People with intellectual disabilities accessing mainstream mental health services: some facts, features and professional considerations
| DOI | https://doi.org/10.1108/JMHTEP-06-2016-0033 |
| Published date | 10 July 2017 |
| Date | 10 July 2017 |
| Pages | 215-223 |
| Author | Penelope Jane Standen,Adam Clifford,Kiran Jeenkeri |
| Subject Matter | Health & social care,Mental health,Mental health education |
People with intellectual disabilities
accessing mainstream mental health
services: some facts, features and
professional considerations
Penelope Jane Standen, Adam Clifford and Kiran Jeenkeri
Abstract
Purpose –The purpose of this paper is to provide information for non-specialists on identifying the
characteristics, assessment and support needs of people with intellectual disabilities (ID) accessing
mainstream services.
Design/methodology/approach –A review of relevant policy and research literature is supplemented with
observations from the authors’own experience of working in mental health services for people with ID.
Findings –With change in provision of services the likelihood of mainstream staff encountering someone
with ID will increase. However, information on whether a person has ID or their level of ID is not always
available to professionals in acute mental health services meeting an individual for the first time. Reliance on
observational and interview-based assessments can leave people with ID vulnerable to a range of over- and
under-diagnosis issues. This is as a result of difficulties with communication and emotional introspection,
psychosocial masking, suggestibility, confabulation and acquiescence. For people with poor communication,
carers will be the primary source of information and their contribution has to be taken into account.
Practical implications –Knowing or suspecting an individual has ID allows staff to take into account
the various assessment, diagnosis and formulation issues that complicate a valid and reliable understanding
of their mental health needs. Awareness about an individual’s ID also allows professionals to be
vigilant to their own biases, where issues of diagnostic overshadowing or cognitive disintegration may
be important considerations. However, understanding some of the practical and conceptual issues
should ensure a cautious and critical approach to diagnosing, formulating and addressing this population’s
mental health needs.
Originality/value –This synthesis of a review of the literature and observations from the authors’experience
of working in mental health services for people with ID provides an informed and practical briefing for those
encountering people with ID accessing mainstream services.
Keywords Mental health, Diagnostic overshadowing, Intellectual disabilities, Mainstream services,
Psychological distortion
Paper type General review
Background
There are a range of biopsychosocial factors that put people with intellectual disabilities (ID) at
greater vulnerability to mental health problems than the general population. Current e stimates put
theprevalenceofmentalhealthproblemsinthispopulationatmorethan1in3(35-41percent)
(Emerson et al., 2001; Cooper et al., 2007), compared to an almost 1 in 4 point-prevalence
(23.4 per cent) reported in the general population (Health and Social Care Information Centre, 2009).
The rate in ID has been seen to extend to nearly 1 in 2 (46 per cent), when “problem behaviours”
are included as a psychiatric complaint (Bhaumik et al., 2008). This approximates to an estimate of
416,000 adults with ID in England (Emerson et al., 2011) potentially seeking some form of mental
health support.
Received 21 June 2016
Revised 7 December 2016
Accepted 8 February 2017
Penelope Jane Standen is a
Professor in Health Psychology
and Learning Disabilities at the
Department of Rehabilitation
and Ageing, School of
Medicine, University of
Nottingham, Nottingham, UK.
Adam Clifford and Kiran Jeenkeri
are both based at the
Department of Intellectual and
Developmental Disability
Services, Nottinghamshire
Healthcare NHS Trust,
Nottingham, UK.
DOI 10.1108/JMHTEP-06-2016-0033 VOL. 12 NO. 4 2017, pp. 215-223, © Emerald Publishing Limited, ISSN 1755-6228
j
THE JOURNAL OF MENTALHEALTH TRAINING, EDUCATION AND PRACTICE
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