Sheila Hollins

• MBBS, FRCPsych, FRCP, FRCPCH
• University of London

We think a reversal in the rate of antidepressant prescribing can be achieved by following through with various public health recommendations, in line with the NHS National Medicines Optimisation Opportunities 2023-24. These include stopping the prescribing of antidepressants for mild conditions for new patients; adhering to the 2022 NICE guidance...

Intellectual disability (ID) is a lifelong neurodevelopmental condition involving deficits in both intellectual and adaptive functioning, with onset during the developmental period (from birth to 18 years of age). Individuals with ID experience a greater burden of co-occurring physical and mental illness compared to the general population, and freq...

Despite numerous UK government policies aimed at reducing the number of autistic people and people with an intellectual disability in mental health hospitals, little progress has been made, with many experiencing lengthy stays that offer little therapeutic benefit. Once admitted, people are at risk of restrictive interventions and significantly del...

We believe that the NHS has a clinical and moral obligation to help those who have been harmed by taking their medication as prescribed. Panorama has revealed the scale of the problem and the horrendous impact it has had on so many people’s lives. To help mitigate these impacts, we therefore urgently call upon the UK government to fund and implemen...

Background: Euthanasia review committees (Regionale Toetsingscommissies Euthanasie, RTE) scrutinise all Dutch cases of euthanasia and physician-assisted suicide (EAS) to review whether six legal 'due care' criteria are met, including 'unbearable suffering without prospect of improvement'. There are significant complexities and ethical dilemmas if...

Disabled children and adults are more vulnerable to abuse across all belief systems, cultures and social classes, with intellectual developmental disability (IDD), in particular, known to be a predisposing factor for abuse. Mild intellectual disability shades into illiteracy and may remain hidden in countries without adequate post-primary education...

This article reports the outcomes of a two year project involving 22 Special Schools in England and Northern Ireland . With the Mental Health of children and young people as a major area of concern in schools , especially with those with Special Needs, resources that are curriculum compatible and appropriate are limited . The Open Book Project tria...

Sabyasachi (Sab) Bhaumik, OBE, MD, DPM, FRCPsych (Hon) - Regi Alexander, Sheila Hollins

The Open Book Research Project involves 22 schools across England and Northern Ireland, exploring the role of wordless books from the Book Beyond Words series, ( www.booksbeyondwords.co.uk), to increase emotional literacy in the context of the Social , Emotional and Mental Health Curriculum area. This article reports findings for phase 1 , covering...

In 2018, the authors published their analysis of nine online case reports by the Euthanasia Review Committee in the Netherlands, involving people with intellectual disability and/or autism spectrum disorder who were given euthanasia. In this commentary, they reflect further on the challenges of assessing “unbearable suffering without prospect of im...

The case for removing intellectual disability and autism from the Mental Health Act – ERRATUM - Sheila Hollins, Keri-Michèle Lodge, Paul Lomax

Intellectual disability (also known as learning disability in UK health services) and autism are distinct from the serious mental illnesses for which the Mental Health Act is designed to be used. Their inclusion in the definition of mental disorder is discriminatory, resulting in unjust deprivations of liberty. Intellectual disability and autism sh...

Background: Euthanasia and assisted suicide (EAS) have been legally possible in the Netherlands since 2001, provided that statutory due care criteria are met, including: (a) voluntary and well-considered request; (b) unbearable suffering without prospect of improvement; (c) informing the patient; (d) lack of a reasonable alternative; (e) independe...

The world population of women and girls in prison is increasing. Evidence points to high rates of mental health problems. Approaches to these problems vary and include both psychiatric epidemiology and gender-sensitive understanding and intervention. Prison environments and women prisoners' needs are complex and demand gender-aware care in view of...

While the numbers of young people who become parents in their teenage years is declining, there remains a stigma associated with young parenthood. Young parents disrupt socially constructed ideas of the family and challenge ideals of childhood. It is common for young parents to have experienced social exclusion and poverty as well as to have relati...

Purpose Based on a literature and practice review, the purpose of this paper is to examine the theoretical and clinical basis for using wordless books with patients who have intellectual disabilities (ID) and/or autism. Design/methodology/approach A literature review identified seminal peer-reviewed English language articles relating to the neuros...

The prime minister’s commitment to “fighting against the burning injustice that if you’re born poor, you will die on average nine years earlier than others”1 is welcome and achievable. As her government has acknowledged,2 half of this difference in life expectancy is due to the higher rates of smoking among the least affluent, so major improvements...

Purpose The purpose of this paper is to introduce the social and scientific rationale for book clubs, whose members read wordless books together, and give examples of storytelling with picture books in libraries and other community settings for people with intellectual disabilities and autism. Design/methodology/approach The authors consider the i...

