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An intensive personalised support approach to treating individuals with psychosis and co-morbid mild intellectual disability

Published online by Cambridge University Press:  13 May 2016

M. Raftery ,
K. Burke ,
N. Murray ,
O. O’Duinn ,
I. Murray  and
B. Hallahan
M. Raftery*
Affiliation:
Galway Roscommon Mental Health Services, Roscommon Primary Care Centre, Roscommon, Ireland Brothers of Charity Services Roscommon, Roscommon, Ireland
K. Burke
Affiliation:
Department of Psychology, Health Service Executive West, Mental Health Services, Claremorris, Co. Mayo, Ireland
N. Murray
Affiliation:
Brothers of Charity Services Roscommon, Roscommon, Ireland
O. O’Duinn
Affiliation:
Galway Roscommon Mental Health Services, Roscommon Primary Care Centre, Roscommon, Ireland
I. Murray
Affiliation:
Galway Roscommon Mental Health Services, Roscommon Primary Care Centre, Roscommon, Ireland
B. Hallahan
Affiliation:
Galway Roscommon Mental Health Services, Roscommon Primary Care Centre, Roscommon, Ireland Department of Psychiatry, National University of Ireland Galway, Galway, Ireland
*
*Address for correspondence: M. Raftery, BA, MSc, Psychology Department, Galway Roscommon Mental Health Services, Roscommon Primary Care Centre, Roscommon, Ireland. (Email: martina.raftery@gmail.com)
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Abstract

Objectives

To evaluate the clinical benefits and associated cost effectiveness of an intensive personalised support (IPS) approach for clients suffering from psychosis and co-morbid mild intellectual disability (ID).

Method

Four individuals with a psychotic disorder and co-morbid mild ID participated in an 18-month IPS rehabilitative intervention. Biopsychosocial measures were used to evaluate clinical effectiveness. A cost analysis was undertaken to examine the cost effectiveness of the intervention.

Results

Reductions in psychopathology including anxiety symptoms were noted in all individuals. In addition, increased functioning and quality of life were demonstrated in all cases. Overall cost reductions were noted in inpatient care, accommodation and legal/emergency expenses.

Conclusion

The IPS approach was clinically effective particularly in addressing individual’s psychosocial needs, psychological functioning, daily living skills and overall quality of life. Costs had decreased for three of the four individuals, ranging from a 17% to 46% savings. The findings highlight that the intervention was cost effective in most cases at this early stage. However, further research is necessary in order to ascertain if cost savings occur over time.

Keywords

Co-morbidintensive personalised supportmild intellectual disabilitypsychosis
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 34 , Issue 2 , June 2017 , pp. 99 - 109
Copyright
© College of Psychiatrists of Ireland 2016 

