Intellectual Disability Psychiatry Research Articles

Dr John Hurst MB, DPM, FRCPsych: Formerly Consultant in Psychiatry of Intellectual Disability, Lea Castle Centre, Wolverly, Nr. Kidderminster, Worcestershire

![Figure][1] Dr John Hurst's approach to the treatment of people with intellectual disabilities was ahead of its time. In the early 1970s, John, who has died aged 79, developed the pre-discharge unit at South Ockenden Hospital, Essex, as a therapeutic community, as well as a number of

A review of recommendations for medical undergraduate intellectual disability psychiatry teaching from UK reports

Purpose– The purpose of this paper is to amalgamate recommendations from contemporary national reports on healthcare provision and needs of people with intellectual disabilities. The paper combines these with recommendations for undergraduate curricula of medical students from the GMC and Royal College of Psychiatrists (RCPsych).Design/methodology/approach– National reports from Mencap, Department of Health, Disability rights commission, NHS Executive, the GMC and RCPsych were searched for relevant recommendations to undergraduate medical education in ID psychiatry. Recommendations were collated and grouped to form a single list for use when planning future curricula or auditing existing teaching.Findings– In total, 13 relevant recommendations were identified in nine groups. These included that people with intellectual disabilities and their carers should be involved in the teaching. That teaching should include the ethical, moral and legal obligations and should include the mental capacity act and equality act. Institutional and individual discrimination should be highlighted as a problem and diagnostic overshadowing should be covered.Originality/value– This paper has collated in a single document the combined recommendations of multiple reports. These are relevant to medical undergraduate teaching and may also be of use to other undergraduate healthcare courses. They are a useful template for others wishing to examine or benchmark the content of their medical undergraduate ID psychiatry teaching against an amalgamated list.

A national survey of offending behaviour amongst intellectually disabled users of mental health services in Ireland.

Offenders with an intellectual disability pose a major challenge to Intellectual Disability Service providers in the Republic of Ireland. This is especially so as no national Forensic Intellectual Disability Service currently exists. The Forensic Intellectual Disability Working Group of the Irish College of Psychiatrists was established in order to take steps to address this issue by establishing the level of need for a Forensic Intellectual Disability Service in Ireland and developing a college position paper. No previous study has been carried out to measure offending behaviour amongst persons with an intellectual disability attending mental health services in Ireland. A postal survey was undertaken targeting the lead clinicians of all Intellectual Disability Psychiatry, General Adult Psychiatry and Forensic Psychiatry Services in the Republic of Ireland. This survey requested anonymous data regarding service users with an intellectual disability and offending behaviour in this population. Data relating to 431 service users was returned. Those reported to engage in offending behaviour were predominantly young males. Assault was the most common offence type. A significant number of serious offences such as unlawful killing, sexual assault and arson were reported. There is an urgent need for the development of a Forensic Intellectual Disability Service in the Republic of Ireland. The current efforts of the National Forensic Mental Health Service to establish such a service by the creation of a post of Consultant Forensic Psychiatrist (special interest in intellectual disability) are to be welcomed.

Application of community treatment orders (CTOs) in adults with intellectual disability and mental disorders

Purpose – The purpose of this paper is to explore use of community treatment orders (CTOs) in adults with intellectual disability (ID) and mental health problems across England and Wales. Design/methodology/approach – A web-based exploratory survey was sent to 359 consultants on the database of the Faculty of the Psychiatry of ID, Royal College of Psychiatrists who had declared ID as their main speciality. Socio-demographic details of responding consultants, clinical characteristics of adults with ID on CTO, subjective views of consultants on using CTOs in people with ID were collected and analysed. Findings – In total, 94 consultant questionnaires were returned providing information on 115 patients detained under CTO. More than 75 per cent of the respondents had used CTO in their clinical practice. Patients subject to CTO were generally young, white males with mild ID and living in supported accommodation. CTOs were primarily used in situations of non-engagement (52.2 per cent), non-compliance with medication (47 per cent) or non-compliance with social care supports (49.6 per cent). Practical implications – Responding consultants expressed concerns about encroachment of civil liberties and ethics of using CTOs in people with ID who may lack capacity and stressed that decision to use CTOs needs to be therefore done on individual basis. Originality/value – This is the first national study to examine the practice of applying CTOs in adults with ID and mental disorders. Current practice is based on evidence from research done in adults with normal intelligence. Further research is needed to investigate the utility of CTOs in routine clinical practice in adults with ID and mental disorders.