Professor Sheila Baroness Hollins sits in the House of Lords as an independent cross-bench peer and speaks about health and social care policy and press regulation. Her particular interest is in the mental and physical health and care of people with intellectual disabilities arising from her innovative clinical work, research, policy advocacy and f...

Aims: To understand issues around carer roles that affect carer involvement for people with intellectual disabilities in acute hospitals BACKGROUND: There is evidence that a lack of effective carer involvement can lead to poorer health outcomes for people with intellectual disabilities, but there is a lack of insight into the reasons for poor care...

While information from other countries suggests varying degrees of knowledge about foetal alcohol spectrum disorders (FASD), understanding of the condition among UK health professionals is unclear. This mixed methodology study aims to ascertain the UK picture. It comprised a standardised FASD questionnaire completed by 505 professionals and focus g...

This paper seeks to explore the moral accounts of young people’s own interpretation of their choice of parenthood, the new meanings in their lives brought about by the responsibility of parenthood, and the transformative experience that this responsibility generated. Drawing on a study of young parents in South West London this paper considers how...

Introduction: Foetal alcohol spectrum disorders (FASD) are a set of preventable conditions where the foetus is exposed to alcohol in utero and as a result suffers adverse consequences. To develop a public health strategy related to FASD, it is important to first establish what is known by the public about this condition. This study aimed to assess...

Background: There has been evidence in recent years that people with intellectual disabilities in acute hospitals are at risk of preventable deterioration due to failures of the healthcare services to implement the reasonable adjustments they need. The aim of this paper is to explore the challenges in monitoring and preventing patient safety incid...

People with intellectual disabilities are at risk of premature death due to failings in healthcare provision. To prevent this, it is important for healthcare services to identify and flag not only vulnerable conditions (including intellectual disability, dementia and mental health problems), but also the specific adjustments needed by individual pa...

To identify the factors that promote and compromise the implementation of reasonably adjusted healthcare services for patients with intellectual disabilities in acute National Health Service (NHS) hospitals. A mixed-methods study involving interviews, questionnaires and participant observation (July 2011-March 2013). Six acute NHS hospital trusts i...

Summary Good communication is central to psychiatric consultation. It informs assessment, diagnosis and treatment, and is an important part of empowering people to take more control of their own mental health. But active listening and personally tailored explanations may require additional skills and may need to be practised in the context of ethic...

There has been consistent evidence that people with learning disabilities experience health inequalities and poor NHS health-care provision, leading to avoidable harm and premature, avoidable death. Objectives To describe the factors in NHS hospitals that promote or compromise a safe environment for patients with learning disabilities, in the ligh...

Mukherjee, R., Wray, E., Curfs, L., & Hollins, S. (2013). Estimation of alcohol content of wine, beer and spirits to evaluate exposure risk in pregnancy: Pilot study using a questionnaire and pouring task in England. The International Journal Of Alcohol And Drug Research, 2(3), 71-78. doi:10.7895/ijadr.v2i3.78 (http://dx.doi.org/10.7895/ijadr.v2i3....

Research suggests that caring for a child with Fetal Alcohol Spectrum Disorders (FASD) creates unique challenges for carers. To investigate this, three focus groups and education sessions, attended by 66 people, were held in the UK. Knowledge about FASD and its impact on families was evaluated using the focus groups, the Parental Stress Index and k...

Mukherjee, R., Wray, E., Curfs, L., & Hollins, S. (2013). Estimation of alcohol content of wine, beer and spirits to evaluate exposure risk in pregnancy: Pilot study using a questionnaire and pouring task in England. The International Journal Of Alcohol And Drug Research, 2(3), 71-78. doi:10.7895/ijadr.v2i3.78 (http://dx.doi.org/10.7895/ijadr.v2i3....

Because we’d failed them by our disregard Panorama’s broadcast of Undercover Care: The Abuse Exposed during May 2011 made “real” the abusive treatment of patients with intellectual disabilities and adults with autism at a private hospital owned by Castlebeck Care (Teesdale) Ltd, which had become their “home.” The BBC’s undercover reporting enabled...

Ethical and social issues surround the issue of sexuality and parenting for people with intellectual disabilities. The traumatic history of eugenics is encapsulated in Nazi Germany's description of those with intellectual disability as unworthy of life and the 250 000 children and adults who were gassed but conscious and unconscious wishes to deny...

This review is based in part on Dr Mukherjee's lecture at the RCPE Mental Health Needs of Children and Young People Symposium held in Edinburgh on 29 September 2011.

Social health and mental health needs change throughout life, and this chapter highlights those particularly relevant for adolescents and elderly people. As a general rule, people with intellectual disabilities have the same needs as other members of the community, but they may also have additional needs for which they are entitled to extra support...

