Mental Health Problems In People Research Articles

Rural mental health

A significant proportion of people live and work in rural areas, and rural mental health is important wherever psychiatry is practised. There are inherent difficulties in conducting rural research, due in part to the lack of an agreed definition of rurality. Mental health is probably better in rural areas, with the exception of suicide, which remains highest in male rural residents. A number of aspects of rural life (such as the rural community, social networks, problems with access, and social exclusion) may all have particular implications for people with mental health problems. Further issues such as the effect of rural culture on help-seeking for mental illness, anonymity in small rural communities and stigma may further affect the recognition, treatment and maintenance of mental health problems for people in rural areas. Providing mental health services to remote and rural locations may be challenging.

The Mental Health of People with Intellectual Disabilities who Offend

There are a growing number of studies concerning people with intellectually disabilities (ID) who offend, how- ever few studies systematically record prevalence of mental health problems. This article will attempt to determine the prevalence mental health problems in people with ID who offend. Search terms were entered into the CINAHL, EM- BASE, Ovid MEDLINE(R) and PsycINFO databases. Studies were also selected through discussion with clinicians and references from relevant papers. Fourteen relevant articles were found that indicated the prevalence of mental health prob- lems in people with an ID who offend. Mental health problems may be more prevalent in individuals with an ID who of- fend than those with an ID who do not offend with schizophrenia/psychotic difficulties occurring more frequently. The possible increased prevalence should be considered within treatment regimes in order to effectively rehabilitate individu- als.

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Mental health The Care Services Improvement Partnership (CSIP) has published Finding a Shared Vision of How People's Mental Health Problems Should Be Understood, its draft guidance on mental health care.

Assessment of mental health problems in people with autism

The general public and professionals from a range of backgrounds have increasingly become interested in autism spectrum disorders. This interest is particularly relevant to learning disability practitioners. Both autism and learning disabilities are independently associated with increased risk of mental health problems. Thus, when a person has learning disabilities and an autism spectrum disorder, a comprehensive assessment for mental health problems is of paramount importance. This paper provides an overview of the assessment of mental health problems in adults and children with neurodevelopmental disorders. The general assessment principles are outlined followed by assessment issues related to specific conditions such as psychoses, mood disorders and attention deficit hyperactivity disorder. Finally conclusions on the clinical implications are drawn.

Ageing and mental health problems in people with intellectual disability

Increasing numbers of people with intellectual disability are now living well into old age. This paper will review the recent literature pertaining to the mental health of older people with intellectual disability. Overall, the prevalence of mental health problems is high in adults of all ages with intellectual disability. A major epidemiological study did not report sufficient detail to examine the effect of ageing on specific disorders or the differential effects of ageing and early mortality in people with Down's syndrome. At least a third of people with Down's syndrome can expect to develop Alzheimer's disease in middle age whilst for other people with intellectual disability, Alzheimer's disease is probably no more common than in the general population. Diagnosis and management of dementia is complicated by the high rates of comorbid physical and mental health problems. Overall, mental health problems in older people with intellectual disability are similar to younger people with intellectual disability, however there are more cases of dementia and physical health problems. Further research is needed to improve our understanding of the effects of ageing on the mental health and care needs of older people with intellectual disability.

Co-morbidity of psychiatric disorder and medical illness in people with intellectual disabilities

To examine the most recently published studies on the co-morbidity of medical and mental-health problems in people with intellectual disabilities. Studies that have been published in the review period have advanced our understanding and strengthened the evidence base on how to meet the complex healthcare needs of people with intellectual disabilities more effectively and reduce their health inequalities, as compared with the general population. In particular, there is much emphasis on epidemiology, epilepsy, dementia, use of psychotropic medications and health-screening intervention. In view of the common interface of medical and mental-health problems in people with intellectual disabilities, and the disparity in health they often face, initiatives should be taken to enhance their healthcare. Family carers, social-care providers, primary-care practitioners and specialist psychiatric teams can all play an important role in recognizing ill health and navigating access to the appropriate health services that people with intellectual disabilities need.

The Role of Training in Improving Community Care Staff Awareness of Mental Health Problems in People with Intellectual Disabilities

Background Care staff play a key role in identifying individuals with intellectual disabilities and additional mental health problems. Yet, few receive training in mental health, and evidence about the effectiveness of training is scant.Materials and Methods A pre–post study is reported, using a mental health screen and a self‐report questionnaire to examine staff awareness of mental health problems and to measure whether training improved knowledge of psychopathology, attitudes towards mental health services and referral decisions.Results Prior to training, deficits in awareness were evident. The Psychiatric Assessment Schedule for Adults with a Developmental Disability (PAS‐ADD) Checklist detected significant psychopathology in approximately one‐third of the individuals judged to have no mental health problems according to staff. Four months after the delivery of training, significant improvements in knowledge, attitudes and referral decisions were observed.Conclusion Brief training interventions may improve awareness of mental health problems, but further research is needed to understand the referral process and to demonstrate the role of training in influencing actual staff behaviour.

