PurposeThis paper describes a service improvement project with two aims: to identify and screen all adults with Down's syndrome aged over 30 years in a defined locality using a standardised instrument to establish functional baselines; and to set up a database to facilitate early diagnosis of dementia in this population.Design/methodology/approachAn assistant psychologist used a standardised instrument to screen participants who were identified through contact with health, social, and third sector, and housing services.FindingsEligible people were identified and screened using an informant‐based measure. Three groups were identified: group 1 showed no significant change; group 2 showed significant change but no signs of dementia; and group 3 showed significant change plus signs of dementia. People with suspected dementia were referred on for further investigation/assessment and supportive services.Practical implicationsTerminology is important in engaging families in a screening project, as is the opportunity to provide information. A proactive screening project can be established by employing working partnerships between intellectual disability and older adult services to aid diagnosis.Originality/valueAdults with Down's syndrome aged over 30 years in a defined locality can be identified through contact with health, social, and third sector, and housing services. Those identified can be screened using a standardised instrument and a database of screening results established in order to establish baselines against which future re‐screening can be conducted. Partnership working between older adult mental health services and intellectual disability services can improve the diagnostic service to adults with Down's syndrome.

Purpose In spite of the greater prevalence of mental ill-health in people with intellectual disabilities, there has been little work specifically aimed at how this group recognise threats to their mental health and the strategies used to minimise them. This study aims to look at the first stage of development of a guided self-help (GSH) pack called the Self Assessment and INTervention pack (SAINT). Design/methodology/approach Delphi methods and focus groups were employed to gather opinions from two expert groups: professionals or clinical experts (ranged N=15-33); and service users (n=9), to inform the contents of the SAINT. The Delphi was conducted by e-mail. Results from each round were shared between the two groups to develop a consensus. Findings Retention rates for clinical experts were 45.45 per cent, during the Delphi and 100 per cent for the service user experts in the focus groups. Both groups were able to reach a consensus of the items that would make up the SAINT. Delphi methods combined with focus groups were able generate the contents of the SAINT and demonstrated versatility in this dual approach by being able to gain a consensus from both groups. Research limitations/implications There is no consensus as to how many people are ideal for a Delphi. Although the final number in round 3 was low, it can be argued that those remaining had most interest in the subject. Practical implications The aim is to produce and pilot the SAINT, a GSH package for people with intellectual disabilities, following reliability and validity testing. Social implications Currently GSH is widely used for mild depression in Primary Care and other disorders such as mild anxiety, obsessive compulsive disorder, and other related conditions. However, there are no specific GSH packages for people with intellectual disabilities. Currently the GSH tools that are available are not designed for people with cognitive impairments and do not reflect the lifestyles of many people with intellectual disabilities. Originality/value This paper should be of value to anyone with an interest in supporting people with intellectual disabilities to recognise and manage specific symptoms or feelings that threaten the person's mental well being.

PurposeThe purpose of this paper is threefold: to summarize data on rates of sexual abuse and interpersonal trauma in people with intellectual disability (ID); to demonstrate the relationship between such trauma and psychological distress; and to describe a promising treatment technique for such exposed individuals.Design/methodology/approachA review of the literature on rates of abuse and trauma among people with ID is presented with particular attention paid to the role of developmental level in both the experience and impact of trauma. Drawing from this understanding of the phenomenology of traumatic exposure in people with ID, the authors present a theoretical framework for psychotherapeutic intervention.FindingsThis paper establishes the inverse relationship between the higher‐than‐average rates of trauma and interpersonal violence in the ID population, co‐occurring with lower‐than‐average access to treatment, and lower‐than‐average treatment model development for this population. Further, this paper provides a description of a theoretically based therapeutic intervention with preliminary research efficacy.Practical implicationsThis paper documents three key areas in need of attention in order to reduce the suffering of people with ID: the need to address the high rates of exposure to abuse; the importance of taking into account developmental level when assessing the impact of potentially traumatic experiences; and the efficacy of the interactive‐behavioral model of group psychotherapy for people with ID who have trauma‐related distress.Originality/valueThis paper points to the need for systematic efforts to reduce the rate of traumatic exposure to which people with ID are disproportionately exposed. Moreover, it establishes how important the role of developmental level is in understanding how exposure to abuse may result in the development of psychological disorders. Finally, this paper provides a clear understanding of a targeted therapeutic approach and the need for a system of accessible care so that afflicted individuals may have the benefit of such therapy.