Intellectual disability and the ICD-11: towards clinical utility?

Purpose – The 11th revision of the International Classification of diseases which sets global standards for defining, reporting and managing health conditions is under way. The International Classification of Diseases (ICD) underpinning principle of clinical utility is currently poor for persons with Disorders of Intellectual Development (DID) and mental disorders. This impedes access to healthcare resources; services and social inclusion thereby further aggravating their vulnerability. The purpose of this paper is to present a critical overview and evidence informed recommendations within the context of an international collaborative programme, undertaken by the Faculty of Psychiatry of Intellectual Disability, Royal College of Psychiatrists, UK with support from the World Health Organisation (WHO). Design/methodology/approach – The authors carried out: first, a systematic review (SR) of literature, using PRISMA guidelines regarding the reliability, validity and utility of the ICD-10/Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria in people with DID (PWDID); second, a national and international consultation exercise with partners, stakeholders and experts; third, a multicentric survey of problem behaviours in PWDID; and finally, information dissemination/dialogues including presentations and workshops at key scientific events, consultation networking, data gathering and consensus building. Findings – The SR revealed a dearth of robust studies – most consisting of weak research methodologies. Significant difficulties were highlighted regarding the application of diagnostic criteria in the current classificatory systems – particularly in people with severe/moderate DID. Recommendations supported the introduction WHERE APPROPRIATE of modifications based on observed phenomena (signs) in PWDID in lieu of reported symptoms to facilitate DIAGNOSIS AND better access to healthcare and the community. Heterogeneity precluded quantitative pooling and meta-analysis. The consensus building exercise globally revealed that problem behaviours were the commonest reasons for referral to healthcare services with significant numbers without a diagnosed mental disorder being prescribed psychoactive medication. Research limitations/implications – The consensus gathering exercise WAS SELECTIVE AND did not cover all of the 194 member states of WHO due to resource and time constraints and this constitutes the main limitation of our study. Based on the SR and expert consensus, the authors submitted evidence informed pragmatic proposals to the WHO aimed at addressing the shortcomings of the ICD-10. The key recommendations focused on improving clinical utility within the context of epistemic iteration which would consolidate and strengthen the future evidence base. It was also recommended that self-injurious behaviour should form a standalone sub category in view of its relevance for healthcare services and resources which underpin clinical utility. Practical implications – The ICD-11 is a global, multidisciplinary and multilingual development for public health benefit with 70 per cent of the world's health expenditures assigned using this system for resource allocation. Currently mental disorders in PWDID can be misinterpreted, unrecognised and under reported resulting in barriers to access to treatment and healthcare resources. Conversely disorders may be over diagnosed when the inherent discrepancies between the chronological age and the developmental level of functioning are not considered. Conclusions and recommendations from this study will result in better diagnosis of mental disorders and healthcare resources in this population. Social implications – PWDID are a vulnerable sector of the population with an increased prevalence of mental health problems who are marginalised and discriminated by society. Early detection, treatment and management of these conditions will prevent further decompensation and stigmatisation. Originality/value – To the best of the authors knowledge this is the first comprehensive, large-scale study which evaluates the ICD classificatory system within the context of clinical utility for PWDID, including experts and stakeholders from both lower/middle- and high-income countries. The international consultation/consensus building process culminating in the formulation of evidence informed recommendations, aimed at improving the clinical utility of the ICD-11 for this population, has the potential to improve access to appropriate healthcare and treatment and consequent enhancement of their quality of life.

Use of melatonin for sleep disturbance in a large intellectual disability psychiatry service

