Family and caregivers’ experience of mental illness in migrants with intellectual disability – reflections on practice
| Pages | 76-88 |
| DOI | https://doi.org/10.1108/AMHID-06-2018-0029 |
| Published date | 04 March 2019 |
| Date | 04 March 2019 |
| Author | Jane Margrete Askeland Hellerud,Trine Lise Bakken |
| Subject Matter | Health & social care,Learning & intellectual disabilities |
Family and caregivers’experience of
mental illness in migrants with intellectual
disability –reflections on practice
Jane Margrete Askeland Hellerud and Trine Lise Bakken
Abstract
Purpose –The purpose of this paper is to investigate the families’and professional caregivers’experience of
mental health services for patients in the migrant population with intellectual disability (ID).
Design/methodology/approach –To highlight this rarely studied topic, the authors chose a qualitative
approach, using a semi-structured interview guide. The authors performed a search for relevant articles.
Three families of former patients of a specialized psychiatric inpatient unit and 12 professional caregivers were
interviewed. The interviews were taped, transcribed and analyzed using a thematic analysis.
Findings –In total, 17 themes from the families’answers and 14 themes from the caregivers’answers were
grouped into four main themes each. Two main themes were identical for both groups: perspectives on
mental illness and “the Norwegian system.”Additionally, the families were concerned about the impact on the
patient and family and coping strategies. The caregivers highlighted patient–caregiver interaction and
family–caregiver interaction.
Research limitations/implications –Further research should include the patients’opinions based on the
findings of this study. Also, studies including larger samples from both specialist services and community
services are needed to develop evidence-based services for these patients.
Practical implications –Proposed adaptations to enable assessment and treatment of mental illness in
migrants with ID should be adapted to cultural preferences. The following adaptations are proposed:
inclusion of the entire family, awareness of cultural dimensions, information about the health care system,
education in mental illness, the use of interpreters and adequate time spent with the families.
Originality/value –Mental health services for this group are an understudied topic. Clinical experience
indicates that professionals struggle when providing services for such patients.
Keywords Mental health, Assessment, Intellectual disability, Families, Migrants, Transcultural psychiatry
Paper type Research paper
Introduction
As there is a dearth of publications on mental health in migrants with intellectual disability (ID), this
paper uses insights from the fields of ID and mental health, mental health in migrants/refugees
and migrants/refugees with ID and their families. Currently it is generally accepted that people
with ID develop the same mental illnesses (Cooper et al., 2007; Chaplin et al., 2009; Deb et al.,
2001) and studies have found an even higher prevalence of mental illness in people with ID
compared to the general population. (Cooper et al., 2007; Deb et al., 2001) A core element in
diagnosing mental illness in this group is diagnostic overshadowing (Bakken et al., 2009; Cooper
et al., 2007). This term refers to the problem of separating symptoms of mental illness from the
phenomenology of ID and addresses the fact that symptoms of mental disorder are often
overlooked and are therefore regarded as a trait of ID and/or autism spectrum disorder. This is
particularly evident with regard to challenging behaviors such as aggression, irritability, passivity
and self-harm (Reiss et al., 1982; Bakken et al., 2009). People with ID who develop severe
mental illnesses such as schizophrenia or other psychosis, bipolar disorder or major depression
will, in most cases, experience a significant decline in global functioning (Bakken et al., 2016).
Received 13 June 2018
Revised 9 November 2018
9 April 2019
Accepted 12 April 2019
Jane Margrete Askeland
Hellerud and Trine Lise Bakken
are both based at Regional
section Psychiatry,
Intellectual Disability/Autism,
Oslo University Hospital,
Asker, Norway.
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VOL. 13 NO. 2 2019, pp.76-88, © Emerald Publishing Limited, ISSN 2044-1282 DOI 10.1108/AMHID-06-2018-0029
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