for determining intellectual disability: the one appearing in DSM-5 and another formulated by the American Association of Intellectual and Developmental Disability (AAIDD). Both sets of criteria, which are similar, emphasize that a single score on an IQ test is not sufficient to assess intellectual disability; instead, a comprehensive assessment of intellectual and adaptive functioning using contemporary standards by a mental health professional is necessary. In Hall v. Florida, the Court said Florida’s criteria—which relied on a single score on an IQ test—was not in accordance with the more comprehensive criteria of APA and the AAIDD and therefore failed to protect from execution individuals who might be intellectually disabled.This became relevant in Moore, Appelbaum explained, because following the Court’s original ruling in Atkins, a Texas Court of Criminal Appeals adopted a set of nonclinical factors (called the “Briseno factors,” after the name of a defendant in a capital case) for determining intellectual disability that appear to be especially idiosyncratic. According to the amicus brief, “The court … cited no mental health or medical authority as the basis for these factors, instead alluding to a fictional character [Lennie Small] in John Steinbeck’s 1937 novel Of Mice and Men as the basis for its reasoning about intellectual disability diagnosis.”The amicus includes a detailed list of the ways in which the Briseno factors fall short of the accepted professional criteria and concludes: “[T]he so-called Briseno factors are incompatible with the consensus among the mental health professions and, when used, provide inaccurate and unreliable diagnoses of intellectual disability. The use of antiquated diagnostic criteria, refusal to interpret IQ scores using clinical standards, and the inclusion of nonclinical factors to diagnose intellectual disability all create significant risks that individuals with intellectual disability will be executed in violation of the Eighth Amendment.” ■The amicus curiae brief can be accessed here. 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Previous research has shown attachment avoidance in adulthood to be a strongnegative predictor of desire to have children, bonding in pregnancy, and abilityto relate to children after birth (Rholes, Simpson, & Blakely, 1995; Rholes,Simpson, Blakely, Lanigan, & Allen, 1997). Other research has shown that relationships between adult attachment and prenatal bonding and parenting style are sometimes mediated by caregiving style (Walsh et al., 2011; Millings, Walsh, & O’Brien, 2008). The two studies presented here explore the roles of attachment and caregiving in how individuals without children think about their intentions to become a parent and their expectations of what future parenting will be like. Study 1 demonstrated that, in accordance with other literature, attachment avoidance was a good negative predictor of desire to have children, but that caregiving style did not mediate this relationship. There appeared to be different predictors for young men and young women such that attachment avoidance predicted desire to have children for women, but caregiving responsiveness to partner predicted desire to have children for men. The second study sought to replicate and extend these results by examining attachment, caregiving, and relationship influences on expectations of future parenting. This research adds to our understanding of the correlates and predictors of parenting intentions and expectations, and the relative importance of relationship and individual processes.

To evaluate outcomes after major surgery in children and adolescents with intellectual disability. We used 2004 to 2013 claims data from Taiwan's National Health Insurance programme to conduct a nested cohort study, which included 220292 surgical patients aged 6 to 17years. A propensity score matching procedure was used to select 2173 children with intellectual disability and 21730 children without intellectual disability for comparison. Logistic regression was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of the postoperative complications and 30-day mortality associated with intellectual disability. Children with intellectual disability had a higher risk of postoperative pneumonia (OR 2.16, 95% CI 1.48-3.15; p<0.001), sepsis (OR 1.67, 95% CI 1.28-2.18; p<0.001), and 30-day mortality (OR 2.04, 95% CI 1.05-3.93; p=0.013) compared with children without intellectual disability. Children with intellectual disability also had longer lengths of hospital stay (p<0.001) and higher medical expenditure (p<0.001) when compared with children with no intellectual disability. Children with intellectual disability experienced more complications and higher 30-day mortality after surgery when compared with children without intellectual disability. There is an urgent need to revise the protocols for the perioperative care of this specific population. Surgical patients with intellectual disability are at increased risk of postoperative pneumonia, sepsis, and 30-day mortality. Intellectual disability is associated with higher medical expenditure and increased length of stay in hospital after surgical procedures. The influence of intellectual disability on postoperative outcomes is consistent in both sexes and those aged 10 to 17 years. Low income and a history of fractures significantly impacts postoperative adverse events for patients with intellectual disability.