Aims and methods:A retrospective case note analysis was undertaken to evaluate prescribing practices, tolerability and perceived effectiveness in patients treated with melatonin for sleep disturbance in a psychiatry service caring for people with intellectual disability in a city with a population of 1·1 million.Two authors scrutinized notes to extract information on to a previously agreed proforma on degree of intellectual disability, comorbid conditions and medication, type of sleep disturbance, dose of melatonin, response to treatment and side effects.Results:One hundred and nineteen patients of whom 103(86·5%) had Autism Spectrum Disorder or traits, had been prescribed melatonin; Eighty eight (73·9%) of these had documented improvements in their sleep pattern. There was variation in prescribing practice regarding doses used and titration regime. No serious adverse effects were associated with its use in the short term; those which did occur probably do not represent a rise above events that would be seen by chance in this population. Patients with autistic spectrum disorder (ASD) or autistic traits were more likely to show a positive response to melatonin than those with learning disability and no ASD/autistic traits (P = 0·0229.). Some subjects showed a loss of efficacy after initial response, some of who responded to a higher dose.Clinical implications:Melatonin appears to represent an effective treatment for sleep disorders in children and adults with intellectual disability (ID), patients with ASD are likely to be responders. It is associated with few serious side effects. There is a need for large-scale studies to further evaluate short and long-term side effects and to determine optimal dosing regimes.

Are specialist psychiatric services losing the PbR race?: commentary on… clustering in mental health payment by results

SummaryPayment by results (PbR) is a payment platform for healthcare services. Introduced to acute physical healthcare services in England in 2003–2004, the system has continued to expand and is currently being implemented in acute mental health services. Owing to the variations and complexities of the patients who access specialist psychiatric services, existing clusters do not always accurately capture their needs. The development of PbR tools specific to psychiatric subspecialties is ongoing, but might not be available in the short term. The funding of acute mental health services through PbR might have funding implications for specialist services such as psychiatry of intellectual disability.

The relationship between area deprivation and contact with community intellectual disability psychiatry

People with intellectual disabilities (ID) have high rates of psychiatric illness and are known to live in more deprived areas than the general population. This study investigated the relationship between area deprivation and contact with ID psychiatry. Psychiatric case notes and electronic records were used to identify all patients who had face-to-face contact with community ID psychiatric services over 1 year in the North East Community Health Partnership of Greater Glasgow and Clyde (estimated population 177,867). The Scottish Index of Multiple Deprivation (SIMD) were determined for the patient sample and for the general population living in the same area. Between 1 June 2012 and 1 June 2013, 184 patients were seen by ID psychiatry over a total of 553 contacts, with valid SIMD data for 179 patients and 543 contacts. Fifty-two per cent of patients (n = 93) lived in the most deprived SIMD decile, and 90.5% (n = 152) in the lowest 5 deciles. Compared with the general population, there were significantly more patients than expected living in the most deprived decile (Fisher's Exact test, P = 0.009) and in the most deprived 5 deciles (Fisher's Exact test, P = 0.001). The median number of contacts was 2 (interquartile range = 1-3). There was no significant association between the number of contacts and SIMD decile. Forty-eight point one per cent (n = 261) of all contacts were with patients living in the most deprived decile and 88.6% (n = 481) in the most deprived 5 deciles. This was significantly more than expected compared with general population data (Fisher's Exact test, P = 0.008 and Fisher's Exact test, P ≤ 0.001). In the area under study, contact with ID psychiatry was greater in more deprived areas. Given the high psychiatric morbidity of people with ID, if services do not adjust for deprivation, this may lead to further discrimination in an already disadvantaged population.

A guide to intellectual disability psychiatry assessments in the community

SummaryPsychiatric assessment in the community is an important part of both the initial assessment process and delivery of follow-up care in adult intellectual disability services in the UK. This article examines how such assessments can be carried out safely and explores the clinical skills required to perform them effectively. Use of the psychiatric interview and mental state examination to elicit information is discussed. Communication difficulties experienced by people with intellectual disabilities and strategies that may be employed to address these in the assessment process are also explored. The article is directed at psychiatrists, in particular specialty trainees, and other healthcare professionals who work with intellectually disabled people.

Competency based advanced training in Intellectual Disability Psychiatry: a NSW prototype

This paper describes a competency based advanced training year in adult Intellectual Disability Psychiatry enabled through a partnership between disability and mental health sectors. This training experience could be viewed as a prototype for further specialised training schemes in Intellectual Disability Psychiatry, and has relevance for the implementation of competency based psychiatric training schemes in Australia. The need for a specific training curriculum in Intellectual Disability Psychiatry is outlined with reference to epidemiological evidence and human rights. The formulation of the training programme and the training experience itself is described and evaluated. Conclusions on the implications of this experience for the future competency based training schemes are drawn. Building a skilled workforce is necessary to address the significant inequalities in mental health experienced by people with intellectual and developmental disabilities. A significant initial step for this would be the development of a specialised training curriculum. Service provision for this population is scattered across many disciplines and organisations with historically little mutual cooperation. Additionally, proposed competency-based training schemes stipulate that a medical expert develops a wide skill set across multiple domains. Thus, formal cross sector collaboration is fundamental for any competency based training scheme to be feasible.