The rates and management of psychological problems in Australian general practice

Objective: General practitioners (GPs) provide the majority of care for people's mental health problems. The recently introduced Better Outcomes in Mental Health Care initiative aims to improve the quality of mental health care in general practice. This study examines current GP management of psychological problems and any changes in their management in the decade leading up to this initiative. Method: Current practice was examined through a secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) (2000–02) data. We compared BEACH data with the Australian Morbidity and Treatment Survey (1990–1991) to investigate management changes over the past decade. Results: Between April 2000 and March 2002, psychological problems were managed at a rate of 11.5/100 encounters. Problems most commonly managed were mood disorders, stress-related disorders, behavioural syndromes and disorders due to psychoactive substances. Prescriptions occurred at a rate of 69.5/100 contacts and clinical treatments at a rate of 50.0/100 contacts with psychological problems from 1990 to 1991. The management rate of psychological problems increased from 9683/100 000 encounters (95% CI = 9129–10 237) in 1990–1991 to 11 557 (11 136–11 977) in 2000–2002. Prescription rates (from 63.3, 95% CI = 60.5–66.1 to 69.1, 95% CI = 67.1–71.1) and clinical treatments (from 36.0, 95% CI = 33.4–38.7 to 53.1, 95% CI = 51.3–54.9) increased. Conclusions: This study shows that prior to the introduction of the Better Outcomes in Mental Health initiative changes had already occurred in rates and management of psychological problems in general practice. It also provides a baseline from which future research can measure the impact of the recent reforms on mental health care.

The rates and management of psychological problems in Australian general practice.

General practitioners (GPs) provide the majority of care for people's mental health problems. The recently introduced Better Outcomes in Mental Health Care initiative aims to improve the quality of mental health care in general practice. This study examines current GP management of psychological problems and any changes in their management in the decade leading up to this initiative. Current practice was examined through a secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) (2000-02) data. We compared BEACH data with the Australian Morbidity and Treatment Survey (1990-1991) to investigate management changes over the past decade. Between April 2000 and March 2002, psychological problems were managed at a rate of 11.5/100 encounters. Problems most commonly managed were mood disorders, stress-related disorders, behavioural syndromes and disorders due to psychoactive substances. Prescriptions occurred at a rate of 69.5/100 contacts and clinical treatments at a rate of 50.0/100 contacts with psychological problems from 1990 to 1991. The management rate of psychological problems increased from 9683/100,000 encounters (95% CI=9129- 10,237) in 1990-1991 to 11 557 (11,136-11 977) in 2000-2002. Prescription rates (from 63.3, 95% CI=60.5-66.1 to 69.1, 95% CI=67.1-71.1) and clinical treatments (from 36.0, 95% CI =33.4-38.7 to 53.1, 95% CI =51.3-54.9) increased. This study shows that prior to the introduction of the Better Outcomes in Mental Health initiative changes had already occurred in rates and management of psychological problems in general practice. It also provides a baseline from which future research can measure the impact of the recent reforms on mental health care.

‘Diagnostic Overshadowing’ Amongst Clinicians Working with People with Intellectual Disabilities in the UK

Background Mental health problems are known to be hard to recognize in people with intellectual disabilities. One factor that may contribute to this is the diagnostic overshadowing bias, which describes the tendency of the clinicians to overlook symptoms of mental health problems in this client group and attribute them to being part of ‘having an intellectual disability’. Although a small amount of research has investigated this in the USA, very little has taken place in the UK.Materials and methods Two clinical vignettes were produced. Both described identical clinical problems, except that one vignette described a man with an IQ of 58 and impaired social functioning (i.e. an intellectual disability) and one a man with an IQ of 108 and normal social functioning (i.e. non‐intellectually impaired). Psychiatrists (n = 274) and clinical psychologists (n = 412) throughout UK were randomly assigned to either the low IQ or normal IQ condition, and sent a corresponding clinical vignette.Results One hundred and thirty‐three psychologists and 90 psychiatrists responded. Diagnostic overshadowing did appear to be present. Clinicians were more likely to recognize a range of symptoms in those with IQs in the normal range than those with intellectual disabilities. Furthermore, psychiatrists appeared more likely to make this error under some circumstances than clinical psychologists.Conclusions Diagnostic overshadowing may contribute to the difficulties that mental health professionals commonly experience in identifying mental health problems in people with intellectual disabilities. However, the methodology commonly used in this type of research has a number of weaknesses, and would benefit from an alternative approach.

