BACKGROUND: Autistic adults are at increased risk of mental health difficulties; however Adult Mental Health Services (AMHS) often struggle to offer appropriate support to this group. Within England, Government initiatives, such as the \'Transforming Care\' programme which included \'Building the Right Support\' (NHS England, 2015) have promoted the need for AMHS to consider how they can better provide autism-informed support to autistic adults.
OBJECTIVE: Here, we describe the first two years of work of the Transforming Care in Autism (TCA) Team; a specialist service that supports autistic adults, without a moderate or severe intellectual disability or presenting significant risk to others, experiencing a mental health crisis. The service model is described, and descriptive data is presented over the two years of the service operation.
RESULTS: Between February 2019 and February 2021, 110 referrals were received; 52 (47%) were accepted. Support offered to autistic adults included psychoeducation, psychological interventions, family-focused interventions, and consultation with professionals about specific individuals. Seventy autism training sessions were delivered to professionals working in medical health settings, AMHS, social care and residential services.
CONCLUSIONS: Developing more autism-informed community and inpatient AMHS is vital for improving care. Further research about the experiences and needs of autistic adults using AMHS is needed, along with improved awareness of autism and provision of tailored intervention within these settings.
UNASSIGNED: Autistic people have mental health problems more often than people who are not autistic. When autistic people need help from mental health services, often these services do not know how to help autistic people. The Government says mental health services must do more to help autistic people. In this paper we write about a new team, called the Transforming Care in Autism team. In its first two years the team was asked to help 110 people and worked with 52 of them. Help included talking to autistic people about how autism affects them and offering therapy. We also worked with families and professionals supporting autistic adults and offered 70 training sessions. More work is needed to make sure mental health services work well with autistic people. We also need to ask autistic people about their experiences of getting help from mental health services.

BACKGROUND: NHS England\'s Transforming Care agenda aims to reduce the number of adults with intellectual disabilities and autistic adults in mental health hospitals. The aim was to understand the demographic and clinical characteristics of those most at risk of admission.
METHODS: A cohort, retrospective study of adults using community intellectual disability services in the North West of England from 2018 to 2022 was undertaken.
RESULTS: We compared 211 adults at imminent risk of admission to a mental health hospital and 249 at significant (but not imminent) risk on a validated risk stratification tool. Individuals at significant risk were more likely to have moderate intellectual disability. Individuals at imminent risk were more likely to have diagnoses of mild intellectual disability, autism, personality disorder, or psychosis.
CONCLUSIONS: By furthering our understanding of the clinical characteristics of those most at risk of admission, the findings inform more appropriate targeting of resources.

The draft Mental Health Bill published by the UK Government in July 2022 aims to reform mental health legislation in England and Wales. One significant proposal is to remove intellectual disability and autism from the scope of the legislation in all but a limited number of circumstances. The basis for this proposed change is not clear and there are no plans to introduce alternatives to the current legislation for people with intellectual disabilities and autism whose behaviour is challenging and present significant risks to themselves or others. This paper examines the implications of these proposals for people with intellectual disabilities. It considers the New Zealand experience as the only other common-law jurisdiction to implement a similar legislative change. Links to the government\'s Transforming Care de-institutionalisation programme and associated policies are explored and calls for a review of this approach are set out.

BACKGROUND: We examined whether a series of variables were related to the number of psychiatric inpatients using publicly available data about English psychiatric bed utilisation and NHS workforce.
METHODS: Using linear regression, with auto-regressive errors, we examined relationships between variables over time using data from December 2013 to March 2021.
RESULTS: Over time, the number of inpatients reduced by either 6.58 or 8.07 per month depending upon the dataset utilised, and the number of community nurses and community nursing support staff reduced by 7.43 and 2.14 nurses per month, respectively. Increasing numbers of consultant psychiatrists were associated with fewer inpatients over time. More care and treatment reviews (CTRs) were associated with more admissions over time, while more post-admission CTRs were associated with increased discharges over time.
CONCLUSIONS: Future studies should examine whether psychiatric bed utilisation elsewhere within the NHS by people with intellectual disabilities has increased.

Following serious case review, the Transforming Care agenda (DH, 2015) highlights the need for adults with learning disabilities, autism, mental health issues or behaviors that challenge to be supported within communities rather than hospitals. Poor or absent leadership has been identified as contributing to serious cases of abuse in health-care settings [Department of Health (DH), 2012]. This paper aims to focus on identifying the elements required for good leadership and service delivery in community forensic services (CFS).
The perspectives of 12 support workers working in CFS were obtained through semi-structured interviews.
Thematic analysis identified two predominant themes, namely, authentic leadership and effective team practice. A culture of trust and learning occurs when teams are well led. This culture leads to consistent practice which benefits services users and reduces risk of poor practice. Analysis suggests a framework for service delivery which is complimented by aspects of the Total Attachment model.
The data set was collected from the same organisation and views may have been aligned to existing organisational policy. However, the sample was taken across different teams and geographical locations to collate more generalised experiences of team dynamics. The lead researcher works for the organisation and this dual role may have affected the candour with which individuals shared information during interviews.
Using a model to understand the functional dynamics of teams within CFS may support leaders and practitioners to improve service delivery.
Improving service delivery within CFS may increase opportunity to meet the Transforming Care Agenda.
This paper examines staff perspectives and the application of theoretical frameworks to propose a unique service delivery model for supported living within CFS.