The global aging population has rendered dementia a critical public health challenge, with approximately 47 million people affected worldwide in 2015, a number projected to reach 132 million by 2050. Upholding dignity is widely recognized as a core ethical obligation in dementia care. However, the perspectives of healthcare professionals, who serve as the direct practitioners of dignity care, have not yet been systematically synthesized. This study aims to systematically synthesize qualitative research on healthcare professionals' perspectives regarding dignity care for patients with dementia in order to inform clinical practice, care management, and policy development. This study followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ). A systematic search was conducted across ten Chinese and English databases, including PubMed, from database inception to November 25, 2025. Two reviewers independently screened articles against eligibility criteria and assessed quality using the Critical Appraisal Skills Programme (CASP) checklist. A total of 13 studies were included, comprising qualitative studies and the qualitative components of mixed methods studies that explored healthcare professionals' perspectives on dignity care for patients with dementia. Data were synthesized using Thomas and Harden's thematic synthesis approach. The synthesis generated four analytical themes and twelve subthemes: (1) the ethical foundation of dignity care; (2) multidimensional practice strategies for dignity care; (3) dilemmas and adaptive strategies in dignity care; and (4) influencing factors of dignity care. Across these themes, healthcare professionals described central tensions involving the dynamic balance between authenticity and protection, autonomy support and necessary care, and professional boundaries and emotional connection. Dignity care for patients with dementia is not a standardized technical procedure, but a dynamic, context-bound practice grounded in ethical relationships. Its realization requires not only individual ethical sensitivity and practical wisdom but also supportive organizational cultures, adequate institutional resources, and broader societal recognition of the value of elderly care.

Identifying the long-term needs of stroke survivors and modeling implications for innovative services

BackgroundPersonalized breast cancer screening is a novel strategy that estimates individual risk based on age, breast density, family history of breast cancer, personal history of benign breast lesions, and polygenic risk. Its goal is to propose personalized early detection recommendations for women in the target population based on their individual risk. Our aim was to synthesize the factors that influence women’s decision to participate in personalized breast cancer screening, from the perspective of women and health care professionals.MethodsSystematic review of qualitative evidence on factors influencing participation in personalized Breast Cancer Screening. We searched in Medline, Web of science, Scopus, EMBASE, CINAHL and PsycINFO for qualitative and mixed methods studies published up to March 2022. Two reviewers conducted study selection and extracted main findings. We applied the best-fit framework synthesis and adopted the Multilevel influences on the cancer care continuum model for analysis. After organizing initial codes into the seven levels of the selected model, we followed thematic analysis and developed descriptive and analytical themes. We assessed the methodological quality with the Critical Appraisal Skills Program tool.ResultsWe identified 18 studies published between 2017 and 2022, conducted in developed countries. Nine studies were focused on women (n = 478) and in four studies women had participated in a personalized screening program. Nine studies focused in health care professionals (n = 162) and were conducted in primary care and breast cancer screening program settings. Factors influencing women’s decision to participate relate to the women themselves, the type of program (personalized breast cancer screening) and perspective of health care professionals. Factors that determined women participation included persistent beliefs and insufficient knowledge about breast cancer and personalized screening, variable psychological reactions, and negative attitudes towards breast cancer risk estimates. Other factors against participation were insufficient health care professionals knowledge on genetics related to breast cancer and personalized screening process. The factors that were favourable included the women’s perceived benefits for themselves and the positive impact on health systems.ConclusionWe identified the main factors influencing women’s decisions to participate in personalized breast cancer screening. Factors related to women, were the most relevant negative factors. A future implementation requires improving health literacy for women and health care professionals, as well as raising awareness of the strategy in society.

