Mental Health Disability Research Articles

Impact of nurse education prior to and during COVID-19 on nursing students’ preparedness for clinical placement: a qualitative study

Introduction: Nursing students internationally entered challenging clinical placements during COVID-19. Lessons learnt could inform nurse education planning, particularly in preparation to implement future workforce plans.Aim: This study aimed to explore the impact of COVID-19 on nursing students undertaking clinical placements across the UK, particularly the extent to which nursing education prior to and during COVID-19 had prepared them for placements, and to distil key messages for future nursing education.Methods: A UK-wide qualitative study was conducted using audio or written placement diaries and post-placement telephone or online interviews with nursing students from all years of study and from adult, children, mental health and learning disability disciplines. Transcripts were analysed thematically using the Framework Approach. A pre-survey collected participants’ demographic information, details and expectations of their upcoming clinical placements, and how well prepared they felt. Ethical approval was gained.Results: Two hundred and sixteen nursing students from across the UK participated in the study. Five key themes were identified: ‘stepping up to the challenge and feeling the fear’, ‘new ways of learning’, ‘theory versus clinical practice’, ‘impact on clinical and academic partnerships’, and ‘concerns around demonstrating proficiency’.Discussion: Differing levels of preparedness of nursing students for clinical placement were reported. While many felt honoured to be a part of the nursing workforce during COVID-19, the rapidly changing clinical landscape led to unplanned changes to placements, lack of skills practice, uncertain practice supervision and distance learning which impacted on their confidence and perceived levels of competence leading to anxiety around demonstrating proficiency and achieving practice hours. Greater collaboration between universities, clinical placement teams, policy makers and regulators are key lessons post COVID19 to improve the support and preparedness of nursing students.

Assessment of Food Preferences, Eating Practices, and Nutritional Status Among In-school Able and Disabled Adolescents of Ages 10 - 19 Years in Minna, Niger State, Nigeria

Background: Malnutrition affects school-age children's health, growth, and academic performance. Adolescents often consume unhealthy fast foods and follow crash diets influenced by peers, media, and cultural norms. Adolescents with disabilities, including physical, intellectual, sensory, developmental, and mental health disabilities, may face additional challenges in accessing and maintaining a balanced and nutritious diet as they may face additional barriers. Understanding the unique needs and challenges faced by adolescents with disabilities is crucial in promoting their overall health and well-being. Objectives: The study aimed to compare the nutritional status of able and disabled adolescents in Government Vocational and Technical College and Niger State School of Special Education in Minna, as well as their food preferences, eating practices, and the factors affecting their nutritional status. Methods: The study used a cross-sectional design, administering 400 questionnaires to disabled and able students. The responses were 100% collected using self-administered structured questionnaires. Data were analyzed, and results were presented utilizing tables and figures, with a statistical significance level set at P < 0.05. The IBM statistical product and service solutions (IBM SPSS statistics), version 27.0 software was employed for data analysis to explore and understand the food preferences, eating practices, and nutritional status of in-school adolescents with disabilities in Minna, Niger State, Nigeria. This approach allowed for a comprehensive assessment of the diverse factors influencing the dietary habits and nutritional well-being of adolescents with disabilities in the study. Results: The study involved 400 participants, with 12.8% aged over 12 years, 50.3% aged 12 - 15 years, and 37.0% above 15 years. Females made up 51.0% of the participants. About 40% of disabled participants had inadequate dietary patterns, compared to 10% of able participants. There was a significant difference in the distribution of BMI groups between the able and disabled subjects (x2 = 26.984, df = 3, P = 0.000). Socio-demographic of the participants based on age and gender showed a significant association with the nutritional status of able adolescents at (χ2 = 44.593, P = 0.000) and (χ2 = 4.650, P = 0.031) respectively and among disabled at (χ2 = 18.303, P = 0.000) and (χ2 = 23.925, P = 0.000) respectively. Conclusions: The study revealed disabled adolescents often skip meals, consume fast foods, and have poor dietary habits. Interventions like education and increased access to healthy food options are needed.

