Rehabilitation services for people with mental illnesses have been extensively researched. However, services with similar aims and specifications for patients with intellectual disabilities (IDs) have had little focus. This study describes the characteristics and outcomes of 21 patients admitted to a specialist ID rehabilitation service over an 8-year time frame. Rather that solely accepting ‘step-down’ referrals, some patients were referred from community settings. During the study, 20 patients were discharged, 80% to lower levels of service restriction, while 14.3% to higher levels. The study suggested that rehabilitation services have an important role within the wider service model for people with ID. Within the service studied, patients were referred from both higher and lower levels of restriction, suggesting the rehabilitation service ‘bridged the gap’ between inpatient and community settings, supporting the aim of caring for patients in the least restrictive setting for their needs.
Devapriam, J., Fosker, H., Chester, V., Gangadharan, S., Hiremath, A. & Alexander, R. T.Read research
There are approximately 1.2 million people with an intellectual disability (ID) in the UK. They have comorbid mental health problems at a rate of about 40%, which is substantially higher than the general population. About 21% of them are in contact with specialist health services. This guidance provides some pointers for practicing clinicians in CLDTs on addressing these risks and vulnerabilities. It draws on published guidance from a range of national bodies.
Alexander, R.Read research
This guidance provides some pointers for practicing clinicians on addressing these risks and vulnerabilities. It draws on published guidance from a range of national bodies including Public Health England, NHS England, Royal College of Psychiatrists, Royal College of Psychiatrists – ID faculty, MENCAP, RADIANT, National Autistic Society, Autistica, Challenging Behaviour Foundation, Books beyond Words, etc.
Alexander, R.Read research
People with Intellectual Disability: Guidance on Advances Planning for Treatment Escalation, Ceiling of Care, Palliative Care and End of Life
Ravi, A., Barclay, H., Mukherji, K., Chester, V. & Alexander, R.T.Read research
Autism is difficult to identify in adults due to lack of validated self-report questionnaires. We compared the effectiveness of the autism-spectrum quotient (AQ) and the Ritvo autism-Asperger's diagnostic scale-revised (RAADS-R) questionnaires in adult mental health services in two English counties.
Brugha, T., Tyrer, F., Leaver, A., Lewis, S., Seaton, S., Morgan, Z. Tromans, S., Van Rensburg, K.Read research
The current COVID-19 pandemic is a pressing world crisis and people with intellectual disabilities (IDs) are vulnerable due to disparity in healthcare provision and physical and mental health multimorbidity. While most people will develop mild symptoms upon contracting severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), some will develop serious complications. The aim of this study is to present guidelines for the care and treatment of people with IDs during the COVID-19 pandemic for both community teams providing care to people with IDs and inpatient psychiatric settings. The guidelines cover specific issues associated with hospital passports, individual COVID-19 care plans, the important role of families and carers, capacity to make decisions, issues associated with social distancing, ceiling of care/treatment escalation plans, mental health and challenging behavior, and caring for someone suspected of contracting or who has contracted SARS-CoV-2 within community or inpatient psychiatric settings.
Alexander, R., Ravi, A., Barclay, H., Sawhney, I., Chester, V., Malcolm, V., Brolly, K., Mukherji, K., Zia, A., Tharian, R., Howell, A., Lane, T., Cooper, V. & Langdon, P.E.Read research
Autistic adults who have a history of committing crimes present a major problem for providers of services in terms of legal disposal options and possible interventions, and greater understanding of this group and their associated needs is required. For this reason, we aimed to investigate the face validity of a proposed sub-typology of autistic adults detained in secure psychiatric hospitals in the United Kingdom. Initially, a focus group was completed with psychiatrists, clinical psychologists, healthcare workers, family members and autistic adults who had been detained in hospital, leading to revisions of the sub-typology. Following this, a consensus rating exercise of 10 clinical vignettes based on this sub-typology with three rounds was completed with 15 psychiatrists and clinical psychologists; revisions to the vignettes to improve clarity were made following each round. The findings indicated that these subtypes possess face validity and raters were able to classify all 10 clinical case vignettes into the sub-typology, and percentage of agreement ranged from 96% to 100% for overall subtype classification. This study suggests that the further validity of the sub-typology should be investigated within a larger study, as these subtypes have the potential to directly inform the hospital care pathway such that length of stay can be minimised.
