Introduction

Staff supporting people with intellectual disabilities (ID) constitute a significant workforce. Although precise statistics are unavailable, there were an estimated 83 000 staff in England working with people with ID in 1999 (Ward, 1999); estimates for the USA in 2000 were well over 600 000 support staff (Hewitt & Lakin, 2001). Given the relatively high proportion of people with ID who also experience mental health problems and the general lack of mental health services for people with ID in the UK and elsewhere (Bailey & Cooper, 1997; Bouras and Holt 2004), a significant proportion of staff will be supporting at least one person with ID and a mental health problem (Quigley et al., 2001).

In many countries around the world, services supporting people with ID have shifted from predominantly state-run institutional services to community-based services provided by diverse agencies (Braddock et al., 2001). This shift has led to a workforce characterized by:

• Large proportions of unqualified staff (75% estimated in England; Ward, 1999; 73% in the USA; Larson et al., 1998).

• Support staff being predominantly young, inexperienced at supporting people with ID, female, and without dependants (Hatton et al., 1999b; Larson et al., 1998).

• High staff turnover and vacancy rates. In UK residential services, staff annual turnover rates have been estimated between 18% and 25%, with services reporting vacancy rates of 6%–10% (Ward, 1999). In the USA, staff annual turnover rates are much higher, particularly in independent sector services (e.g. 50%–75% independent sector versus 20%–25% state-run; Larson et al., 2002), with correspondingly high vacancy rates (e.g. 12%; Larson et al., 1998).

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