Young relative age within the school year has previously been associated with attention-deficit/hyperactivity disorder (ADHD) diagnosis and, based on limited evidence, diagnosis of intellectual disability. No study to date has examined the association between relative age and diagnosis of depression. To estimate the associations with intellectual disability and ADHD and investigate a potential novel association between relative age and childhood depression. This population-based cohort study of 1 042 106 children aged 4 to 15 years used electronic record data collected before January 3, 2017, from more than 700 general practices contributing to the UK Clinical Practice Research Datalink. Multivariable Cox proportional hazards regression modeling was used to explore the association between relative age and the incidence of intellectual disability, ADHD, and depression before age 16 years. Data were analyzed between July 2017 and January 2019. Relative age within school year determined by month of birth and categorized into four 3-month groups. Intellectual disability, ADHD, and depression. In the total cohort of 1 042 106 children, 532 876 were male (51.1%) and the median age at study entry was 4.0 years (interquartile range, 4.0-5.0). There was evidence that being born in the last quarter of the school year (ie, being the youngest group in a school year) was associated with diagnosis of intellectual disability (adjusted hazard ratio [aHR], 1.30; 95% CI, 1.18-1.42), ADHD (aHR, 1.36; 95% CI, 1.28-1.45), and depression (aHR, 1.31; 95% CI, 1.08-1.59) compared with being born in the first quarter. A graded association was seen with intermediate age groups at a smaller increased risk of each diagnosis compared with the oldest group, with aHRs for intellectual disability for those born in the second quarter of 1.06 (95% CI, 0.96-1.17) and for those born in the third quarter of 1.20 (95% CI, 1.09-1.32); aHRs for ADHD for those born in the second quarter of 1.15 (95% CI, 1.08-1.23) and for those born in the third quarter of 1.31 (95% CI, 1.23-1.40); and aHRs for depression for those born in the second quarter of 1.05 (95% CI, 0.85-1.29) and for those born in the third quarter of 1.13 (95% CI, 0.92-1.38). In this study, relative youth status in the school year is associated with an increased risk of diagnosis of ADHD, intellectual disability, and depression in childhood. Further research into clinical and policy interventions to minimize these associations appears to be needed.

BackgroundA national birth cohort study was used to investigate whether high-risk family factors at 1.5-year-olds can increase the risk of attention-deficit/hyperactivity disorder (ADHD) diagnosis when children reach 5.5 years. The pathway relationship of high-risk family factors, children's developmental conditions, risk of autism spectrum disorder (ASD), and diagnosis of intellectual disability (ID), learning disability (LD), and ASD was also investigated.MethodsThe 1.5-, 3- and 5.5-year-old Taiwan Birth Cohort Study (TBCS) dataset was used (N = 19,185). The high-risk familial factor was measured using five questions assessing whether parents are currently unmarried, unemployed, do not have any social insurance, perceive a “very heavy” economic childcare burden, and at least one of the parents has a disability certification. Developmental conditions were assessed using the Taiwan Birth Cohort Study—Developmental Instrument (TBCS-DI), and ASD risk was measured using the Modified Checklist of Autism in Toddlers. Data on ADHD, ID, LD, and ASD diagnoses were collected at age 5.5. The odds ratio model investigated whether children from families with high-risk factors at 1.5-years were at increased risk of ADHD, ID, LD, or ASD diagnosis at 5.5-years, compared to those children from families without such risks. Structural equation modeling investigated the logistic regression pathway relationship of high-risk familial characteristics, children's developmental conditions, autism screening, and diagnosis.ResultsIn the national birth cohort dataset of 19,185 children, 2070 (10.8%) met at least one of the high-risk familial factors. Children who met one high-risk familial factor had a 1.21-fold increased risk for ADHD diagnosis, 1.36-fold increased risk for LD diagnosis, and 1.80-fold increased risk for ASD diagnosis, compared to children from families without risks. High-risk familial factors directly increased the risk of ADHD and ID diagnosis, and indirectly increased the risk of ADHD, ID, LD, and ASD diagnosis through the mediating factor of children's development.ConclusionsChildren who met more high-risk familial characteristics were at higher risk of ADHD, ID, LD, and ASD diagnosis. Development at three years was predictive of diagnosis at 5.5 years. Thus, developmental screening at age three is vital for interventions. Preventive, family-focused, and/or child-rearing services for at-risk families are important for improving outcomes for these children and their families.