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References

Adams, CE, Fenton, MK, Quraishi, S, David, AS (2001). Systematic meta-analysis review of depot antipsychotic drugs for people with schizophrenia. British Journal of Psychiatry 179, 290–299.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000). Global Assessment of Functioning (GAF). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Balogh, R, Ouellette-Kuntz, H, Bourne, L, Lunsky, Y, Colantonio, A (2008). Organising health care services for persons with an intellectual disability. Cochrane Database of Systematic Reviews 4, 1–39. (www.update-software.com/pdf/CD007492.pdf). Accessed 10 October 2014.CrossRefGoogle Scholar
Beck, AT, Epstein, N, Brown, G, Steer, RA (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology 56, 893–897.CrossRefGoogle ScholarPubMed
Behan, C, Kennelly, B, O’Callaghan, E (2008). Economic cost of schizophrenia in Ireland: a cost of illness study. Irish Journal of Psychological Medicine 25, 80–87.CrossRefGoogle Scholar
Behan, C (2007). Client socio-demographic and service receipt inventory-Irish version. Unpublished. Adapted from: Chisholm D, Knapp MR, Knudsen HC, Amaddeo F, Gaite L, van Wijngaarden B (2000). Client sociodemographic and service receipt inventory: development of an instrument for international research. British Journal of Psychiatry 177, 28–33.Google Scholar
Chaplin, R (2009). Annotation: new research into general psychiatric services for adults with intellectual disability and mental illness. Journal of Intellectual Disability Research 53, 189–199.CrossRefGoogle ScholarPubMed
Chaplin, R (2004). General psychiatric services for adults with intellectual disability and mental illness. Journal of Intellectual Disability Research 48, 1–10.CrossRefGoogle ScholarPubMed
Coelho, RJ, Kelley, PS, Deatsman Kelley, C (1993). An experimental investigation of an innovative community treatment model for persons with a dual diagnosis (DD/MI). Journal of Rehabilitation 59, 37–42.Google Scholar
Cook, A, Miller, E (2012). Talking Points. Personal Outcome Approach. Practical Guide. Joint Improvement Team, Scottish Government: Edinburgh. (http://www.jitscotland.org.uk/wp-content/uploads/2014/01/Talking-Points-Practical-Guide-21-June-2012.pdf). Accessed on 29 January 2016.Google Scholar
Cooper, SA, Smiley, E, Morrison, J, Williamson, A, Allan, L (2007). Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. British Journal of Psychiatry 190, 27–35.CrossRefGoogle ScholarPubMed
Davis, E, Barnhill, L, Saeed, S (2008). Treatment models for treating patients with combined mental illness and developmental disability. Psychiatric Quarterly 79, 205–223.CrossRefGoogle ScholarPubMed
Department of Health (2012). Value for Money and Policy Review of Disability Services in Ireland. Department of Health: Dublin.Google Scholar
Department of Health and Children (2006). A Vision for Change: Report of the Expert Group on Mental Health Policy. Department of Health and Children: Dublin. (http://www.dohc.ie/publications/pdf/vision_for_change.pdf?direct=1). Accessed 9 September 2014.Google Scholar
Dickens, G, Weleminsky, J, Onifade, Y, Sugarman, P (2012). Recovery star: validating user recovery. The Psychiatrist 36, 45–50.CrossRefGoogle Scholar
Fisher, AG (2003). Assessment of Motor and Process Skills. Development, Standardisation and Administration Manual, 5th edn., Vol. 1. Three Star Press: Fort Collins, CO.Google Scholar
Fisher, AG, Bray Jones, K (2010). Assessment of Motor and Process Skills. 1: Development, Standardization, and Administration Manual, 7th edn. Three Star Press: Fort Collins, CO.Google Scholar
Hassiotis, A, Tyrer, P, Oliver, P (2003). Psychiatric assertive outreach and learning disability services. Advances in Psychiatric Treatment 9, 368–373.CrossRefGoogle Scholar
Hassiotis, A, Ukoumunne, OC, Byford, S, Tyrer, P, Harvey, K, Piachaud, J, Gilvarryu, K, Fraser, J (2001). Intellectual functioning and outcome of patients with severe psychotic illness randomised to intensive case management: report from the UK700 trial. British Journal of Psychiatry 178, 166–171.CrossRefGoogle ScholarPubMed
Hemmings, C, Bouras, N, Craig, T (2014). How should community mental health of intellectual disability services evolve? International Journal of Environmental Research and Public Health 11, 8624–8631.CrossRefGoogle ScholarPubMed
Heres, S, Lambert, M, Vauth, R (2014). Treatment of early episode in patients with schizophrenia: the role of long acting antipsychotics. European Psychiatry 291, 1409–1413.CrossRefGoogle Scholar
Herman, D (2013). Transitional support for adults with severe mental illness: critical time intervention and its roots in assertive community treatment. Research on Social Work Practice 24, 556–563.CrossRefGoogle Scholar
Jones, SH, Thornicroft, G, Coffey, M, Dunn, G (1995). A brief mental health outcome study: reliability and validity of the Global Assessment of Functioning (GAF). British Journal of Psychiatry 166, 654–659.CrossRefGoogle ScholarPubMed
Kemp, R, David, AS (1997). Insight and compliance. In Treatment Compliance and the Therapeutic Alliance (ed. B. Blackwell), pp. 61–84. Gordon and Breach Publishing Group: Newark, NJ.Google Scholar
Killaspy, H, White, S, King, M (2012). Psychometric properties of the Mental Health Recovery Star. British Journal of Psychiatry 201, 65–70.CrossRefGoogle ScholarPubMed
Lehman, A, Dixon, L, Hoch, J, Deforge, B, Kernan, E, Frank, R (1999). Cost-effectiveness of assertive community treatment for homeless persons with severe mental illness. British Journal of Psychiatry 174, 346–352.CrossRefGoogle ScholarPubMed