The use of Community Treatment Orders in an intellectual disability service

Purpose – The literature on the use of Community Treatment Orders (CTOs) is primarily focused on people without intellectual disabilities. This paper aims to explore how CTOs are used in people with intellectual disability in the UK.Design/methodology/approach – An audit was conducted among Consultant Psychiatrists in intellectual disability psychiatry in Nottinghamshire Healthcare NHS Trust. Each consultant was asked to provide information on demographic data of their patients on CTOs, reasons for being on a CTO, conditions specified, patients' capacity to consent and their understanding of their CTOs. Conditions of CTOs were analysed using thematic analysis.Findings – There were 17 CTOs done for patients with intellectual disability from November 2008 to May 2011. Mean age was 38 with a range of 20‐59. All patients had a mild or moderate intellectual disability. Only a small percentage of patients had a diagnosis of schizophrenia. More than 50 per cent had a diagnosis of pervasive developmental disorder...

Intellectual Disability Psychiatry: A Practical Handbook Editors: edited by AngelaHassiotis, Diana AndreaBarron, and IanHallPublisher: Wiley Blackwell, West Sussex, UK2009, 276 pages, Cost in UK (from Wiley website, accessed May 2, 2012): £39.50/€47.40; Cost in Canada (from Wiley website, accessed May 2, 2012): CDN$72.95 ISBN: 978‐0‐470‐74251‐8

Intellectual Disability Psychiatry: A Practical Handbook Editors: edited by AngelaHassiotis, Diana AndreaBarron, and IanHallPublisher: Wiley Blackwell, West Sussex, UK2009, 276 pages, Cost in UK (from Wiley website, accessed May 2, 2012): £39.50/€47.40; Cost in Canada (from Wiley website, accessed May 2, 2012): CDN$72.95 ISBN: 978‐0‐470‐74251‐8

Antipsychotic prescribing in people with intellectual disabilities: a clinical audit

Purpose – Great controversy surrounds the prescribing of antipsychotics for people with an intellectual disability. This stems from a lack of research to support their use in this specific population together with their “off label” use to treat behaviour problems. This paper aims to review prescribing practice of antipsychotics by the Salford Intellectual Disability Psychiatry Department in accordance with standards adapted from nationally recognised guidelines.Design/methodology/approach – Data was collected from all 178 patients under this department including patient demographics, severity of intellectual disability, co‐morbid diagnoses and details of any antipsychotic drug use. Main standards of prescribing measured: indication of antipsychotic prescribing; documented review of medications; documentation of side effects; documentation of physical health parameters including weight, blood pressure, blood glucose, lipids.Findings – In total, 126 (72 per cent) were prescribed antipsychotics. 42 (33 per c...

Intellectual Disability Psychiatry: A Practical Handbook

Journal of Intellectual Disability ResearchVolume 55, Issue 2 p. 250-251 Intellectual Disability Psychiatry: A Practical Handbook Harm Boer, Harm Boer Janet Shaw Clinic, Birmingham, UKSearch for more papers by this author Harm Boer, Harm Boer Janet Shaw Clinic, Birmingham, UKSearch for more papers by this author First published: 17 August 2010 https://doi.org/10.1111/j.1365-2788.2010.01321.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume55, Issue2Mental Health and Intellectual Disability: XXVII (Edited by S.-A. Cooper)February 2011Pages 250-251 RelatedInformation

International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities

Psychotropic medications are used regularly to manage problem behaviours among people with intellectual disabilities. This causes concern because often these medications are used out of their licensed indications in this context. The WPA Section on Psychiatry of Intellectual Disability has recently developed an evidence and consensus-based international guide for practitioners for the use of psychotropic medications for problem behaviours among adults with intellectual disabilities. This guide advises on assessment of behaviours, producing a formulation, initiation of treatment, assessment of out-come and adverse effects, follow-up arrangements, and possibility of discontinuation of treatment.

