Mental Handicap Hospital Research Articles

Discharge into the community from a mental handicap hospital

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EPILEPSY IN A MENTAL HANDICAP HOSPITAL: A SURVEY REPORT

Case notes of 308 longstay residents of a mental handicap hospital were studied during 1992 and the details of epilepsy management for 102 (33%) residents were noted. Theer were 58 (57%) males and 44 (43%) females, and 90% of them had an IQ less than 50. A total of 1986 seizures (83% generalized, 15.5% partial and 1.5% unclassified) were recorded. 72% of the residents had one or more seizures and 26.5% had more than 10 seizures.

The workload of a psychiatric registrar in a mental handicap hospital – implications for training and community care

The widespread move to community care for people with a learning disability has caused a change in roles for both the psychiatrist and the general practitioner. The general practitioner is now widely recognised as the primary medical carer for people with a learning disability (Howells, 1991), with the psychiatrist providing specialist support.

NEW LONG‐STAY PATIENTS AT A MENTAL HANDICAP HOSPITAL

AbstractLegislative changes and the development of community mental handicap services make it essential to identify the future requirement for mental handicap hospitals. One means of doing this is to look at patients who become long‐stay hospital residents despite the existence of community‐based services. This paper reports a study of 31 new long‐stay patients in an English mental handicap hospital. Most were young, male, mobile and physically‐active. Half had either social impairments and/or communication disabilities, three‐fifths had psychiatric disorders, and four‐fifths were severe or potential management problems because of disturbed behaviour. The characteristics of this group reflect the absence of alternative provision for patients with mental illness and/or disturbed behaviour, and these will need to be developed before mental handicap hospitals are closed.

Detentions in a mental handicap hospital: A ten-year retrospective study

Abstract The case notes of 56 people with mental handicap, detained in hospital between 1980 and 1990, were reviewed. There were 67 episodes of detention. Sixty per cent of the people detained were less than 30 years of age. Seventy per cent had mild mental handicap. Forty-three per cent were mentally ill, and forty-three per cent were detained because of mental ‘subnormality’ or ‘impairment’ as defined in the Mental Health Acts 1959 and 1983. The number of new detentions remained approximately constant over the 10-year period, but the number of patients detained at any one time declined due to a decrease in the duration of detention. The proportion of detained patients with a classification of mental impairment declined during the study period. People with a classification of mental impairment were detained for longer periods than those with mental illness

Is the money following the clients with learning disabilities?

For the past decade patients with learning disabilities living in long stay mental handicap hospitals have been resettled in the community. Local authorities have also taken on the care of new patients who would once have been long stay residents. The imperfect data that are available suggest that in England about half the residents in mental handicap hospitals in 1981 are now the responsibility of local authorities; the figures for Wales and Northern Ireland are 38% and 33%. Data on revenue suggest that the savings to the health service are much less--perhaps 9% in Northern Ireland and 3.6% in England, although there have also been capital gains through the sale of hospitals. Existing methods of transferring money from health to local authorities--joint finance and "dowries" for individual patients--do not seem adequately to have compensated local authorities. Moreover, as patients still to be transferred are more severely disabled local authorities will require larger sums--about 26 000 pounds per patient per year plus 39 200 pounds in capital. If the government chooses not to transfer these resources from health authorities it will be switching funds away from learning disabled people to other care groups.

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

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.

Survey of psychotropic medication: usage in a large mental handicap hospital

The populations in the large mental handicap hospitals are known to be diverse, ranging from elderly non-psychiatric residential groups to acutely psychotic and behaviourally disturbed patients. At present demographic variables, medical and psychiatric characteristics of populations in these hospitals are changing in parallel with implementation of community care and resettlement programmes. In resettlement programmes, discharge priorities have been given to the easy to manage and less dependent residents while new challenging behavioural units and admission assessment wards are being opened to care for the multi-handicapped population.

