Recent studies show a high proportion of psychiatric troubles in the population with learning disability. However, the literature demonstrates a lack of adapted psychiatric care for people with dual diagnosis. If this kind of structure exists, it remains quite rare and misjudged. Since
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Recent studies show a high proportion of psychiatric troubles in the population with learning disability. However, the literature demonstrates a lack of adapted psychiatric care for people with dual diagnosis. If this kind of structure exists, it remains quite rare and misjudged. Since 1970 the psychiatric department of the University Hospital of Geneva proposes a specific structure for this population: the “Psychiatric Unit of Learning Disability” (UPDM) offers care and support to about 280 persons presenting dual diagnosis. The tools of UPDM are: two hospital units (18 beds), a consultation centre, a mobile team and a day hospital. Presenting an alternative to psychiatric hospitalisation, the UPDM’s Day Hospital offers to persons with learning disability and psychiatric troubles a therapeutic place where they can benefit from different therapies, individually or in groups. This structure allows the care of people in crisis situation avoiding a complete hospitalisation. These people who live either in socio-educational institutions or families can be helped very quickly at the very beginning of the crisis and receive adapted care, provided by a multidisciplinary team including psychiatrists, nurses, psychologists, speech therapists, socio-educator, social assistant. Each person receives a personal program and frequents the day hospital according to his or her needs (from one hour a week, for a special group; to five days a week, for a complete program). The system concerns several lines of action: observation and evaluation, creation of a “space” of interaction and communication, preservation and improvement of competencies, mobilisation, stress, anger, communication and social skill management care. The Day Hospital represents also a great tool for preparing the discharge of hospitalised patients and their integration (or reintegration) into the socio-educational institutions or the families. This paper shows the results of a study about the efficacy of this adapted care in the above-mentioned Day Hospital. Thirty patients of the Day Hospital were evaluated with the “Aberrant Behaviour Checklist” (ABC) during a period of 22 months. The patients participating in the Day Hospital program were assessed by observation of behaviour troubles. We underline that behaviour troubles often lead to complete hospitalisation. The instrument used for the assessment, the ABC, is a rating scale specially adapted to persons with learning disability: originally developed to measure treatment effects and as an instrument for assessing behaviour problems, the ABC is composed of 58 items, translated into French and validated. It also possesses a strong theoretical and practical baseline: its factor validity was determined by several studies and its scale items were divided into five subscales issued from factor analysis. These subscales were labelled as follows: (I) irritability, agitation, crying; (II) lethargy, social withdrawal; (III) stereotypic behaviour; (IV) hyperactivity, noncompliance and (V) inappropriate speech. The questionnaires were completed by two trained raters (psychologists of the UPDM) after observation of one week with the participation of the staff of the Day Hospital. The results show the presence of improvement during the period the study was going on: a Friedman analysis showed a significant change in time for factors F1, F3, F4 and Total. Using a more careful evaluation of our population, we noted a different trend based on the intellectual level. Thus, the participants with mild to moderate learning disability showed a decrease in behaviour problems (especially concerning agitation [I], stereotypic behaviour [III] and hyperactivity [IV]), while the participants with severe to profound learning disability showed almost stable results: we observed almost no significant change between two data collections or a slight increase, especially with the stereotypic behaviour (III) and hyperactivity (IV). This study, based on clinical observations, suggests the actual incomplete adequacy of therapeutic approach in day hospital structure: the treatment proposed in Day Hospital do not suit all the clients. This is probably the consequence of the fact that our attention and our skills are largely influenced by therapies aimed at the general population. The main part of the care are group therapies and fit well with a population of a better cognitive level. Even if a number of groups are non-verbal and specifically created for clients with severe to profound learning disability, the general therapy approach may not be adapted enough to the abilities of the clients: persons with severe to profound learning disability need more individual care and more carers in group activities. We are still thinking that people with severe to profound learning disability could benefit from group activities because we must prepare them to live in natural groups in socio-educational residences or workshops, but more attention could be dedicated to adapt the day hospital approach to a population with a low cognitive level. Thus, we should sustain spaces of individual care in groups, to allow people with severe to profound learning disability to obtain adapted individual care respecting their need and permitting to benefit from group dynamics.
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