Organising care for complexity: a pathways model for adult community intellectual disability services
Shankar, Rohit sawhney, indermeet Tromans, Samuel J Perera, Bhathika Korb, Laura Sheehan, Rory Hanna, Heather O'Kane, Niall DeVilliers, Jana Rajagopal, Ganesan
Shankar, Rohit
sawhney, indermeet
Tromans, Samuel J
Perera, Bhathika
Korb, Laura
Sheehan, Rory
Hanna, Heather
O'Kane, Niall
DeVilliers, Jana
Rajagopal, Ganesan
Affiliation
University of Plymouth; Cornwall Partnership NHS Foundation Trust; Hertfordshire Partnership NHS Foundation Trust; University of Leicester; Leicestershire Partnership NHS Trust; University College London; Barnet, Enfield and Haringey Mental Health NHS Trust; Kings College London; Southern Health and Social Care Trust; Camden and Islington NHS Foundation Trust; The State Hospital, Scotland; NHS Lothian, Scotland; Swansea Bay University Health Board; Sussex Partnership NHS Foundation Trust; Central and Northwest London NHS Foundation Trust; Coventry and Warwickshire Partnership NHS Trust
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Publication date
2026-02
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Abstract
Adult community intellectual disability services in the United Kingdom (UK) are required to deliver specialist, evidence-based care for a variety of conditions while minimising restrictive practices and reliance on inpatient provision. Care pathway models have emerged as a potential mechanism to reconcile these aims yet remain under-used in care philosophies in intellectual disabilities. We propose a generalisable pathways model for community intellectual disability services and examine its implications for policy, clinical practice, and research. The model integrates care navigation, proportionate specialist input, and defined clinical condition care including behaviours that challenge, mental and physical health, forensics, neurodevelopmental conditions, epilepsy, and dementia within a community-based service architecture. It considers recent focus on digitalsation, prevention, workforce and practice innovation. The model aligns with contemporary policy priorities. We argue that pathway-based care delivery provides a pragmatic and ethically grounded framework for organising services. It supports consistency, integration, and preventative care while reducing reliance on reactive risk-based responses. By synthesising service design principles, core pathway functions, and system interfaces, this paper offers a coherent model for contemporary community intellectual disability services. Further empirical evaluation is required to assess the impact of care pathways on outcomes, patient experience, and cost-effectiveness.
Citation
Shankar R, Sawhney I, Tromans SJ, Perera B, Korb L, Sheehan R, Hanna H, O'Kane N, DeVilliers J, Rajagopal G, Watkins L, McCarthy J, Laugharne R, Purandare K, Alexander R, Roy A, Zia A, Gangadharan S, Hassiotis A. Organising care for complexity: a pathways model for adult community intellectual disability services. Int Rev Psychiatry. 2026 Feb 2:1-12. doi: 10.1080/09540261.2026.2624620. Epub ahead of print. PMID: 41630460.
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Article