Mental Health Classification and Care for Individuals With Intellectual Disability and Severe Challenging Behaviour: A Three-Year Follow-Up on Quality of Life.

Quality of life and behaviour were rated by a staff member who knew the resident, not by the residents themselves, because most were not able to self-report. Only 116 of the 184 had complete quality-of-life data and 137 had complete behaviour data across all three time points; the people missing behaviour data had higher challenging behaviour at the start (mean item score 0.62 versus 0.52 on items scored 0 to 2, P = 0.015), so the behaviour findings may not reflect those with the most difficulty. The two groups differed at the start: the group with a mental health classification had significantly different cognitive functioning from the group without one (P = 0.033), so some differences between them may reflect overall ability rather than the classification. No one was assigned to a group. The researchers recorded what was already in the support plans and followed people forward, so the study can show links over time but cannot show that classifying mental health problems, or setting a particular number of goals, causes anything. The authors state that missing data, unequal group sizes and the number of statistical tests performed mean the results should be treated with caution. A large share of those who agreed to take part did not end up in the analysis: 57 of the 289 who consented dropped out and 48 more were excluded for missing records.

The SCORE project is funded by a consortium of the specialised care organisations that look after people with intellectual disability and challenging behaviour in the Netherlands: Ipse de Bruggen, De Hartekamp Groep, Cordaan and Ons Tweede Thuis. Ipse de Bruggen, one of those funders, is also described as the largest organisation taking part in the study and its ethics committee approved the work. The authors declare no conflicts of interest.

Do not read the goal-count findings as advice to cut support goals. Nobody was assigned to fewer or more goals; the researchers recorded what was already in the plans, the link between fewer goals and improvement appeared in the group without a mental health classification but not in the group with one, and the authors themselves warn that missing data and the number of tests performed mean the results should be treated with caution.