Carolyn Gracey

The University of Manchester, Manchester, England, United Kingdom

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Publications (7)7.47 Total impact

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    ABSTRACT: This study compares outpatients with intellectual disability (ID) receiving specialised services to outpatients with ID receiving general services in Ontario's tertiary mental healthcare system in terms of demographics, symptom profile, strengths and resources, and clinical service needs. A secondary analysis of Colorado Client Assessment Record data collected from all tertiary psychiatric hospitals in the province was completed for a stratified random sample of 246 outpatients identified as having ID, from both specialised and general programmes. Individuals with ID in specialised programmes differed from patients with ID in general programmes with regard to demographics, diagnostic profile, symptom presentation and recommended level of care. Further research is required to determine why individuals access some services over others and to evaluate whether specialised services are more appropriate for certain subgroups with ID than others.
    Journal of Intellectual Disability Research 02/2011; 55(2):242-7. · 1.88 Impact Factor
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    ABSTRACT: There is increasing recognition around the world that individuals with intellectual disabilities (ID) and mental health issues with forensic involvement are a particularly complex patient group whose needs are not well met. However, few studies have examined how these individuals may differ from other service users within a psychiatric hospital setting. Inpatients with ID and forensic involvement were compared to non-forensic inpatients with ID and to forensic inpatients without ID in terms of psychiatric diagnoses and clinical issues. Inpatients with ID and forensic involvement were younger, more often male, had greater lengths of stay, were more likely to have a personality disorder diagnosis and less likely to have a mood disorder diagnosis than their counterparts with ID. They were also similar to their forensic counterparts without ID with regards to demographics, but were less likely to have a substance abuse or psychotic disorder diagnosis. Furthermore, patients with ID and forensic involvement exhibit more severe symptoms, have fewer resources, and a higher recommended level of care than other forensic patients. Patients with ID and forensic involvement present with unique demographic and clinical profiles. The characteristics that set these individuals apart from other services users should be taken into account in order to better meet the needs of this complex group.
    Psychology Crime and Law 01/2011; 17(1):9-23. · 0.69 Impact Factor
  • Yona Lunsky, Carolyn Gracey
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    ABSTRACT: Hospital emergency departments are not well prepared to meet the needs of individuals with intellectual disabilities. Negative experiences can be very traumatic, particularly when the emergency visit is because of a behavioural or psychiatric problem. A focus group study was conducted in 2005 in Toronto, Canada with four women with intellectual disabilities who had paid repeated visits to their local emergency department due to a psychiatric or behavioural crisis. These women spoke about not feeling respected, the trauma of being restrained physically or chemically, and about hospital staff not being comfortable working with women with intellectual disabilities. Clinical implications are discussed and recommendations are presented to improve the experience of women who require emergency services in the future.
    Journal of Intellectual Disabilities 07/2009; 13(2):87-98.
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    ABSTRACT: Background Strains on the mental health system and inaccessible services for individuals with intellectual disabilities (ID) often force caregivers to bring individuals with ID to the emergency department (ED) when in psychiatric crisis. The purpose of this study was to understand the experience of caregivers and adults with ID and mental health issues, according to caregivers’ perspectives.Method Focus groups were conducted with one group of unpaid caregivers (i.e. family members) and two groups of paid caregivers (i.e. staff from community agencies) from Ontario, Canada.Results Caregivers identified a number of issues centering on a lack of services, on respect, on knowledge and on expertise. Diagnostic overshadowing and overmedication were also prevalent concerns.Conclusions Input from caregivers points to deficiencies in the system that lead them to use the ED when other options have been exhausted. A number of recommendations can be implemented to improve the emergency psychiatric care of adults with ID in the ED.
    Journal of Applied Research in Intellectual Disabilities 06/2009; 22(4):354 - 362. · 1.38 Impact Factor
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    ABSTRACT: There are few published studies on the relationship between gender and psychiatric disorders in individuals with intellectual disabilities. Adults (N = 1,971) with and without intellectual disabilities who received inpatient services for psychiatric diagnosis and clinical issues were examined. Among individuals with intellectual disabilities, women were more likely to have a diagnosis of mood disorder and sexual abuse history; men were more likely to have a substance abuse diagnosis, legal issues, and past destructive behavior. Gender difference patterns found for individuals with intellectual disabilities were similar to those of persons without intellectual disabilities, with the exception of eating disorder and psychotic disorder diagnoses. Gender issues should receive greater attention in intellectual disabilities inpatient care.
    American Journal on Intellectual and Developmental Disabilities 02/2009; 114(1):52-60. · 2.08 Impact Factor
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    Yona Lunsky, Carolyn Gracey, Sara Gelfand
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    ABSTRACT: Strains on the mainstream mental health system can result in inaccessible services that force individuals with intellectual disabilities into the emergency room (ER) when in psychiatric crisis. The purpose of this study was to identify clinical and systemic issues surrounding emergency psychiatry services for people with intellectual disabilities, from the perspective of hospital staff. Focus groups were conducted with emergency psychiatry staff from 6 hospitals in Toronto, Canada. Hospital staff reported a lack of knowledge regarding intellectual disabilities and a shortage of available community resources. Hospital staff argued that caregivers need more community and respite support to feel better equipped to deal with the crisis before it escalates to the ER and that hospital staff feel ill prepared to provide the necessary care when the ER is the last resort. Input from hospital staff pointed to deficiencies in the system that lead caregivers to use the ER when other options have been exhausted. Both staff and caregivers need support and access to appropriate services if the system is to become more effective at serving the psychiatric needs of this complex population.
    Intellectual and developmental disabilities 01/2009; 46(6):446-55. · 1.44 Impact Factor
  • Yona Lunsky, Carolyn Gracey, Elspeth Bradley
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    ABSTRACT: BackgroundAdults with Autism Spectrum Disorders (ASD) represent a small, but challenging sub-group of patients within Ontario's mental health care system. However, few studies have documented the clinical characteristics of this population and examined how such individuals differ from other psychiatric patients, with or without intellectual disabilities (ID).MethodA secondary analysis of data from the 2003 Comprehensive Assessment Projects from three psychiatric hospitals in Ontario was conducted to describe patients with ASD and ID and to determine how their profile compared to other hospital users.ResultsTwenty-three patients with ASD and ID were matched on gender and patient status (inpatient/outpatient) to individuals with and without ID. Individuals with ASD and ID were similar in terms of demographics to patients with and without ID. However, individuals with ASD and ID were younger, spent more days in hospital and were less likely to have a psychotic disorder diagnosis than both patients with and without ID. Inpatients with ASD and ID were recommended for a higher level of care than hospital service users without ID.ConclusionsClearly, this small sub-group of individuals within the hospital population has high clinical needs that are not always well met.
    Research in Autism Spectrum Disorders.