Annotation: New research into general psychiatric services for adults with intellectual disability and mental illness.
General psychiatric clinics need ID-trained staff and community ID team backup to serve adults with both ID and mental illness.
01Research in Context
What this study did
Chaplin (2009) looked at every paper it could find on general psychiatric care for adults who have both intellectual disability and mental illness.
The author read policy reports, audits, and small studies from the UK and beyond.
No new data were collected; the goal was to map what is known about whether regular mental-health clinics can serve this group alone.
What they found
The review found again and again that ordinary psychiatric services fall short.
Adults with ID plus mental illness need staff who understand ID, longer visits, and easy links to community ID teams.
Without these extras, assessment is poor, treatment plans are vague, and people bounce between services.
How this fits with other research
Crosbie (1993) warned about the same gap sixteen years earlier, right after large hospitals closed.
Chaplin (2009) echoes that warning but adds a fix: embed ID-trained workers inside general clinics and let community ID teams step in.
Robertson et al. (2014) show one practical form of this fix: yearly health checks that catch missed needs and trigger clear referrals.
Wong et al. (2018) extend the idea to housing, mapping that adults with ID live in more scattered, safer neighborhoods than adults with psychiatric disability; safe housing and safe clinics must work together.
Why it matters
If you serve adults with dual diagnosis, do not assume the community mental-health center can handle them alone.
Ask for a standing slot for an ID nurse or BCBA in the psychiatric clinic, or set up a direct hotline so you can brief the psychiatrist before the visit.
One small change can cut repeat crises and wasted appointments.
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02At a glance
03Original abstract
BACKGROUND: There are a variety of models for the mental health care of adults with comorbid intellectual disability (ID) and mental illness. There has been a long-running debate as to whether this should be provided by general psychiatric or specialised ID services. A previous review concluded that there was no clear evidence to support either model with research being often of a poor quality, lacking replication, and outcome measures were often inappropriate or varied between studies. This review aims assess differences in outcome for patients with ID and mental disorders treated in general or specialised ID mental health services. METHOD: A literature review was conducted using electronic databases and websites of ID and mental health organisations to locate all references where people with ID receive mental health care in general psychiatric services from 2003. No meta-analysis was attempted because of the divergent nature of the studies. RESULTS: People with ID (especially severe ID) have reduced access to general psychiatric services. General psychiatric inpatient care is unpopular especially with carers but can be improved by providing specially trained staff and in-reach from community ID teams. Opportunities may exist to enhance the care of people with borderline intellectual functioning within general psychiatric services. CONCLUSIONS: Although no new randomised controlled trials have been published, the weight of research is accumulating to suggest that provision of general psychiatric services without extra help is not sufficient to meet the needs of people with ID.
Journal of intellectual disability research : JIDR, 2009 · doi:10.1111/j.1365-2788.2008.01143.x