Evaluating Disability Rights Legislation: The Impact of the Americans with Disabilities Act on Social Equality in the United States

The Americans with Disabilities Act (ADA), enacted in 1990, set a milestone in protecting the civil rights of disabled Americans. This paper evaluates the impact of the ADA through its historical contexts, components, challenges in enforcement, and contributions of the ADA to the lives of the American people, including employment, equal access to education, public space and transportation. The ADA has successfully reduced barriers and fostered greater inclusion in society. However, its enforcement also faced many significant challenges, especially in rural areas and for small businesses due to limited economic conditions and lack of resources. Furthermore, the ADA places a significant focus on accommodating the need for physical abilities, which makes public society question whether the ADA can satisfy the needs of people with mental health and cognitive disabilities. Finally, the paper recommends regularly updating the ADA to integrate assistive technical supports. Continuous advocacy is required to enhance the position of the ADA as a legal tool for promoting equality and ensuring that all Americans can participate fully in their lives.

Fitness to stand trial: 415 consecutive defendants assessed by a New Zealand forensic psychiatry service.

New Zealand defendants found unfit to stand trial following a Court-ordered forensic mental health assessment cannot be detained in prison and must either be released, or made subject to a mental health or intellectual disability order. There is increasing awareness of the need to identify these people and protect their rights. Retrospective audit of 8years of Court-ordered health assessor reports addressing fitness to stand trial prepared by a New Zealand regional forensic mental health service with a catchment area of around 850,000. Between 2014 and 2022, Courts referred 415 defendants for assessment of fitness to stand trial. The number of reports requested increased by 20% between 2014 and 2022. Report subjects were 81% male and had a median age of 31. Commonest primary diagnoses were psychotic disorders (37%), intellectual disability (13%) and acquired neurocognitive disorders (15%). Few people with foetal alcohol spectrum disorder were identified. Despite the increase in assessments, the number of defendants considered unfit by report writers remained stable over time. The increasing number of referrals for assessment of fitness to stand trial has resourcing implications for forensic mental health services.

The language of inclusion: A randomized trial of how DEI statements influence hiring practices for people with visible and invisible disabilities

BackgroundCompanies are increasingly motivated to ensure that they are effective at hiring people with disabilities, but bias in the process remains a challenge. While Diversity, Equity, and Inclusion (DEI) statements are generally crafted as external-facing signaling devices, little is known about their potential effect on the employees themselves with regard to internal decisions, such as hiring. ObjectiveThis study aims to explore whether various DEI statements may encourage more positive hiring decisions for job candidates with both visible and invisible disabilities. MethodsAn experiment with a 2 × 4 × 2 design was used (DEI Language: legal/traditional or heartfelt; Disability Type: none, visible, and two types of invisible disabilities; Candidate's Tone: warm or overconfident). Quantitative and qualitative items measured general reactions to the candidate as well as perceptions about his employability, degree of risk as a new hire, skills at negotiating for his salary, and integrity. Statistical tests include analyses of variance and z-tests for proportions. ResultsHeartfelt statements improved ratings of candidates with disabilities in general, and more so for those with invisible disabilities. In addition, the two types of invisible disability were distinct from each other, with the mental health disability more stigmatized than the neurological one. ConclusionsThese results suggest that the DEI language that a company uses is an important signaling device not just for external constituents but also for internal employees. In addition, it is among the first to demonstrate differences in types of invisible disabilities, indicating that more nuance is needed to understand bias in this context.

What does trauma-informed care mean to people admitted to a forensic mental health and intellectual disability service? A reflexive thematic analysis.

What does trauma-informed care mean to people admitted to a forensic mental health and intellectual disability service? A reflexive thematic analysis.

