What should services in the community provide for adults with intellectual disabilities and mental health problems?

摘要

Background People with intellectual disabilities (ID) and coexisting mental healthproblems are among the most vulnerable and disadvantaged in society. Services for them vary widely and there is a great need for their evaluation. A preliminary study using clinician interviews had sought to clarify what the essential features of Assertive Community Treatment might be for people with ID. It found a lack of understanding and agreement about this specific service model. A literature review of community services' research found no consensus even on what should be provided routinely. Aims The primary aim was to investigate opinions of clinicians, service users and carers regarding community service provision for people with ID and mental health problems. The secondary aim was to then test one of the service components widely considered to be essential in an exploratory study. Method Three sequential studies of opinions regarding services were carried out: (i) a comparison of focus groups of service users, carers and clinicians, (ii) a Delphi survey of clinicians and (iii) in-depth expert clinician interviews. One service component was then selected for further exploration. Results A wealth of opinions was elicited regarding community services and a number of key themes were identified. One service component discussed repeatedly was the provision of crisis information forservice users. A feasibility study then demonstrated that it was possible to produce crisis information in an accessible form which people with ID valued and wanted to carry. Conclusions The findings should help generate research hypotheses and to provide a foundation for future evaluation studies of services and their components. The findings of the crisis information study will inform the planning of a larger, randomized controlled pilot study of accessible, portable crisis information. The limitations of this research and its possible future directions are discussed.