Understanding the current provisions of support for people with an intellectual disabilities and/or autism in crisis: A mixed methods study.

Abstract

There has been significant reduction in inpatient beds for people with intellectual disability and/or autism (PwID/A) in the UK in the last decade following high profile national scandals in specialist psychiatric hospitals. To reduce inappropriate admissions a new strategy (Blue-Light, an emergency multi-disciplinary meeting to prevent admission to hospital) was introduced. However, there is no research on the influence of Blue-Light on crisis management for PwID/A. To assess Blue-Light's impact on PwID/A's crisis presentations. Co-produced with experts-by-experience, a mixed methods approach using a 13 question Likert based survey of health and social-care professionals along with semi-structured interviews of carers involved with consecutive Blue-Light patient reviews was undertaken in Cornwall UK (population: 538,000). Patient data was accessed to understand the patient journey. All data analysis was descriptive in nature. Semi-structured interviews were transcribed and thematically analysed using Braun and Clarke's six-step process. Ten patient journeys were examined. Staff interviewed had a good understanding of the Blue-Light process, Blue-Light activation practical challenges and considered Blue-Light reactive. Nearly half wanted ID/A specialist beds recommissioned. A majority wanted improved supervision and standards for third sector providers. Semi-structured interviews of 10 patient-carers identified a lack of consistency from professionals, limited infrastructure provision, the prolongation of crises and a lack of definition of crisis as carers did not feel supported by services. Current crisis support systems are not standardised and often leave carers feeling unsupported in crises. An evidence-based debate of crisis support and the inpatient role for PwID/A is required.