Supplemental Material for What Does Trauma-Informed Care Mean to People Admitted to a Forensic Mental Health and Intellectual Disability Service? A Reflexive Thematic Analysis

Supplemental Material for What Does Trauma-Informed Care Mean to People Admitted to a Forensic Mental Health and Intellectual Disability Service? A Reflexive Thematic Analysis

Vocational rehabilitation service usage and outcomes for transition-age youth with serious mental health conditions

BACKGROUND: The postsecondary vocational outcomes of students with mental health disabilities (MHD) are poor and vocational rehabilitation factors contributing to better outcomes have not been identified. OBJECTIVE: Characterize demographic, service use and service outcome differences between youth with MHD and youth with other disabilities from state vocational rehabilitation agencies (SVRA) and identify factors predicting service use and service outcomes within youth with MHD. METHODS: Data were from 2015–2017 Rehabilitation Services Administration-911 case closure files. The sample consisted of 14–24-year-old SVRA applicants. Cross-disability characteristics, service use and outcomes were compared. Within youth with MHD, multivariate analyses examined factors contributing to having an Individual Plan for Employment (IPE) and successful case closure (i.e., with employment). RESULTS: Youth with MHD were underrepresented, older at application and were less likely to have IPEs and successful closures than youth in other disability groups. Within youth with MHD, application age and SVRA characteristics were the strongest predictors of having an IPE. Education and employment status at application strongly predicted successful closure. CONCLUSION: Youth with MHD, as in previous cohorts, continue to have lower service use and successful SVRA outcomes. Efforts are needed to increase their connection to SVRAs at younger ages. Youth with MHD without employment at application may need additional supports to achieve successful closures. Addressing several SVRA performance characteristics may improve their service use and outcomes.

The Relationships Among Neighborhood Disadvantage, Mental Health and Developmental Disabilities Diagnoses, and Race/Ethnicity in a U.S. Urban Location.

Childhood health disparities by race have been found. Neighborhood disadvantage, which may result from racism, may impact outcomes. The aim of the study is to describe the distribution of mental health (MH) and developmental disabilities (DD) diagnosis across Child Opportunity Index (COI) levels by race/ethnicity. A cross-sectional study using 2022 outpatient visit data for children < 18years living in the Louisville Metropolitan Area (n = 115,738) was conducted. Multivariable logistic regression analyses examined the association between diagnoses and COI levels, controlling for sex and age. Almost 18,000 children (15.5%) had a MH or DD (7,905 [6.8%]) diagnosis. In each COI level, the prevalence of MH diagnosis was lower for non-Hispanic (N-H) Black than for N-H White children. In adjusted analyses, there were no significant associations between diagnoses and COI for non-White children for MH or DD diagnoses. The odds of receiving a MH [OR: 1.74 (95% CI: 1.62, 1.87)] and DD [OR: 1.69 (95% CI: 1.51, 1.88)] diagnosis were higher among N-H White children living in Very Low compared to Very High COI areas. Current findings suggest that COI does not explain disparities in diagnosis for non-White children. More research is needed to identify potential multi-level drivers such as other forms of racism. Identifying programs, policies, and interventions to reduce childhood poverty and link children and families to affordable, family-centered, quality community mental and physical health resources is needed to ensure that families can build trusting relationships with the providers while minimizing stigma.

The Involvement of the Ventral Tegmental Area in the Electroacupuncture Alleviation of Anxiety-Like Behaviors Induced by Chronic Restraint Stress in Mice.

Emotional stress is a significant environmental risk factor for various mental health disabilities, such as anxiety. Electroacupuncture (EA) has been demonstrated to have pronounced anxiolytic effects. However, the neural mechanisms underlying these effects and their contribution to behavioral deficits remain poorly understood. Here, we addressed these issues using a classical mouse anxiety model induced by chronic restraint stress (CRS).Anxiety-like behaviors were evaluated with the open field test and elevated plus maze. Neuronal activation in various brain regions was marked using c-Fos, followed by calculations of interregional correlation to characterize a network that became functionally active following EA at the HT7 acupoint (EA-HT7). We selected the hub regions and further investigated their functions and connections in regulating anxiety-like behaviors by using a combination of chemogenetic manipulations and behavioral testing. CRS exposure induced anxiety-like behaviors. Interestingly, EA-HT7 mitigated these behavioral abnormalities. The c-Fos expression in 30 brain areas revealed a vital brain network for acupuncture responsiveness in naïve mice. Neural activity in the NAcSh (nucleus accumbens shell), BNST (bed nucleus of the stria terminalis), VMH (Ventromedial Hypothalamus), ARC (arcuate nucleus), dDG (dorsal dentate gyrus), and VTA (ventral tegmental area) was significantly altered following acupuncture. Notably, both c-Fos immunostaining and brain functional connectivity analysis revealed the significant activation of VTA following EA-HT7. Interestingly, blocking the VTA eliminated the anxiolytic effects of EA-HT7, whereas chemogenetic activation of the VTA replicated the therapeutic effects of EA-HT7. EA-HT7 has demonstrated benefits in treating anxiety and enhances brain functional connectivity. The VTA is functionally associated with the anxiolytic effects of EA-HT7.