Screening for psychiatric symptoms: PAS-ADD Checklist norms for adults with intellectual disabilities.

The Psychiatric Assessment Schedule for Adults with Developmental Disabilities Checklist (PAS-ADD Checklist) is a screening instrument designed to help carers recognize likely mental health problems in people with intellectual disabilities (ID). To date there are no published PAS-ADD Checklist data on a large nonpsychiatric population of adults with ID, an important step towards developing norms for comparative purposes. Informants who had known participants for a median 24 months completed the PAS-ADD Checklist on 1155 adults with ID living in community, residential care and hospital settings in a county district in the North-east of England. Normative data were obtained for the PAS-ADD Checklist for the study population with reference to gender, age, and type of residence. The overall prevalence of mental health problems was 20.1%, and the rates for affective/neurotic, organic and psychotic disorders were 14%, 3.9%, and 10.2%, respectively. Significant differences in the rates for particular disorders were found across gender, age and, residence type. The rates of mental disorders found in the study population were consistent with previous studies of general populations of people with ID using over-inclusive screening instruments. The PAS-ADD Checklist appears to be an easy-to-use and sensitive tool for identifying mental health cases in ID populations, but further investigation is required concerning the specificity of the instrument.

From research and development to practice-based evidence: clinical governance initiatives in a service for adults with mild intellectual disability and mental health needs.

Practice-based evidence represents the contribution of practitioners who utilize research methodologies to examine the quality of their clinical practice and service provision. The present paper describes the evolution of a routine practice-based evidence system (PBES) via four phases of research and development. The four phases are described, as is their relevance to assessment and intervention with regard to the mental health problems of people with mild intellectual disability. Phase four describes the development of a routine PBES. The PBES is capable of profiling the individual mental health needs of service users and examining service effectiveness and quality at an organizational level. The PBES is discussed according to its current utility and possible directions for future development. The system is presented as an example of clinical governance that could be utilized by multidisciplinary teams to develop and maintain an organizational culture of quality.

The presentation and assessment of mental health problems in people with learning disabilities

The presentation and assessment of mental health problems in people with learning disabilities

Staff Knowledge about Symptoms of Mental Health Problems in People with Learning Disabilities

The present study examined the knowledge of 116 health and social care staff working in learning disability services about the symptoms of mental health problems in this client group, using the Mini PAS-ADD as a comparator. Seventy-one percent of participants currently supported a client with mental health problems and learning disabilities; however, only 47 percent had received any training in this area. The health staff scored significantly higher than the residential and day care staff in relation to knowledge of symptoms for anxiety, depression and psychosis, but overall levels were low for all three groups. Those individuals who had received training in the area had significantly greater knowledge about symptoms, and higher confidence levels in supporting this client group, than those who had not. The staff also reported a range of behavioural symptoms, which were not included in the Mini PAS-ADD. Implications of the study are discussed.

Identification of mental health problems in people with learning disability

Identification of mental health problems in people with learning disability

Designing and implementing a ‘dual diagnosis’ module: a review of the literature and some preliminary findings

People with a learning disability experience the full range of mental health problems, with prevalence greater than in the general population. The literature suggests that the move to community care has highlighted their special needs, as they face a complexity of life experiences and risks. Nurses play a key role, and must be equipped with appropriate knowledge and expertise to respond to the mental health problems of people with a learning disability (‘dual diagnosis’). Major national initiatives support research and propose access to appropriate education for care professionals.In order to respond to locally identified educational needs a ‘dual diagnosis’ module was developed for nurses working with people with a learning disability who experienced mental health difficulties. The aims were to increase knowledge, to consider implications for learning disability nursing, to increase awareness of research and policy issues, and ultimately to enhance practice.Preliminary findings suggest that participants have moved from an entry position of professional bias and lack of knowledge and skill, to a changed perspective and enhanced practice relating to the mental health needs of clients with a learning disability. These changes are, however, speculative and may be attributable to variables other than module completion. Implications for further research and development are suggested.

