A comparison of patients with intellectual disability receiving specialised and general services in Ontario's psychiatric hospitals.
Adults with ID in specialised psychiatric wards act out more and carry mood-disorder labels, but they need the same daily help as those in general wards.
01Research in Context
What this study did
Hardan et al. (2008) looked at adults with intellectual disability who stayed in Ontario psychiatric hospitals. They compared two groups: those in specialised ID units and those in general psychiatric units.
The team wanted to see if the two groups differed in behaviour, diagnosis, or care needs. They used hospital records to describe each patient.
What they found
Specialised-unit patients showed more challenging behaviour and more mood disorders. General-unit patients had fewer behaviour problems and different diagnoses.
Despite these differences, both groups needed about the same level of daily care.
How this fits with other research
Lunsky et al. (2011) extends the same idea to outpatients. The later study found similar profile differences, showing the pattern holds after discharge.
Chaplin (2004) reviewed earlier work and said we still do not know which service model is better. The 2008 data fall inside that evidence gap; they describe but do not settle the debate.
Rutherford et al. (2003) saw the same diagnostic split in outpatients: people with ID received more antipsychotics and mood drugs, while general patients got antidepressants. Together the papers suggest diagnostic bias travels across settings.
Why it matters
If you refer adults with ID to psychiatric beds, expect those who land in specialised units to show more severe behaviour and mood signs. Yet their daily care needs will match peers in general units, so plan staffing the same. Use these findings to brief receiving teams and to push for consistent behaviour support no matter which door the person enters.
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02At a glance
03Original abstract
BACKGROUND: Over the years, the closure of institutions has meant that individuals with intellectual disabilities (IDs) must access mainstream (i.e. general) mental health services. However, concern that general services may not adequately meet the needs of patients with ID and mental illness has led to the development and implementation of more specialised programmes. This study compares patients with ID receiving specialised services to patients with ID receiving general services in Ontario's tertiary mental healthcare system in terms of demographics, symptom profile, strengths and resources and clinical service needs. METHOD: A secondary analysis of Colorado Client Assessment Record data collected from all tertiary psychiatric hospitals in the province was completed for all 371 inpatients with ID, from both specialised and general programmes. RESULTS: Inpatients in specialised programmes were more likely to have a diagnosis of mood disorder and were less likely to have a substance abuse or psychotic disorder. Individuals receiving specialised services had higher ratings of challenging behaviour than those in more general programmes. The two groups did not differ significantly in terms of recommended level of care, although more inpatients from specialised programmes were rated as requiring Level 4 care than inpatients from general programmes. CONCLUSIONS: In Ontario, inpatients in specialised and general programmes have similar overall levels of need but unique clinical profiles that should be taken into consideration when designing interventions for them.
Journal of intellectual disability research : JIDR, 2008 · doi:10.1111/j.1365-2788.2008.01049.x