A UK-wide survey of community forensic services for adults with intellectual disability and/or autism.

Specialist forensic community teams for people with intellectual disability and/or autism have been developed, but little is known about their extent and delivery. To describe specialist forensic community teams for people with intellectual disability and/or autism across the UK. An online survey was sent to representatives of each UK Trust/Health Board providing adult mental health and/or intellectual disability services. Questions covered the availability, structure and activities of specialist community forensic services. Quantitative data were summarised and associations between access to specialist forensic teams and care were tested with Chi-squared tests. Thematic analysis of free-text survey responses was used to understand the challenges of providing community forensic mental health services for this group. A total of 49 out of 78 (63%) eligible Trusts/Health Boards responded, of which 25 (51%) had access to a specialist forensic community team. Teams operated either as part of a single Trust/Board (n = 13) or over a larger regional footprint (n = 12). The availability of specialist forensic community teams was associated with better access to offence-related interventions (χ2 = 15.1002, P < 0.005) and co-production of patient care plans (χ2 = 7.8726, P = 0.005). Respondents reported a wide variation in availability, expertise and perceived quality of community services. The availability of secure and generic in-patient beds, commissioning and legal barriers were also significant challenges in providing appropriate care. Coverage of specialist community forensic teams is not universal. There are indications that such teams are associated with improved care processes, but further work is needed to establish longer-term outcomes and the optimal model of care.

Mental and Behavioral Health, and Crisis Services for People with Intellectual and Developmental Disabilities in Medicaid Home- and Community-Based Services.

People with intellectual and developmental disabilities (IDD) often have higher rates of comorbid mental health conditions compared to the general population. Yet, many people with IDD also have unmet needs for mental and behavioral health services. The aim of this study was to examine how states provided mental and behavior health, and crisis services to people with IDD in their Home- and Community-Based Services (HCBS) programs, the largest funding mechanism for Long-Term Services and Supports (LTSS) for people with IDD in the United States. We analyzed fiscal year (2021) Medicaid HCBS waivers for people with IDD from across the United States to examine if and how they provided mental and behavior health, and crisis services. States projected spending $968.9million for mental and behavior health, and crisis services for 190,299 people with IDD. Applied behavior analysis services were provided at greater rates than positive behavior supports and other forms of behavior interventions. While most states provided mental and behavior health, and crisis services in their waivers, there were vast inconsistencies in how they did so, across states, waivers, and services. HCBS are a crucial safety net to ensure people with IDD, especially those who also have mental health disabilities, can live and thrive in their communities.

Diagnostic overshadowing: self-injurious behaviour as a manifestation of pain in the head and neck.

In the healthcare domain, diagnostic overshadowing is a concerning issue involving the erroneous attribution of physical symptoms to a patient's mental health, behavioural intricacies, or pre-existing disabilities. Individuals facing learning and communication challenges are particularly susceptible to this phenomenon, struggling to articulate or comprehend their experienced symptoms. Likewise, patients with autism spectrum disorder can have an escalated risk due to possible challenges in interpreting bodily cues. This article delves into the specialised care required for individuals with learning disabilities and/or autism, highlighting the pervasive risk of diagnostic overshadowing and the potential manifestation of pain as self-injurious behaviour in these patient groups. By underscoring the need to mitigate diagnostic overshadowing within dental practice, we advocate for reasonable adjustments in care delivery and comprehensive education of the dental team. Proficient tools for pain assessment and effective communication are emphasised to collectively improve the healthcare experience for these vulnerable patient cohorts.