CHARACTERISTICS OF ELDERLY PEOPLE WITH A MENTAL HANDICAP LIVING IN A MENTAL HANDICAP HOSPITAL: A DESCRIPTIVE STUDY

(1993). CHARACTERISTICS OF ELDERLY PEOPLE WITH A MENTAL HANDICAP LIVING IN A MENTAL HANDICAP HOSPITAL: A DESCRIPTIVE STUDY. The British Journal of Development Disabilities: Vol. 39, No. 76, pp. 31-49.

Mental impairment in the West Midlands.

The case records of 55 people from the West Midlands (UK) fulfilling the Mental Health Act 1983 criteria for mental impairment or severe mental impairment, were studied. Most were young men with mild mental retardation. 73 per cent were resident in (or on leave from) mental handicap hospitals, and 27 per cent resident in special hospitals. 29 per cent were subject to a Restriction Order. Most had lived in hospital for more than six years. The commonest problem behaviours were aggression, property offences and inappropriate or offending sexual behaviour. 31 per cent were mentally ill or had a past history of mental illness. A diverse range of services appears necessary to meet the needs of this group of people.

The Criminal Procedure (Insanity and Unfitness to Plead) Act 1991

In recent years, the procedures and criteria by which defendants are found unfit to plead or not guilty by reason of insanity (the special verdict) have come in for frequent criticism. Under the Criminal Procedure (Insanity) Act 1964 the automatic consequence of a finding of unfitness to plead or a special verdict has been that the defendant is made subject to a hospital order with restrictions without limit of time under sections 37 and 41 of the Mental Health Act 1983. The effect of a restriction order is that the patient may be detained indefinitely, and may only be discharged by the Home Secretary or a Mental Health Review Tribunal (MHRT). Hence, a defendant found unfit to plead under the 1964 Act lost his right to be tried and faced potentially indefinite detention in hospital for a crime which he might not have committed.l Two cases highlighted the potential injustices. The first was that of Glenn Pearson, a tnentally handicapped man who was found unfit to plead to an indictment of stealing three light bulbs and five pounds. He was ordered to be detained under a restriction order at a mental handicap hospital. His appeal against his detention was heard by a MHRT after three months. His discharge was ordered by the tribunal because, although mentally handicapped, he was not suffering from mental impairment, which requires abnormally aggressive or seriously irresponsible conduct.2 Because a tribunal has a duty to discharge a patient who is not suffering from mental disorder within the meaning of the Mental Health Act 1983, Glenn Pearson was discharged to his home.3 The second case was that of Valerie Hodgson who is mentally handicapped and lived with her father. One morning she found her father's body. He had been stabbed in the chest. During interviews with the police, she confessed to the murder. She was found unfit to plead and was detained in a secure hospital. Fourteen months later, new evidence emerged, and her nephew was convicted of the murder. The insanity defence lost its attraction after the introduction of the plea of diluinished responsibility to murder,4 and because under the 1964 Act the automtic consequence of a special verdict was the imposition of a hospital order without limit of time.5 Defendants were therefore unlikely to raise the defence. In fact, the

Consent for treatment in mental handicap hospitals in Scotland

Consent for operation/treatment of a mentally handicapped person has been an issue stimulating much discussion. Generally, in the past, relatives or consultants responsible for their care have given ‘consent’ for treatment when mentally handicapped people were unable to do so. It was appreciated that legally this was not valid once the person was over the age of 16 and so we felt that the ‘consent’ procedure operating at our hospital should be reviewed. We were unsure of the practices in other areas, apart from Lothian Area where we knew new ‘consent’ forms had been devised, and felt that a good starting point would be to contact mental handicap hospitals in Scotland to gather information regarding the present ‘consent’ practices overall.

Admissions to mental handicap hospitals.

Admissions to mental handicap hospitals.

News

Values in Action, the national campaign group for people with learning disabilities, held gatherings at the gates of hospitals throughout the country last week, calling for the closure of mental handicap hospitals and demanding extra funding for community care.