[⇓][1] ![Figure][2] Dr Davies introduces us to 11 of his own Christian heroes, unpacking their personal struggles, failings and successes, and at the same time explaining their Christian beliefs. The heart of his thesis relates to his definition of grace as a part of God’s general

The population of people with intellectual disabilities is ageing, and growing numbers are dying of age-related illnesses, including cancer. This chapter explores the issues that affect the delivery of optimal palliative care to people with intellectual disabilities who have cancer. The literature is reviewed and pertinent issues are highlighted. A...

Abstract The closure of the old “mental handicap” hospitals in the UK has opened up opportunities to improve the lives of institutionalized people moving to campus group homes, and group and other homes in the community. To examine the aftereffects of moves from institutions to small group homes among adults with challenging behaviors, the authors...

Growing numbers of people with learning disabilities are living longer and dying of age related illnesses such as cancer. To explore the experiences of people with learning disabilities who have cancer. The study used participant observation with 13 people with learning disabilities. All had a cancer diagnosis and 10 were terminally ill. Participan...

IntroductionParental expectationsAntenatal diagnosisCase vignette 1Case vignette 2Postnatal diagnosisCase vignette 3Case vignette 4Diagnostic uncertaintyParental responsesParent–infant relationship developmentCase vignette 5Case vignette 6Depression in parents of children with a disabilityResponses of family, friends and wider societyEconomic and s...

Being a disabled parentThe UK contextParents with physical disabilityParents with intellectual disabilityParents with mental illnessA recovery perspective on disabled parents with mental illnessThe social model of disabilityCultural representations of parents with disabilitiesUK policy perspectivesSolutions to support disabled adults as parentsInvo...

Migration of health professionals from low and middle income countries to rich countries is a large scale and long-standing phenomenon, which is detrimental to the health systems in the donor countries. We sought to explore the extent of psychiatric migration. In our study, we use the respective professional databases in each country to establish t...

Growing numbers of people with intellectual disabilities are diagnosed with a life-limiting illness such as cancer. Little is known about disclosure of diagnosis and prognosis to this group. The study aim was to explore how much people with intellectual disabilities who have cancer understand about their diagnosis and prognosis, and to explore how...

Michael James Henry Piachaud (“Jack”) devoted his career to the countless people throughout the world whose health, wellbeing, and access to proper health care are jeopardised by the effects of war, poverty, and environmental damage. His multifaceted career and voluntary activities were a reflection of his humanity and his passions.He grew up at a...

Cancer incidence among people with learning disabilities is rising. There have been no published studies of the needs and experiences of people with learning disabilities and cancer, from their own perspective. To provide insight into the experiences and needs of people with learning disabilities who have cancer. Prospective qualitative study, usin...

The brain drain of health professionals is an issue of continuing interest and debate. The WPA set up a Task Force to examine the phenomenon as it relates specifically to mental health professionals. This report provides a description of the work of the Task Force and its recommendations in regard to how the WPA might act to help address the issue.

Two thousand people with learning disabilities registered as service users in two London districts were followed up for 8 years to ascertain, in those who died, age and cause of death and significant associations with early death. Respiratory disease was documented as the leading cause of death in 52% of the study population compared with only 15%...

The launch of the National Learning Disability Strategy (NLDS) in England (and parallel initiatives in Scotland and Wales) provides the best opportunity for a generation to close the huge gap between the aspirations of people with learning disabilities and their families for a full life, and most people's current experience. The implementation of t...

The population of people with intellectual disabilities is ageing, and growing numbers are dying of age-related illnesses, including cancer. Objective: This paper explores the issues that affect the delivery of optimal palliative care to people with intellectual disabilities who have cancer. Methods: The literature is reviewed and pertinent issues...

The use of primary care services by three matched groups of people with intellectual disabilities was compared over a period of one year. Differences in the patterns of provision were detected between hospital intellectual disability specialists and general practitioners. The degree of behavioural disturbance and disability of the subjects were fou...

Accessible summary We have done research about cancer, death and dying. People with learning disabilities who had cancer were in our studies. This paper is about making sure that our research is ethical . This means that we don’t want to cause any harm (or make people upset) when we do the research. We ask: How do we find people to be in our studi...

In his review, Harold Koenig challenges us to take our patients’ religious beliefs more seriously. The questions he poses and the recommendations he makes are challenging, so what are we doing and what should we do? During recent discussions at the College with leaders of a number of different

This paper explores access to palliative care services by people with learning disabilities. It is based on a study of specialist palliative care professionals in London, involving 32 semi-structured interviews and 543 postal questionnaires. We focus on one aspect of the findings, related to the current use of specialist palliative care services by...

There is a growing interest in the palliative care needs of people with intellectual disabilities (ID). There are indications that palliative care staff face particular problems providing care to this group, but empirical data about the extent of the problem are lacking. This study aims to gain insight into the current use of palliative care servic...