Digitalising Regional Induction for Junior Doctors in Mental Health and Learning Disabilities Department of Betsi Cadwaladr University Health Board

Digitalising Regional Induction for Junior Doctors in Mental Health and Learning Disabilities Department of Betsi Cadwaladr University Health Board

HHS: Rhode Island violated civil rights laws by warehousing children with MI

A multi‐year, comprehensive joint investigation by the U.S. Department of Health and Human Services Office for Civil Rights (HHS OCR) and the Department of Justice (DOJ) District of Rhode Island earlier this month concluded that Rhode Island is in violation of federal civil rights laws for unnecessarily segregating children with mental health and/or developmental disabilities at a state acute‐care psychiatric facility.

Perceptions and Bias of Small Business Leaders in Employing People with Different Types of Disabilities

PurposeDespite existing employment-related legislation and governmental programs, people with disabilities continue to face significant barriers to competitive employment. These obstacles are partially due to biases among employers regarding the contributions of people with disabilities and perceptions about accommodation costs, which can affect their hiring decisions. Existing research on employment barriers and facilitators often treats people with disabilities homogenously and focuses mainly on large companies. This study helps to fill these gaps by exploring the motivations and challenges small employers face when hiring people with disabilities and how their attitudes and willingness to hire vary based on disability type.MethodsWe surveyed business owners and decision-makers at companies with fewer than 100 employees resulting in a sample of 393 company respondents. Through descriptive analyses, we examined variations in respondents’ willingness to hire and the prevailing attitudes among the company leaders sampled. We explored how employer attitudes can either hinder or support the hiring of people with disabilities. We conducted multivariate analysis to explore the connections among attitudinal barriers, facilitators, and willingness to hire individuals with various disabilities, reflecting disability’s heterogeneous nature.ResultsOur findings reveal that, in terms of hiring people with disabilities, the most important concerns among employers are: inability to discipline, being unfamiliar with how to hire and accommodate, and uncertainty over accommodation costs. These concerns do not differ between employers covered by the Americans with Disabilities Act (ADA) and non-covered employers. However, ADA-coverage may make a difference as ADA-covered employers are more likely to say they would hire an applicant with a disability. We find that for small companies (less than 15 employees), the positive effect of the facilitators (positive perceptions about workers with disabilities) almost completely offsets the negative effect of the barriers. However, for the larger companies, the marginal effect for an additional barrier is significantly more predictive than for an additional facilitator. Among the disabilities we examined, employers are least likely to hire someone with blindness, followed by mental health disabilities, intellectual disabilities, deafness, and physical disabilities, underscoring that employers do not view all types of disabilities as equally desirable at work.ConclusionsUnderstanding small employers’ underlying concerns and effectively addressing those factors is crucial for developing effective intervention strategies to encourage small employers to hire and retain people with different disabilities. Our results suggest greater openness among ADA-covered employers to hiring people with disabilities, but the perceived barriers indicate a need for ongoing information on effective intervention strategies to increase disability hiring among all small employers.

Preparedness and training needs of a regional public mental health service to support people with intellectual disability.

To explore the preparedness and training needs of a regional public mental health workforce to support people with intellectual disability and mental ill health. Staff from a regional public mental health service in Victoria, Australia. A mixed-methods design comprised a survey, interviews and a focus group to collect data about staff attitudes, confidence, education and professional development regarding supporting people with intellectual disability and mental ill health. Descriptive and thematic analyses were used. Data from 31 survey respondents, seven interviews and one focus group were analysed. Survey descriptive analyses showed participants believed treating people with intellectual disability was part of their role but reported areas of low confidence along with insufficient education and training in intellectual disability mental health. Thematic analyses from interviews showed that underpinning confidence, education and training were the themes (1) need for flexibility, such as having more time and (2) solutions but with challenges, such as limited opportunity to upskill and availability of experts. A need for collaborative problem-solving where staff share skills and information to work towards person-centred solutions was a key theme from the focus group analysis. Professional development in intellectual disability mental health is required for the regional public mental health workforce but needs to account for the challenges experienced and reflect how teams function. Exploration of described preparedness offered a possible learning approach informed by workforce members. Collaborative learning approaches to supporting people with intellectual disability and mental ill health are suggested.