ICT in the Delivery of an International Program on Psychiatry of Intellectual Disability

This paper describes a case of how ICT was employed in an international collaborative project between two higher education institutions to develop an online international Psychiatry “unit of study” on Intellectual Disability. The paper also discusses the way in which the teaching and learning online environment served as a design and development tool, which allowed experts from dispersed locations around the world to contribute, review, and develop their materials and activities. The aim of the unit is for participants to gain the fundamental knowledge and skills to be able to conduct psychiatric assessment of people with intellectual disability and to develop and implement a management plan within their own cultural and service contexts. Based on the sensitivity to cultural and social diversity, the program will integrate international perspectives, relate to international sources of knowledge, build explicit links between principles and practice, and embed teaching and learning in the students’ clinical practice, local service systems and cultures. Les TICE et la diffusion d’un programme international sur la psychiâtrie du handicap mental Le présent article décrit un cas montrant comment les TICE ont été employées dans un projet collaboratif international entre deux établissements d’enseignement supérieur pour créer un « groupe d’études psychiâtriques internationals » en ligne portant sur le handicap mental. L’article étudie aussi comment l’environnement d’enseignement et d’apprentissage a fourni un outil de conception et de développement dont le but était de permettre à des experts se trouvant dans des sites dispersés à travers le monde de présenter, passer en revue et développer leurs productions et leurs activités. Le but du groupe d’études est de permettre aux participants d’acquérir les connaissances et compétences fondamentales qui permettent d’effectuer une évaluation psychiâtrique des personnes handicapées mentales et de mettre au point et d’appliquer un plan de gestion au sein de leur propre contexte culturel et administratif. En se fondant sur la conscience de la diversité sociale et culturelle, ce programme va intégrer des perspectives internationales, se lier aux sources internationales de connaissance, construire des liens explicites entre les principes et la pratique et intégrer l’enseignement et l’apprentissage dans la pratique clinique des étudiants, et dans les structures de service et les cultures locales. Nutzung von IuK bei der Auslieferung eines internationalen Programms zur Psychiatrie Intellektueller Behinderungen Diese Arbeit beschreibt, wie IuK in einem Projekt internationaler Zusammenarbeit zwischen zwei höheren Bildungseinrichtungen dazu eingesetzt wurde, eine internationale Psychologie‐Studieneinheit zu Intellektuellen Behinderungen online zu entwickeln. In diesem Papier wird ebenfalls dargestellt, auf welche Weise die Online‐Lehr‐ und Lernumgebung auch als Entwurfs‐ und Entwicklungswerkzeug diente, wodurch es den Experten möglich war, aus aller Welt ihre Beiträge, Änderungen, Entwicklungsmaterialien und Aktivitäten einzubringen. Der Zweck dieser Einheit für Teilnehmer ist, ihnen das fundamentale Rüstzeug zu vermitteln, um sie zu befähigen, psychiatrische Bewertungen von Menschen mit intellektuellen Behinderungen zu erstellen und einen Behandlungsplan innerhalb ihres eigenen Kultur‐ und Servicekontextes zu entwickeln und einzuführen. Auf der Grundlage von Sensitivität für kulturelle und soziale Unterschiede wird das Programm internationale Perspektiven, bezogen über internationale Wissensquellen, integrieren, explizit Brücken zwischen Theorie und Praxis aufbauen und Lehren und Lernen in die klinische Praxis der Studenten, der lokalen Servicesysteme und Kulturen einbetten. Las TICs en la difusión de un programa internacional sobre la siquiatría de un programa internacional sobre la discapacidad intelectual Este artículo describe un ejemplo de uso de las TICs dentro de un proyecto colaborativo internacional entre dos instituciones de enseñanza superior para desarrollar una unidad internacional siquiatrica de estudio de la discapacidad intelectual. El artículo describe tambien la manera en que el entorno de enseñanza/aprendizaje en línea, funcionó como una herramienta de diseño y desarrollo, con el objetivo de permitir a expertos situados en lugares dispersos del mundo de contribuir, reseñar y desarrollar sus materiales y actividades. La finalidad de esa unidad es ofrecer a los participantes la posibilidad de adquirir los conocimientos y competencias fundamentales para llevar a cabo evaluaciones siquiátricas de personas con discapacidades intelectuales y de desarrollar y aplicar un plan de gestión dentro de sus propios contextos culturales y administrativos. Este programa se basa en una cierta sensibilidad hacia la diversidad social y cultural de modo a integrar perspectivas internacionales, relacionándose con fuentes internacionales de conocimiento, construyendo enlaces entre los principios básicos y la práctica e implantando la enseñanza y el aprendizaje dentro de la práctica clínica de los estudiantes así como también en los respectivos sistemas administrativos y culturas.