IntroductionA Chronicle of Developing IdeasSome InconsistenciesFoundations and Ideas for ProgressReferences

The historical and social context framing current discussionHow did this thinking impact on practice?Issues of bereavement for older people with IDOlder people and their aging parentsIntervening before a deathInclusion at bereavementA current bereavement intervention studySummaryReferences

Feeding and swallowing impairments are key predictors of increased morbidity and mortality in adults with learning disabilities. This postal survey and interview study sought to identify risk factors in adults with learning disabilities who have histories of choking. A total of 2000 questionnaires were sent to carers of all adults with learning dis...

e asked examiners,medical students and theactors themselves forfeedback on a new programmethat employs adults withintellectual disabilities (ID) inteaching and objective structuredclinical examinations (OSCEs).Who do you think made thefollowing comments, and whowere they talking about?• I feel sorry for them• I really want to help them• I’ve learne...

Previous Presidents wrote Council reports of their overseas visits and one wonders how wide an audience their reflections actually reached. What good fortune for me, then, that I can share my reflections in the pages of International Psychiatry . The title of this paper was given to me by a disgruntled senior member of the College working in Englan...

Previous research into deinstitutionalization has largely ignored the perspective of people with intellectual disabilities, especially those with severe intellectual disabilities. This research aimed first to understand how women with severe intellectual disabilities experienced transition from a locked ward of an old long-stay hospital into other...

The subject of sexual abuse is a major focus of professional and public concern. Sexual abuse of (and by) people with learning disabilities evokes even greater disquieting emotions, and makes severe demands on the social services, and the criminal justice system. The aims of the project were: 1) to determine whether group psychotherapy produced eff...

This paper discusses a number of ethical issues that arise in the context of ethnographic research with people with severe intellectual disabilities and mental health problems living in closed institutions. These very vulnerable people have tended to live emotionally and physically deprived lives in segregated and bleak environments, and because th...

The Royal College of Psychiatrists’ Annual General Meeting in Edinburgh in June 2007 witnessed the launch of the joint position statement from the College, the Care Services Improvement Partnership and the Social Care Institute for Excellence ‘A Common Purpose: Recovery in Future Mental Health Services’ as part of its opening session. This is now a...

Growing numbers of people with intellectual disabilities (ID) are in need of palliative care, but there is inequity of access to palliative care services for this group. This study investigates the issues and difficulties arising for palliative care staff in providing care for people with ID. Semi-structured interviews were conducted with 32 pallia...

This paper is a report of a study using the Nominal Group Technique as a method to elicit the views of people with intellectual disabilities on sensitive issues, in this example end-of-life care provision. Establishing consumer views is essential in providing appropriate end-of-life care, yet people with intellectual disabilities have historically...

Background The aims were to identify referral characteristics and outcomes for people with intellectual disabilities referred to a psychodynamic psychotherapy service. Materials and Methods A retrospective case notes review of anonymized data relating to 100 sequential patient episodes. Results A total of 81 people out of 100 with a range of intell...

Accessible summary What we did: We made a picture book about cancer for people with learning disabilities. The book explains about cancer. It also explains about the treatments for cancer. We wanted to find out if the book is useful for people with learning disabilities. We met five people with learning disabilities who wanted to find out about can...

Introduction There have been many barriers preventing people with intellectual disabilities (ID) from accessing psychodynamic treatments. Therapists, notably Freud in the early 1900s and later Carl Rogers in the 1960s, believed that people with ID were unsuitable for psychodynamic therapies, as they did not have the intelligence seen as a prerequis...

On 3 July 2006 we emailed members and fellows to inform them of Council’s decision that the College should apply to change from six certificates of completion of training (CCTs) to one CCT. We have been asked some questions about this change and here are the answers to the most frequently asked

Ethical and social issues surround the issue of sexuality and parenting for people with learning disabilities. Keywords: disability; parenting; sexuality; competence; reproduction; eugenics

There has been an increase in awareness of fetal alcohol spectrum disorders in both the lay and academic press of late. However, evidence from national, regional and local conferences as well as a pilot survey of awareness (unpublished data) suggests they remain a set of conditions that are poorly understood in the UK both by the general public and...

Bereaved adults with intellectual disabilities are known to experience prolonged and atypical grief which is often unrecognized. The aim of this project was to find an effective way to improve mental health and behavioural outcomes. Subjects were randomized to two different therapeutic interventions: traditional counselling by volunteer bereavement...

Many people with intellectual disabilities will be affected by cancer in their lifetime. There is a lack of available knowledge about people with intellectual disabilities' understanding and experience of cancer, and about their need for cancer information. The principal aim of the study was to explore the information needs of people with intellect...

Community-based health and social care professionals have little knowledge of the past experiences of people with severe learning disabilities and challenging behaviour who are living in institutions. To gain a greater understanding of the experiences and needs of men who are living in a locked ward. The study sample consisted of 20 men who were li...