Despite longstanding efforts at de-institutionalisation, around 2000 people with learning disabilities and/or autistic people in England currently live in hospital settings, amidst reports of protracted stays, limited progress towards living more ordinary lives and scandals of abuse and poor care. Yet, there is relatively little research on why people with learning disabilities and/or autistic people are delayed in hospitals, and what exists has significant limitations. In particular, previous studies have rarely talked directly to people with learning disabilities and/or autistic people, their families and frontline staff about their experiences of living or working in such settings, the barriers to discharge and what would help more people to lead chosen lifestyles. This paper presents the findings of a structured literature review conducted between January and March 2021 on delayed discharges of people with learning disabilities in long-stay hospital settings. It investigated: the proportion of people with learning disabilities delayed in long-stay hospital settings, the suggested reasons for these delays and the proposed solutions. The literature reported delays for 11%-80% of inpatients in different settings. The reasons reported are related either to particular characteristics of the person (which we find problematic) or limitations of the system supporting them. However, delays were defined and reported inconsistently, reasons usually lacked depth and detail, and the majority of included studies did not engage directly with the people living in long-stay settings, their families or frontline staff. Without listening to these voices, genuine solutions will be difficult to find.

BACKGROUND: Concerns have been expressed regarding the impact of Transforming Care (TC) an English deinstitutionalisation mandate, on forensic services. With nursing staff positioned as significant in delivering TC; this research explored nursing experiences.
METHODS: Nine face-to-face semi-structured interviews were completed with nursing staff working in either inpatient or community forensic teams. Multi-perspectival interpretive phenomenological analysis was used to explore participants\' experiences. Interviews were analysed independently, prior to a mini meta-synthesis.
RESULTS: Participants from the inpatient group experienced TC as a threat, which resulted in consistency of perspective and practice. Participants from the community group viewed TC as a worthwhile challenge, which presented opportunity. The community infrastructure was experienced as inadequate by both groups, with the needs of people in forensic services needing more consideration, leading to widespread frustration.
CONCLUSIONS: The blanket approach of TC may not be suitable for this population, with those leading TC perceived as naïve.

SummaryThe Transforming Care national plan for England to develop community services and close hospital beds for people with intellectual disabilities and/or autism was published in October 2015 and is due to finish in March 2019. In this editorial the key plan objectives are evaluated, with particular reference to people with intellectual disabilities and/or autism who offend or are at risk of offending. The conclusion is that, to date, the plan has failed to meet its targets to reduce the number of in-patients with intellectual disabilities and/or autism and to invest in community services, and the number of patients in independent sector beds is increasing.Declaration of interestThe author is employed by Northumberland, Tyne and Wear National Health Service Foundation Trust, however the opinions expressed in this article are the author\'s own and do not reflect the views of the Trust.

BACKGROUND: In recent years, concerns have been raised that too many patients stay for too long in forensic psychiatric services and that this is a particular problem in those with an intellectual disability.
OBJECTIVE: To compare the characteristics, needs, and care pathways of long-stay patients with and without intellectual disability within forensic psychiatric hospital settings in England.
METHODS: File reviews and questionnaires were completed for all long-stay patients in high secure and a representative sample of those in medium secure settings in England. Between-group analyses comparing patients with and without intellectual disability are reported.
RESULTS: Of the 401 long-stay patients, the intellectual disability and non-intellectual disability groups were strikingly similar on many sociodemographic, clinical and forensic variables. The intellectual disability group had significantly lower lengths of stay, fewer criminal sections, restriction orders and prison transfers, and higher levels of behavioural incidents and risk assessment scores.
CONCLUSIONS: In spite of similar offence histories and higher risk levels, those with intellectual disability appear to be diverted away from the criminal justice system and have shorter lengths of stay. This has implications about the applicability of the Transforming Care programme to this group.

BACKGROUND: Transforming Care is making mixed progress in supporting people with intellectual and developmental disabilities, and complex needs, move to more appropriate specialist accommodations closer to home. Community support staff often spend greatest amounts of time with service-users, yet are some of the least heard voices about why placements succeed and fail to varying extents.
METHODS: Managers and support staff (n = 13), working in ostensibly \"specialist\" community placements, were interviewed about perceived barriers and facilitators to implementing Transforming Care. Transcripts were subjected to thematic analysis.
RESULTS: Participants identified difficulties balancing people\'s rights, safety and quality of life needs, and felt the system\'s expectations of them are hard to deliver within the resources, legislation, values and support models provided them. Multidisciplinary expertise was highly valued for both emotional and practical support, but was least valued when perceived as overly blaming or inspectorial. Specialist health input was seen to withdraw prematurely for this particular client group.
CONCLUSIONS: Recommendations are provided for how staff perspectives should inform Transforming Care in interests of service-users.