To describe the perspectives of patients using digital services on the digital counselling competence of healthcare professionals. A descriptive qualitative interview study. The analysed data were collected in Finland during the spring of 2023 via 11 individual, semi-structured interviews from participants who had received video-mediated counselling. The interviews were carried out online through Microsoft Teams and adhered to an interview guide using main and ancillary questions. The data were analysed using inductive content analysis. The patients' perspectives of healthcare professionals' digital counselling competence were related to five categories: (1) competence in preparing for video-mediated counselling, (2) digital competence in implementing the video-mediated counselling, (3) competence in interacting with the patient during the video-mediated counselling, (4) competence in supporting the patient's self-management in video-mediated counselling and (5) competence in self-development as a digital counsellor. The results of this study indicate that healthcare professionals need to possess a wide range of digital counselling competencies when providing video-mediated counselling. This study thus lays the groundwork for future studies of patients' perspectives of healthcare professionals' digital counselling competence. The results of this study can be used to develop healthcare professionals' digital counselling competence and patient-centered care. The presented insights can also be used to map further research topics. The Consolidated criteria for reporting qualitative research (COREQ) checklist was used when reporting the results. Patients who had experience in using digital services participated in the data collection of this study. What problem did the study address? Healthcare professionals may well need to develop new competencies as counselling is increasingly moving to digital environments. What were the main findings? The main areas of digital counselling competence that emerged from the patients' perspectives were competence in preparing for video-mediated counselling, digital competence, competence in interacting with the patient, competence in supporting self-management and competence in self-development as a digital counsellor. Where and on whom will the research have an impact? The research can be used to build and develop healthcare professionals' digital counselling competence, as well as improve the delivery of patient-centered care.

Approximately 2.5 million people in the United States-one percent of the population-have an intellectual disability (previously referred to as mental retardation). These conditions range from genetic disorders such as Down syndrome to disabilities caused by infectious diseases and brain injury. Intellectual Disability: A Guide for Families and Professionals, by one of the country's foremost authorities on intellectual disability, is a comprehensive resource that will be of importance to anyone with a personal connection to a child or adult with a neurodevelopmental disorder. Emphasizing the humanity of persons with intellectual and related developmental disabilities, psychiatrist and pediatrician James Harris provides essential information on assessment and diagnosis of intellectual disability, treatments for specific disorders, and ways to take advantage of the wide array of services available today. The focus throughout is on the development of the person, the positive supports necessary for self-determination, and, to the extent possible, independent decision making. Harris also surveys historical attitudes toward intellectual disability, the medical community's current understanding of its causes and frequency, and the associated physical, behavioral, and psychiatric conditions (such as seizure disorder, depression, and autism) that often accompany particular types of intellectual disability. The book addresses legal, medical, mental health, and research-related issues as well as matters of spirituality, highlighting the ways in which individuals with intellectual disability can meaningfully participate in the spiritual lives of their families and their communities. Each chapter ends with a series of key points to remember, and the book concludes with a list of additional resources of further interest. Intellectual Disability is a must-read for parents and families of those with neurodevelopmental disorders, providing guidance and essential information to help their family members effectively, and to make a significant, positive difference in their lives now and in the future.