Relocation and the characteristics of hospital and hostel regimes

Drawing on evidence from a research evaluation of a local community care programme, this paper explores whether relocation from a British National Health Service mental handicap hospital into local authority hostels (supervised residential facilities) brought about a qualitative change in the residential environment of movers towards less restrictive management practices and caring routines, more responsive attitudes towards their rights and needs as individuals, and greater control over their own lives. The conclusions point to the existence of a substantial measure of overlap in the fundamental characteristics of the hospital and hostel regimes.

People aged over sixty‐five years living in a mental handicap hospital—THIRTEEN YEARS ON

People aged over 65 years living in a mental handicap hospital on July 1st, 1989 were rated using a standardised psychiatric interview and other assessments. The results were compared with a similar survey carried out in 1976. Although the number of people had declined slightly, from 38 to 36, they constituted an increased proportion of the hospital population. Basic ability ratings were lower in 1989 than in 1976, but the difference was not statistically significant. Levels of psychiatric symptomatology were similar in both surveys. It was estimated that 58.3 per cent of the people surveyed in 1989 could be placed in non‐hospital residential care.

Mental handicap and the new long stay

For almost 20 years planning for the mentally ill and mentally handicapped has focused on a shift of care from hospital to community, the advantages and difficulties of this process generating much discussion and interest. The hospital population of the mentally handicapped is currently at the forefront of this change, planning impetus now being propelled by alterations in funding with budgets being transferred from NHS to local and social services. One consequence is the closure, or planned closure, of large mental handicap hospitals situated at the periphery of urban centres, with residents being moved to small group homes and hostels within the towns and cities the hospitals once served. The change should prove beneficial for a majority of residents although the process continues to generate debate.

The Psychiatric Symptoms, Diagnoses and Care Needs of 100 Mentally Handicapped Patients

One hundred randomly selected residents of a mental handicap hospital originating from Dundee were interviewed using a standardised assessment based on the modified Standardised Clinical Interview Schedule. Information on certain behavioural items and self-care skills was obtained from nursing staff and case records. An ICD-9 diagnosis could be made for 80 individuals, including diagnoses usually reserved for children. Thirty subjects were regarded as needing long-term psychiatric mental handicap hospital care. All but one of the remaining 70 subjects required a staffed residential placement and all but 15 some form of out-patient or short-term in-patient provision from specialist health services. The findings indicate a need for approximately 30 psychiatric mental handicap beds per 100,000 population.

John as a utility and ‘utility’

John is a 30-year-old man suffering from severe mental handicap (IQ:30) and epilepsy, without other physical deformities or illness. He is sociable, would initiate social interaction (physical), enjoys a cuddle and going out on trips. He has no communication skills but is able to understand basic commands like ‘open your mouth’, ‘sit down’ and so on. He has been a long-term in-patient in a mental handicap hospital for the past 15 years. He is from an affluent family and had been admitted because of his family's inability to cope. He has visits from his mother once a month, and from his father less frequently. A few months ago his mother left a verbal instruction to the ward staff to make arrangements to donate his organs and to ask me, as responsible medical officer, to leave written instructions to inform the local Organ Transplant Team before his death, whenever it becomes imminent, so that the Organ Transplant Team can remove the necessary organs on his death.

Sudden deaths of patients in a mental handicap hospital

AbstractOne Hundred and two sudden or traumatic deaths of mental handicap inpatients were examined retrospectively over a 28 year period. Data was obtained on each case from medical and nursing case notes and death certificates. Post-mortem results were available for half of the deaths. Cardio-vascular causes accounted for 50% of the total. Sudden deaths of profoundly handicapped patients occurred at a significantly younger age than severely, moderately or mildly handicapped patients. In the latter half of the 28 year period there was an increased incidence of traumatic deaths and sudden deaths due to asphyxia. There was also a significant increase in the mean age of sudden deaths due to epilepsy. Probable explanations for these findings are discussed. In particular, recent accidental traumatic deaths may be related to the process of increased reintegration of patients into the community; a relationship between neuroleptic and anticholingeric medication and asphyxial deaths is proposed.