The challenge of applying mental health law reform to the intellectual disability sector in Ireland.

The full implementation of the Irish Mental Health Act 2001 brings about the introduction of an altered legal definition of mental disorder, mandatory review of involuntary detention within a 21-day period and new statutory rules regarding the use of seclusion and mechanical means of bodily restraint. This legislation came into full effect on November 1, 2006. The implications of this for the intellectual disability psychiatry sector are profound and the full ramifications of these changes will only become fully apparent over time. This also occurs at a time when we are facing unprecedented developments in government mental health policy, major changes to postgraduate training in psychiatry, difficulty recruiting appropriately skilled staff and increasing legal requirements on employers to ensure staff safety. Several of these drivers for change may appear at face value to be in conflict and a complex balance will be required if these changes are to be blended to ultimately improve the care provided to clients of our services.

Developmental Neuropsychiatry: A New Model of Psychiatry for Young People With and Without Intellectual Disability?

Deinstitutionalization of young people with intellectual disability means that they are now cared for by families and served by community-based professionals. Normalization, which has been the guiding philosophy for this re-integration, has challenged child psychiatry to accept its responsibility for the mental health of this special needs group. It is argued that this group, with its special mental health needs, has had an influence on the conceptual framework of child psychiatry, particularly our understanding of development. This article examines the influence of the psychiatry of intellectual disability on child psychiatry and the influence of child psychiatry on the understanding of the mental health needs of those with intellectual disability. In particular, the management of young people with intellectual disability has required child psychiatry to expand its understanding of a biopsychosocial approach. Some of the resulting changes and challenges are presented to illustrate the benefits for both child psychiatry and the psychiatry of intellectual disability. The interaction of different conceptual biases has led to a new and broader conceptual spectrum of developmental neuropsychiatry. Developmental neuropsychiatry recognizes the need to integrate social science and preventative strategies at one end of the spectrum, with the genetics, molecular biology of human behaviour and targeted pharmacology at the other, and consider the developmental and interactive nature of such models. This article argues that this emerging, dynamic and broader conceptual framework of developmental neuropsychiatry enhances our understanding of the child mental health of all children. The article looks at some of the implications for assessment, diagnosis and treatment. As mental health needs become a greater public health priority, the advances in basic sciences will reinvigorate this medical specialty and training programmes will need to reflect these.

The dual diagnosis facility: a renewed engagement with the psychiatry of intellectual disability?

A case study of a pilot residential facility for intellectually disabled adults who also suffer the effects of mental illness I presented in the context of the emergent debate surrounding the issue of dual diagnosis and co-morbidity. The innovative role of nurses in the establishment if this new service is discussed in terms of the beginning of a renewed engagement with the psychiatry of intellectual disability and it’s implications for nursing practice and practice arrangements.

The psychiatric care of people with intellectual disabilities: the perceptions of trainee psychiatrists and psychiatric medical officers.

The main aim of this study was to document the perceptions of trainee psychiatrists and psychiatric medical officers regarding the psychiatric care of people with intellectual disabilities. A 28-item self-administered questionnaire was developed by the investigators and pretested on eight psychiatrists and psychiatric trainees. A revised version of the questionnaire was then sent to 128 psychiatric trainees and 27 medical officers working in the public psychiatric services in Victoria. 116 questionnaires were returned, and the responses analysed. The results indicate a high degree of interest in the psychiatry of intellectual disability, however this was tempered by a feeling that the respondents and their senior colleagues are inadequately trained. The respondents expressed major concerns regarding the care of people with dual disabilities in the hospital and community setting, and significant support for the development of specialised units and subspecialisation within psychiatry. The major concerns which were identified would in part explain why 30% of the respondents felt that they would prefer not to treat people with an intellectual disability and a psychiatric disorder. We can only support the assertion made by the Burdekin Report [12] that "there is an urgent need for academic research, increased clinical expertise and substantial increased resources in the much neglected area of dual disability.