Emergency psychiatric services for individuals with intellectual disabilities: perspectives of hospital staff.
Emergency staff say ID training and community respite are missing—give both to cut repeat crises.
01Research in Context
What this study did
Lunsky et al. (2008) ran focus groups with emergency-psychiatry staff.
They asked what happens when people with intellectual disability show up in crisis.
Staff described real cases and system problems.
What they found
Workers said they lack ID know-how and community back-up.
Without respite or mobile crisis teams, families land in the ER again.
Staff feel stuck and want training.
How this fits with other research
The story repeats on regular wards. Geurts et al. (2008) also used focus groups and heard the same communication breakdowns.
Iacono et al. (2003) surveyed hospitals earlier and found basic needs met only when support persons stayed—echoing the ER plea for more help.
Holingue et al. (2020) asked caregivers and got matching data: after-hours care is weak, so crises snowball into the ER.
Tint et al. (2019) looks like a clash—autistic adults without ID still hate the ED. The gap is not about IQ level; it is about staff skill and sensory fit.
Why it matters
You can shrink the ER pipeline. Teach hospital staff simple ID tools: speak slowly, allow extra time, invite the caregiver in.
Push funders for night and weekend respite. One extra respite night can save a $2 000 ER visit.
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02At a glance
03Original abstract
Strains on the mainstream mental health system can result in inaccessible services that force individuals with intellectual disabilities into the emergency room (ER) when in psychiatric crisis. The purpose of this study was to identify clinical and systemic issues surrounding emergency psychiatry services for people with intellectual disabilities, from the perspective of hospital staff. Focus groups were conducted with emergency psychiatry staff from 6 hospitals in Toronto, Canada. Hospital staff reported a lack of knowledge regarding intellectual disabilities and a shortage of available community resources. Hospital staff argued that caregivers need more community and respite support to feel better equipped to deal with the crisis before it escalates to the ER and that hospital staff feel ill prepared to provide the necessary care when the ER is the last resort. Input from hospital staff pointed to deficiencies in the system that lead caregivers to use the ER when other options have been exhausted. Both staff and caregivers need support and access to appropriate services if the system is to become more effective at serving the psychiatric needs of this complex population.
Intellectual and developmental disabilities, 2008 · doi:10.1352/2008.46:446-455