Clinical outcomes of a specialised inpatient unit for adults with mild to severe intellectual disability and mental illness.
Specialised inpatient care helps adults with ID, but GAF works only for mild ID—swap in ID-friendly tools for others.
01Research in Context
What this study did
Hutzler et al. (2010) ran a before-and-after study in a special inpatient unit. The unit treats adults who have both intellectual disability and mental illness. Staff gave usual hospital care plus extra supports for cognitive limits. They tracked two groups: mild ID and moderate-severe ID.
What they found
Both groups got better on clinical ratings. Only the mild-ID group improved on the GAF scale. GAF asks people to rate their own work, social, and self-care skills. The finding hints that GAF items match mild-ID abilities but miss gains in more disabled adults.
How this fits with other research
Vassos et al. (2023) backs the warning. Their review shows only four tools have solid data for adults with mild-moderate ID. GAF is not on that short list. The review says to pick CORE-LD, IES-ID, LANTS, or SAI instead.
Boudreau et al. (2015) extends the story to the ER. They found adults with moderate-severe ID are admitted more often. Together the papers paint a path: severe-ID adults reach hospital more, yet once there we need better yardsticks to prove they improve.
DeLeon et al. (2005) tried heavy community support before hospital. Their ACT team produced no extra gain over usual care. The 2010 inpatient results now show hospital care does help, suggesting intensity level, not setting type, may drive change.
Why it matters
Stop giving every adult with ID the GAF. Keep it for mild-ID only. For moderate-severe ID choose carer-report or simple pictorial scales. Doing so will show real progress, justify funding, and guide discharge plans.
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02At a glance
03Original abstract
BACKGROUND: Limitations of general psychiatric services have led to the development of specialised psychiatric programmes for patients with intellectual disability (ID) and mental health needs. Few studies have examined treatment outcomes of specialised inpatient units, and no studies have explored how the effects of intervention may differ for individuals at varying levels of cognitive ability. The present study examined clinical outcomes of inpatients with mild ID in contrast to inpatients with moderate to severe ID within the same service. METHOD: Thirty-three patients (17 with mild ID and 16 with moderate to severe ID) discharged between 2006 and 2008 from a specialised inpatient unit in Canada for adults with ID and mental illness were studied. In addition to examining change in scores on clinical measures, outcomes with regard to length of stay, diagnostic change, residential change and re-admission to hospital were explored. RESULTS: Both groups demonstrated clinical improvement from admission to discharge. However, only patients with mild ID demonstrated improvements on the Global Assessment of Functioning. CONCLUSIONS: This study is one of the first to consider outcomes of higher and lower functioning individuals with ID on a specialised inpatient unit. Results suggest that outcomes may be different for these groups, and some clinical measures may be more sensitive to changes in patients with more severe disabilities.
Journal of intellectual disability research : JIDR, 2010 · doi:10.1111/j.1365-2788.2009.01213.x