General psychiatric services for adults with intellectual disability and mental illness.
We still don’t know if general or specialist psychiatric teams work better for adults with ID, so embed quick screens and rehearsal tactics while we wait.
01Research in Context
What this study did
Chaplin (2004) looked at every paper that compared general psychiatric clinics with specialist ID-mental-health teams. The team pulled studies on adults who had both intellectual disability and mental illness.
They asked one simple question: which setting gives better care? They found only a handful of small, weak studies.
What they found
No clear winner. Some adults did okay in general clinics. Others did okay in specialist services. The evidence was too thin to pick either model.
In short, we still don’t know where to send these clients.
How this fits with other research
Whitehouse et al. (2014) followed young adults after they left school. Most still lived with parents, had no jobs, and parents felt crushed. Their data show that, no matter which model we pick, real-world outcomes stay poor.
Mammarella et al. (2022) gives hope. A short behavioral program let half of adults with IDD get a dental exam without sedation. It proves you can fix one access problem fast when you try.
Worsham et al. (2015) adds another layer. In one specialist community team, one in five clients also had alcohol misuse. The clinic rarely caught it. So even “specialist” teams miss major issues.
Why it matters
You can’t wait for the perfect service model. Start small: add a quick alcohol screen like CAGE to your intake, copy the dental study’s rehearsal steps for any new setting, and track parent stress like Whitehouse et al. (2014) did. These mini-fixes move clients forward while the field figures out the big picture.
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02At a glance
03Original abstract
BACKGROUND: Adults with intellectual disability (ID) and mental illness may use general or specialist psychiatric services. This review aims to assess if there is evidence for a difference in outcome between them. METHODS: A literature review was conducted using a variety of electronic databases and hand-search strategies to identify all studies evaluating the outcome of people with ID and mental illness using general psychiatric services. RESULTS: There is no conclusive evidence to favour the use of general or specialist psychiatric services. People with ID stay less time on general psychiatric than specialist inpatient units. People with severe ID appear not to be well served in general services. Older studies of inpatient samples suggest a worse outcome for people with ID. Novel specialist services generally improve upon pre-existing general services. Assertive outreach in general services may preferentially benefit those with ID. Recent studies suggest similar lengths of stay in general psychiatric beds for people with and without ID. CONCLUSIONS: Although 27 studies were located, only two were randomized controlled trials. The evidence is poor quality therefore further evaluation of services employing a variety of designs need to be employed to give more robust evidence as to which services are preferred.
Journal of intellectual disability research : JIDR, 2004 · doi:10.1111/j.1365-2788.2004.00580.x