Manuel, JI, Covell, N, Jackson, C, Essock, S (2011). Does assertive community treatment increase medication adherence for people with co-occurring psychotic and substance use disorders? Journal of the American Psychiatric Nurses Association 17, 51–56.CrossRefGoogle ScholarPubMed
Richmond, PRA (2013). Good practice guidelines for person-centred planning and goal setting for people with psychosocial disability: a project report for disability care Australia. RichmondPRA: Sydney (http://www.ndis.gov.au/sites/default/files/documents/Project_Report_Final.pdf). Accessed 10 September 2014.Google Scholar
Leucht, C, Heres, S, Kane, JM, Kissling, W, Davis, JM, Leucht, S (2011). Oral versus depot antipsychotic drugs for schizophrenia – a critical systematic review and meta-analysis of randomised long term trials. Schizophrenia Research 128, 83–92.CrossRefGoogle Scholar
Luckasson, R, Borthwick-Duffy, S, Buntinx, WHE, Coulter, DL, Craig, EM, Schalock, RL, Snell, ME, Spitalnik, DM, Spreat, S, Tassé, MJ (2002). Mental Retardation: Definition, Classification, and System of Supports. American Association on Mental Retardation: Washington, DC.Google Scholar
Lunsky, Y, Gracey, C, Bradley, E, Koegl, C, Durbin, J (2011). A comparison of outpatients with intellectual disability receiving specialised and general services in Ontario’s psychiatric hospitals. Journal of Intellectual Disability Research 55, 242–247.CrossRefGoogle ScholarPubMed
Lunsky, Y, Bradley, E, Durbin, J, Koegl, C (2008). A comparison of patients with intellectual disability receiving specialised and general services in Ontario’s psychiatric hospitals. Journal of Intellectual Disability Research 52, 1003–1012.CrossRefGoogle ScholarPubMed
Martin, G, Costello, H, Leese, M, Slade, M, Bouras, N, Higgins, S, Holt, G (2005). An exploratory study of assertive community treatment for people with intellectual disability and psychiatric disorders: conceptual, clinical, and service issues. Journal of Intellectual Disability Research 49, 516–524.CrossRefGoogle ScholarPubMed
Mental Health Providers Forum (2008). Mental Health Recovery Star Organisational Guide. Mental Health Providers Forum: London.Google Scholar
McConkey, R, Bunting, B, Ferry, F, Garcia-Iriarte, E, Stevens, R (2013). An Evaluation of Personalised Supports to Individuals with Disabilities and Mental Health Difficulties. Genio Trust: Mullingar.Google Scholar
National Disability Authority (2003). Review of Access to Mental Health Services for People with Intellectual Disabilities. NDA: Dublin (www.nda.ie/__80256F4F005C7F9E.nsf/0/815EB07591494D9D80256F62005E6964?Open&Highlight=2,Review,of,Access,to,Mental,Health,Services) Accessed 14 January 2015.Google Scholar
Oliver, PC, Piachaud, J, Tyrer, P, Regan, A, Dack, M, Alexander, R (2005). Randomized controlled trial of assertive community treatment in intellectual disability: the TACTILD study. Journal of Intellectual Disability Research 49, 507–515.CrossRefGoogle ScholarPubMed
Monthly Index of Medical Specialities (MIMS) (2014). 4th edn. Dublin: MPI Media Ltd.Google Scholar
Patil, P, Keown, P, Scott, J (2013). A rising tide: the increasing age and psychiatric length of stay for individuals with mild intellectual disabilities. Journal of Intellectual Disability Research 57, 783–790.CrossRefGoogle ScholarPubMed
Sanz, M, Constable, G, Lopez-Ibor, I, Kemp, R, David, AS (1998). A comparative study of insight scales and their relationship to psychopathological and clinical variables. Psychological Medicine 28, 437–446.CrossRefGoogle ScholarPubMed
Spitzer, RL, Gibbon, M, Williams, JB, Endicott, J (1994). Global Assessment of Functioning (GAF) Scale. In Outcome Assessment in Clinical Practice (ed. L. l. Sederer and R. Dickey), pp. 76–78. Williams & Wilkins: Baltimore, MD.Google Scholar
Thornicroft, G, Becker, T, Knapp, M, Knudsen, H, Schense, A, Tansella, M, Vazquez-Barquero, JL (2006). International Outcome Measures in Mental Health: Quality of Life, Needs, Service Satisfaction, Costs and Impact on Carers. Gaskell, Royal College of Psychiatrists: London.Google Scholar
Tiihonen, J, Haukka, J, Taylor, M, Haddad, PM, Patel, MX, Korhonen, P (2011). A nationwide cohort study of oral and depot antipsychotics after first hospitalisation for schizophrenia. American Journal of Psychiatry 168, 603–609.CrossRefGoogle ScholarPubMed
Valenstein, M, McCarthy, JF, Ganoczy, D, Bowersox, NW, Dixon, LB, Miller, R, Visnic, S, Slade, EP (2013). Assertive community treatment in veterans affairs settings: impact on adherence to antipsychotic medication. Psychiatric Services 64, 445–451.CrossRefGoogle ScholarPubMed
Van Minnen, A, Hoogduin, CA, Broekman, TG (1997). Hospital vs. outreach treatment for patients with mental retardation and psychiatric disorders: a controlled study. Acta Psychiatrica Scandinavica 95, 515–522.CrossRefGoogle ScholarPubMed
Van Nieuwenhuizen, C, Schene, AH, Koeter, MWJ, Huxley, PJ (2001). The Lancashire Quality of Life Profile: modification and psychometric evaluation. Social Psychiatry Psychiatric Epidemiology 36, 36–44.CrossRefGoogle ScholarPubMed
Wane, J, Owen, A, Sood, L, Bradley, S, Jones, C (2007). The effectiveness of rural assertive outreach: a prospective cohort study in an English region. Journal of Mental Health 16, 471–482.CrossRefGoogle Scholar
Xenitidis, K, Thornicroft, G, Leese, M, Slade, M, Fotiadou, M, Philp, H, Sayer, J, Harris, E, McGee, D, Murphy, DG (2000). Reliability and validity of the CANDID – a needs assessment instrument for adults with learning disabilities and mental health problems. British Journal of Psychiatry 176, 473–478.CrossRefGoogle ScholarPubMed