An introduction and overview of the mental health conditions relevant to people with intellectual disability. The chapter focuses on the evidence base to support or refute whether they suffer greater rates of mental health problems, Psychiatric classification and prescribing; Comparison tables of international classification of diseases (ICD) versions 10 and 11; and the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) 4 and 5 and DC-LD.

Autism Spectrum Disorders (ASDs) are a group of severe developmental and neuropsychiatric disorders usually apparent by the age of three. Autism, referred to as autism spectrum disorder in the 11th revision of the International Classification of Diseases (ICD-11), is a neurodevelopmental condition characterised by persistent deficits in social interaction and social communication, as well as a range of restricted, repetitive behaviours (World Health Organization 2018). The onset of autism is in the developmental period (0–18 years of age), though for some autistic persons the symptoms may manifest later in life, at a time of increased social demands (World Health Organization 2018). In addition to the aforementioned core autistic features, many autistic people have associated symptoms, including hypo- or hypersensitivities to sensory stimuli, difficulties describing their emotional state (alexithymia), and problems with gross motor co-ordination The chapter will discuss the interface between autism spectrum disorder and intellectual disability and the potential management of the disorder. It will also cover the gender variations in presentation.

Families have the potential for causing harm and can play a part in the onset of mental health problems. Women’s behaviour is judged by a different set of standards to that of men. Parents still socialise girls differently from boys. The pressures of family life chip away at our confidence and self-esteem and powerfully influencing our ability to make successful adult relationships. Girls and women may be told that they are ‘hysterical’ or ‘out of their mind’ when their emotional response is quite justified by what is happening to them. However, life pressures can also trigger mental illness, and family stress such as living in poverty and with domestic violence can make this worse. Girls and young women experience much more sexual abuse during childhood than boys – the sheer extent of which was not acknowledged in the past. Improving material and psychological support to families is a mammoth task, but what is within our power, among our own friends, families and communities, is to do something when we suspect that young women are experiencing trauma and abuse – believing, helping and supporting them to find someone to share their stories with who is trustworthy and skilled.

Where the real basis for finding someone to lack capacity is that you consider the beliefs or values that motivate their decision to be distorted by a mental illness, such that the decision is not authentically desired and so is unworthy of respect, this entails a number of empirical and normative claims. This chapter will interrogate these claims by reference to the wide-ranging literature on the nature of mental disorder, and on differing conceptions of autonomy and authenticity (as a component of autonomous decision-making). It will be concluded that while an agent acting on the basis of disordered beliefs or values will often be acting inauthentically (and thus non-autonomously), this will not always be the case, and situations could arise in which there is reason to believe that the agent would endorse or sanction their belief, even knowing it is derived from illness. Moreover, once the shaky conceptual ground on which such judgements must be made is acknowledged, it becomes essential that these judgements are brought out into the open, where they can be subject to appropriate scrutiny.

Just 20 years ago, molecular biologists Leonie Ringrose and Renato Paro published an article provocatively entitled ‘Remembering Silence’. The article focused on how modified epigenetic elements could subsequently return to their silent state (i.e. their epigenetic status before experimental or environmentally induced modulation). Ringrose and Paro raised a question of considerable importance to expanding research in human neuroepigenetics, that of reversibility. For neuroepigeneticists interested in the molecular impact of environments on individuals’ biological profiles, including epigenetic modifications thought to be mediators between life trauma and risk of psychopathology, this question could be translated as: if you experience a traumatic event and thus acquire an epigenetic state considered pathological, can you free yourself of that state? In this chapter, we examine researchers’ ambitions to account for the indeterminacy of life and the speculative possibility of reversing acquired epigenetic states. Bringing together the perspectives of medical anthropology and molecular biology, we explore how reversibility – a return to silence – is envisioned, how therapeutic interventions purported to bring about that silence might function, and what this might mean for the mental health of people who live in the aftermath of trauma.

Reading Lowell’s depictions of madness in poems from The Mills of the Kavanaughs to Day by Day, this chapter follows Lowell’s negotiation of literary conventions to arrive at a notion of diverse mental states that, in life, cannot entirely be controlled. It is argued that he effectively contributes to the reduction of stigmatization by slowly working through conventions of representing madness, such as the gothic, or othering mad persons through race and gender. He arrives at finally owning his mental state as a derangement of his senses, especially his vision, and foregrounds art and humor as coping mechanisms when facing the fragility and suffering of human life.

Psychiatric intensive care units (PICUs) are an important provision but are significantly under-provided internationally. Law, funding and stigma all have significant influence on mental health service provision and the consequent lack of access to appropriate treatment. Whilst this varies from country to country, there are themes throughout which can be applied everywhere. Improving legal frameworks, providing more resources, educating the population and working more closely with patients will be key to creating a truly global approach to severe mental illness. PICUs are a key element in providing safe, effective care for the most unwell people. Practices such as shackling need to end and mental health care in all countries around the world must be brought front and centre in the twenty-first century, having spent so long in the shadows.

This chapter defines the terminological differences between the terms ‘fire-setting’, ‘arson’ and ‘pyromania’, including their place in current diagnostic manuals. An epidemiological perspective on fire-setting in those with mental disorder as well as classification systems and theories of fire-setting with prevailing conceptual models of fire-setting and mental disorder is described. Current approaches in the risk assessment of fire-setting and psychological and pharmacological interventions in fire-setting are discussed. Finally, a care pathway to guide clinical and risk assessment of the patient with fire-setting as a feature of their behaviour or history is suggested.

The phrase ‘complex needs patient’ is often used by clinicians to describe a patient who presents with challenges and needs that require management approaches that are resource intensive and multi-focused. These individuals are often passed from service to service, with high costs to services across the board. In this chapter, we seek to define ‘complex needs patients’, recognising that for many clinicians the phrase refers to those individuals who present with severe mental illnesses together with other comorbid challenges including, but not limited to, serious physical illness, substance misuse or addiction, social problems including a lack of support, homelessness as well as problematic, absent or abusive relationships and the presence of another comorbid mental illness. This chapter explores the possible aetiological factors of complexity as well as its background and characteristics and discusses useful treatment modalities. Lastly, it considers the impact that the Covid-19 pandemic has had both in terms of disease presentation and the impact it has had on services.