Characterising, assessing and responding to the needs of adults with intellectual disabilities and adults with mental health problems

This thesis outlines a body of research relating to the concept of need and needs-led health service responses for people with intellectual disabilities (ID). In summary, it describes the content, linkages, strengths and limitations of seven published research papers, each with a different, but related focus/question about need. The use of diagnoses in the field of mental health and ID is limited, leading some healthcare providers to adopt a more needs-based approach. Need, however, can be conceptualised in a variety of ways, each with its own benefits and drawbacks. Arguably the most objective of these are normative needs (i.e. a professional's assessment of an individual's need against a notional standard). This objectivity, combined with the limitations of diagnoses, has led some parts of the NHS to adopt normative needs assessment as the basis of a new payment system. Initially, the existing needs assessment tool was critiqued and recommendations for its improvement published. Outputs from the original tool's use (clusters of people with similar mental health needs) were also empirically confirmed to have logical relationships with the established diagnostic taxonomy. Subsequently the tool was adapted and validated for use in specialist ID healthcare settings. Analyses of data resulting from this new tool's use identified statistically robust groups/clusters of individuals with similar severities and combinations of objective needs. These clusters were clinically recognisable and differed according to key features such as severity of ID, challenging behaviours, Autism symptoms and physical health problems. Secondary analysis of these data then confirmed an existing clinical hypothesis i.e. that challenging behaviours in people with more severe ID may be viewed as behavioural manifestations of underlying mental health problems. Finally, these analyses suggested the normative needs assessment tool had utility in identifying users of community-based specialist ID services most at risk of admission to a specialist ID hospital

A Review and update of the Health of the Nation Outcome Scales (HoNOS)

Summary Aims and method: The Health of the Nation Outcome Scales (HoNOS) and older adults version (HoNOS 65+) have been used widely for 20 years but their glossaries have not been revised to reflect clinicians’ experiences or changes in service delivery. The Royal College of Psychiatrists convened an international advisory board, with UK, Australian and New Zealand expertise, to identify desirable amendments. The aim was to improve rater experience by removing ambiguity and inconsistency in the glossary rather than more radical revision. Results Changes proposed to the HoNOS are reported. HoNOS65+ changes will be reported separately. Based on the views and experience of the countries involved a series of amendments were identified. Clinical implications While effective clinician training remains critically important, these revisions aim to improve intra- and inter-rater reliability and improve validity. Next steps will depend on feedback from HoNOS users. Reliability and validity testing will depend on funding. Declaration of interest None

"Crying on the bus":first time fathers' experiences of distress on their return to work

There is increasing research interest in the experiences of new fathers taking paternity leave, but less insight into men’s experiences of returning to work after the birth of their first baby. For many men in the UK context, this could take place immediately after the birth or after one or two weeks of paternity leave. This paper utilizes data from a UK-based study whilst also drawing on international literature and policy contexts. A constructivist grounded theory method was adopted to generate theory from the data gathered. Twelve new fathers shared their experiences in this study by participating in audio-recorded, semi-structured interviews. This paper focuses on fathers’ experiences of negotiating the workplace as part of an overall theoretical framework related to broader transitions to fatherhood and sheds light on the distress, guilt and psychological challenges that the participants experienced when they initially returned to work. Whether fathers did or did not explicitly describe distress at this time, they all described a change in their worker identity, which for some participants led to uncertainty in the workplace. Men returning to work at this time in the postnatal period are vulnerable to experiencing distress. Flexibility and support in the workplace could be protective of their mental health. Finally, policy and practice developments are offered to support men’s transitions to fatherhood in the workplace context

Evaluation of PeerTalk Charitable Foundation’s peer support groups

The Evaluation Report is a 36-page document that provides an in-depth analysis of PeerTalk, our work, and rationale for the need of the charity’s presence in the mental health charity space. In order to maximise the chance of securing the attention of busy stakeholders the charity will host a ‘Let’s have a chat’ day. This will include a number of different communication forms and follow up information. The evaluation report will be the anchor for agendas and discussion points but in a more accessible way