The aim of this study was to provide a pilot evaluation of novel, brief formulation development workshops with direct care staff supporting people with intellectual disabilities who display significant psychosocial difficulties. A series of workshops were designed and delivered to a staff team supporting an individual who had been referred to specialist intellectual disabilities health services. The workshops used a psychosocial framework to facilitate development with care staff of a case formulation for the individual they were supporting. Following the workshops, there were decreases in problematic behaviours displayed by the individual and in the staff team's perception of the severity of these behaviours. The staff team felt that the workshops had had a beneficial impact on their practice. The pilot indicated that the workshops were feasible, positively received and associated with changes in the psychosocial difficulties displayed by the individuals staff were supporting.

The aim of the project was to evaluate the short‐term treatment outcomes of patients treated in a medium secure service for people with intellectual disability. A total of 138 patients, 77 discharged and 61 current inpatients, treated over a six‐year period were included in the audit. Information on demographic and clinical variables was collected on a pre‐designed data collection tool and analysed using appropriate statistical methods. The median length of stay for the discharged group was 2.8 years. About 90% of this group were discharged to lower levels of security and about a third went directly to community placements. None of the clinical and forensic factors examined was significantly associated with length of stay for this group. There was a ‘difficult to discharge long‐stay’ group which had more patients with criminal sections, restriction orders, history of abuse, fire setting, personality disorders and substance misuse. However, when regression analysis was done, most of these factors were not predictive of the length of stay. Clinical diagnosis or offending behaviour categories are poor predictors of length of hospital stay, and there is a need to identify empirically derived patient clusters using a variety of clinical and forensic variables. Common datasets and multi‐centre audits are needed to drive this.

Transitions for young people with intellectual disabilities have received much attention from researchers. Little is known, however, about how mental health services link with existing transition partnerships and what the potential service gaps are for young people with intellectual disabilities. Eight mental health professionals in three local authorities in Wales were interviewed to sketch potential research themes in this area. Our findings revealed a remarkable lack of engagement of mental health professionals with transition partnerships for young people with intellectual disabilities, and significant service gaps. The insufficient integration of mental health services in transition planning may contribute to disruptive transitions for young people with intellectual disabilities and their carers. Further research should examine how best to involve mental health services in transition partnerships for young people.

Secure inpatient services for people with intellectual disability are provided in a piecemeal way, often without strategic commissioning. We describe how we conducted a needs assessment that enabled us to develop a new service for men with intellectual disability who often had substantial additional mental health needs. Consulting with all stakeholders was essential, and we found the service user and family perspectives particularly helpful. We had to make special arguments for some aspects of the treatment programme. We found that foundation trusts that are able to develop services at financial risk, before contracts are signed, enabled development to take place at a faster pace. Good relationships with community teams have been essential, as has true integration with mainstream forensic services. Maintaining a relationship with commissioners was a particularly challenging aspect, perhaps because the development was provider‐led. Despite these challenges, many people with intellectual disability with very high needs are being supported much nearer to home.

Services for people with intellectual disabilities would be barely recognisable to clinicians working half a century ago. Two forces in particular stand out as driving the changes that we see today. The first accompanied the closure of the once popular institution‐like hospitals as part of a general reorientation within psychiatry as a whole from the asylum to the community. The second is the push towards incorporating people with intellectual disabilities in ‘mainstream’ services, the principle of ‘normalisation’ that sits at the heart of health and social policy in the UK for this group of people. This article is a reflection on the current status of mental health services for people with intellectual disabilities against this historical and philosophical backdrop and the arguments for their continued existence as a separate specialist entity within the field of psychiatry.