Association between COVID-19 Booster Vaccination and COVID-19 Outcomes among U.S. Adults.

Understanding the association between booster vaccination and COVID-19 outcomes can help strengthen post-pandemic messaging and strategies to increase vaccination and reduce severe and long-term consequences of COVID-19. Using the Household Pulse Survey data collected from U.S. adults from 9 December 2022 to 13 February 2023 (n = 214,768), this study assessed the relationship between COVID-19 booster vaccination and COVID-19 outcomes (testing positive for COVID-19, moderate/severe COVID-19, and long COVID). Disparities were found in COVID-19 outcomes (e.g., testing positive for COVID-19, moderate/severe COVID-19, and long COVID) by sociodemographic characteristics, region of residence, food insecurity status, mental health status, disability status, and housing type. Receipt of a COVID-19 booster vaccination was negatively associated with testing positive for COVID-19 (aOR = 0.75, 95%CI: 0.72,0.79), having moderate/severe COVID-19 (aOR = 0.92, 95%CI: 0.88, 0.97), or having long COVID (aOR = 0.86 (0.80, 0.91)). Even among those who tested positive for COVID-19, those who received the booster vaccine were less likely to have moderate/severe COVID-19 and less likely to have long COVID. Communicating the benefits of COVID-19 booster vaccination, integrating vaccination in patient visits, and reducing access barriers can increase vaccination uptake and confidence for all individuals and protect them against the severe negative outcomes of COVID-19.

"He Stole My Meds to Get High:" The Mental Health and Well-Being of Women Abused by Intimate Partners and Their Disability Status.

While population-based research confirms that women with disabilities abused by their intimate partners experience significant mental health issues, few studies compare this in intimate partner violence (IPV)-specific samples of women with or without disabilities and none analyze possible impacts based on disability type. This secondary mixed methods analysis examined 660 Canadian women (50.6% Indigenous, 43.1% White, and 6.1% visible minority) with respect to whether they reported having a disability that impacted their employability or daily living (291 or 44% yes; 369 or 56% said no). In the 291 women with disabilities, about one-third (30.7%) had a physical disability-only, one-quarter had a mental health disability-only, and 44.1% reported both physical and mental health disabilities. Women with mental health and both physical and mental health disabilities reported significantly more Severe Combined IPV on the Composite Abuse Scale, depression (CES-D-10; Center for Epidemiological Studies-Depression), psychological distress (Symptom Checklist Shortform-10; SCL-10; in the clinical range), PTSD symptoms (PTSD Checklist), and lower quality of life (Quality of Life Questionnaire or QoL-9) than women without disabilities. Education about disabilities is needed for IPV advocates and disability practitioners need education about IPV. Developing services specific to survivors of IPV with disabilities is recommended.

Police oversight in practice: the Special Investigations Unit and civilian police oversight in Ontario, Canada

ABSTRACT The Special Investigations Unit (SIU) of Ontario is a civilian police oversight agency responsible for investigating serious incidents involving police officers and civilians, with the power to charge police officers with criminal offences. Created in 1990, the SIU is considered a pioneer in civilian-led oversight, however, little is known about how the SIU conducts investigations, the complainants in these investigations, and the routine work of this oversight agency. This article examines a variety of indicators to document the work and activity of the SIU, illustrating important aspects of the agency’s performance in the process. Important trends regarding the nature of police misconduct, violence, and use of lethal force are analysed. Our study uncovers previously unknown trends regarding complainants in SIU investigations, including the prevalence of certain characteristics like known mental health disabilities and the relationship between the substantiation of complaints by the SIU and the criminal activity of the complainant. This study empirically documents the nature of police cooperation with oversight. By analysing different indicators of agency performance and work, this study makes an important contribution to the study of police oversight in general, and the findings hold value for understanding police use of force, the nature of police criminality and misconduct, and the functioning of civilian police oversight in practice.