Inpatient care and its outcome in a specialist psychiatric unit for people with intellectual disability: a prospective study.
Specialist inpatient psychiatry cuts psychotic symptoms in adults with ID, but only aftercare moves the needle on anxiety, depression, and behaviour.
01Research in Context
What this study did
Kahng et al. (1999) followed adults with intellectual disability who stayed in a Finnish specialist psychiatric ward. The team watched symptoms while the adults were in hospital and again after they went home. No control group—just before-and-after scores.
What they found
Psychotic symptoms dropped during the stay and stayed lower in aftercare. Non-psychotic problems only eased after discharge. Carers saw gains while the person was still on the ward. Overall, the unit helped, but aftercare mattered for non-psychotic issues.
How this fits with other research
Fournier et al. (2004) later compared the same kind of specialist unit with generic wards. Adults in the specialist unit got better faster and were less likely to be sent far from home. That study builds on and tops the 1999 paper by adding a clear control.
Lai et al. (2011) looked at cost. Adults with ID plus schizophrenia stayed twice as long and cost twice as much per stay. The good news from Kahng et al. (1999) now comes with a price tag—plan for longer, pricier care when psychosis is in the mix.
Gustafsson (1997) showed people with ID were admitted to psychiatric beds less often than others. The 1999 study answers that gap: when a dedicated unit exists, outcomes improve.
Why it matters
If you serve adults with ID and mental health needs, push for a specialist inpatient bed. The gains hold even after discharge, especially for psychosis. Budget for longer stays and strong aftercare—non-psychotic symptoms need that extra step-down support.
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02At a glance
03Original abstract
The outcome of treatment in care units has been thought to reflect the effectiveness of treatment. There have been only a few studies describing inpatient care and its outcome in patients with intellectual disability and psychiatric symptoms. The present study describes the psychiatric inpatient treatment in the specialist psychiatric unit of the Special Welfare District of Southwest Finland and the need for aftercare among people with intellectual disability and psychiatric disorders (n = 40). As an outcome measure of care, the level of psychiatric symptoms was evaluated either with the Brief Psychiatric Rating Scale (BPRS) or with the Diagnostic Assessment for the Severely Handicapped (DASH) scale; self-reports (visual analogue scale) were also used. Patients' psychotic symptoms were reduced significantly on the BPRS during inpatient care and aftercare, but non-psychotic symptoms were reduced significantly only during aftercare. For one patient, the psychiatric symptoms were reduced significantly during inpatient care on the DASH scale, while the psychiatric symptoms remained the same for three patients. Patients and their primary carers considered the patient's psychiatric condition to have improved significantly during inpatient care, but not during aftercare. The specialist unit filled the gap in the care of people with intellectual disability and psychiatric problems in Southwest Finland. It is concluded that psychotic patients particularly benefit from the inpatient care in the specialist psychiatric unit. The care in the unit should include support for primary carers. All patients' outpatient treatment should also be re-evaluated. The present study poses two important questions. Firstly, could these treatment outcomes have been achieved with other interventions? Secondly, what are the necessary services for people with intellectual disability?
Journal of intellectual disability research : JIDR, 1999 · doi:10.1046/j.1365-2788.1999.00201.x