Health gain through screening — Mental health: Developing Primary Health Care Services for People with an Intellectual Disability

Referrals to mental health services are highly variable and depend on local factors such as availability of psychiatric and community nursing services, general practitioners' awareness of mental health problems in people with an intellectual disability, and knowledge and attitudes of professional and family carers. The study aimed to identify individuals with significant mental health problems who were not receiving services. As part of a general health screening procedure the PAS-ADD (Psychiatric Assessment Schedule for Adults with a Developmental Disability) checklist was administered to 127 adults with intellectual disability and their carers. Referrals were then made to the appropriate service. Forty-two (33%) of the individuals screened were rated to have a score above the threshold in one of the PAS-ADD's subscores. Fifty-three percent of this population were receiving active treatment from the local psychiatric service. In contrast, 44% of people below the thresholds were being treated. The difficulties encountered in targeting services are discussed.

Converging Themes in Psychotherapy: Trends in Psychodynamic, Humanistic, and Behavioral Practice

Back to table of contents Previous article Next article ArticleNo AccessConverging Themes in Psychotherapy: Trends in Psychodynamic, Humanistic, and Behavioral PracticeALAN E. KAZDINALAN E. KAZDINSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.140.10.1375AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Converging Themes in Psychotherapy: Trends in Psychodynamic, Humanistic, and Behavioral Practice." American Journal of Psychiatry, 140(10), pp. 1375–1376 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byAssessment of Psychiatric Disorders23 December 2020Assessment of Major Depression in Dual Diagnosis25 July 2020Current Status and Future Directions3 June 2015Behavior Problems and Psychopathology17 August 2013A Review and Analysis of Three Measures for Diagnosis of Mental Illness in Individuals With Intellectual DisabilitiesJournal of Mental Health Research in Intellectual Disabilities, Vol. 1, No. 1Journal of Mental Health Research in Intellectual Disabilities, Vol. 2, No. 1Behaviour Change, Vol. 25, No. 2Mental Health Assessment and Intervention for People With Complex Communication Needs Associated With Developmental DisabilitiesJournal of Policy and Practice in Intellectual Disabilities, Vol. 4, No. 1Tizard Learning Disability Review, Vol. 12, No. 3Journal of Intellectual Disability Research, Vol. 51, No. 10Journal of Policy and Practice in Intellectual Disabilities, Vol. 4, No. 1Journal of Intellectual Disability Research, Vol. 50, No. 6Journal of Intellectual Disability Research, Vol. 50, No. 11Journal of Intellectual Disability Research, Vol. 47, No. 1Journal of Intellectual Disability Research, Vol. 46, No. s1Journal of Intellectual Disability Research, Vol. 46, No. s1Staff Knowledge about Symptoms of Mental Health Problems in People with Learning Disabilities30 November 2016 | Journal of Learning Disabilities, Vol. 5, No. 3British Journal of Learning Disabilities, Vol. 28, No. 3Journal of Intellectual Disability Research, Vol. 43, No. 2Journal of Intellectual Disability Research, Vol. 43, No. 2Tizard Learning Disability Review, Vol. 4, No. 2The British Journal of Development Disabilities, Vol. 44, No. 87The British Journal of Development Disabilities, Vol. 44, No. 87Social Psychiatry and Psychiatric Epidemiology, Vol. 32, No. 6Journal of Intellectual Disability Research, Vol. 41, No. 6Gerontology & Geriatrics Education, Vol. 17, No. 3Cognitive Therapy and Research, Vol. 19, No. 2Journal of Autism and Developmental Disorders, Vol. 24, No. 5Australia and New Zealand Journal of Developmental Disabilities, Vol. 19, No. 2Behavioral Interventions, Vol. 8, No. 1Mental Retardation and Psychiatric IllnessBenedetto Vitiello, and David Behar1 April 2006 | Psychiatric Services, Vol. 43, No. 5Increasing the Reliability of Self-Report by Adults with Moderate Mental Retardation28 November 2016 | Journal of the Association for Persons with Severe Handicaps, Vol. 16, No. 4Mental Retardation and Psychiatric DisordersMagda Campbell, and Richard P. Malone1 April 2006 | Psychiatric Services, Vol. 42, No. 4Journal of Autism and Developmental Disorders, Vol. 21, No. 1Journal of Child Psychology and Psychiatry, Vol. 32, No. 1Journal of the Multihandicapped Person, Vol. 2, No. 4The American Journal of Drug and Alcohol Abuse, Vol. 14, No. 1Journal of Autism and Developmental Disorders, Vol. 16, No. 3Australia and New Zealand Journal of Developmental Disabilities, Vol. 11, No. 4Australia and New Zealand Journal of Developmental Disabilities, Vol. 10, No. 3 Volume 140Issue 10 October 1983Pages 1375-1376 Metrics PDF download History Published online 1 April 2006 Published in print 1 October 1983