Barnoux, M., Alexander, R., Bhaumik, S., Devapriam, J., Duggan, C., Shepstone, L., … Langdon, P. E.Read research
People with Intellectual Disability (ID) and epilepsy are more likely to experience psychiatric conditions, challenging behaviour (CB), treatment resistance and adverse effects of anti-seizure medications (ASM) than those without. This population receives care from various professionals, depending on local care pathways. This study evaluates the training status, confidence, reported assessment and management practices of different professional groups involved in caring for people with ID, epilepsy and CB.
A cross sectional survey using a questionnaire developed by expert consensus which measured self-reported training status, confidence, and approaches to assessment and management of CB in people with ID and epilepsy was distributed to practitioners involved in epilepsy and/or ID.
Kinney, M. O., Chester, V., Tromans, S., Alexander, R.T., Angus-Leppan, H., Bagary, M., Cock, H., Devapriam, J., Hassiotis, A., Mula, M., Reuber, M., Ring, H., Roy, A., Scheepers, M., & Shankar, R.Read research
The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on both the physical and mental well-being of the global population. Relatively few studies have measured the impact of lockdown on utilisation of secondary mental health services in England.
Tromans., S., Chester, V., Harrison, H., Pankhania, P., Booth, H., & Chakraborty, N.Read research
Rapid spread of coronavirus disease 2019 (COVID-19) has affected people with intellectual disability disproportionately. Existing data does not provide enough information to understand factors associated with increased deaths in those with intellectual disability. Establishing who is at high risk is important in developing prevention strategies, given risk factors or comorbidities in people with intellectual disability may be different to those in the general population.
Perera, B., Laugharne, R., Henley, W., Zabel, A., Lamb, K., Branford, D., … Shankar, R.Read research
The approach taken to support individuals during the coronavirus disease 2019 (COVID-19) pandemic needs to take into account the requirements of people with intellectual disabilities and/or autism, who represent a major vulnerable group, with higher rates of co-occurring health conditions and a greater risk of dying prematurely. To date, little evidence on COVID-related concerns have been produced and no report has provided structured feedback from the point of view of people with intellectual disabilities and/or autism or of their family/carers.
The aims of this study were to provide systemised evidence-based information of the priority concerns for people with intellectual disabilities and/or autism regarding the COVID-19 pandemic.
Tromans, S., Kinney, M., Chester, V., Alexander, R., Roy, A., Sander, J.W., Dudson, H. & Shankar. R.Read research
People with neurodevelopmental disorders often present with challenging behaviours and psychiatric illnesses. Diagnosis and
treatment require patients, families and healthcare professionals to work closely together in partnership, acknowledging their
respective areas of expertise. Good treatment outcomes should also be underpinned by robust research evidence. Key research
priorities are highlighted.
Alexander, R.T., Langdon, P.E., O'Hara, J., Howell, A., Lane, T., Tharian, R., Shankar, R.Read research
It has been proposed that autistic individuals are at an increased risk of type 1 and type 2 diabetes. Improved understanding of diabetes prevalence in autistic persons will help inform resource allocation for diabetes-related public health measures for this patient group.
The objective of this report is to conduct a systematic review of published literature pertaining to type 1 and type 2 diabetes prevalence in autistic individuals, including comparison with their non-autistic peers.
Tromans, S.J., Yao, G., Mukaetova-Ladinska, E., Kiani, R., Alexander, R., Al-Uzri, M., Morgan, Z., Chester, V., & Brugha, T.Read research
This report aims to provide an up-to-date review of the current evidence base, clarify the diagnostic process and summarise the management of ADHD in the ID population. It aims to guide psychiatrists working with people with ID to identify and treat comorbid ADHD. The report discusses factors that need to be considered and the value of screening and diagnosing ADHD alongside the pitfalls of not recognising it. It then goes
further and extrapolates from the evidence available in people with ADHD without an ID.
Royal College of PsychiatristsRead research
A guest editorial in 'Advances in Autism', Volume 7, Issue 3.
Chester, V.Read research