Psychiatry and intellectual disabilities: navigating complexity and context

Date10 July 2017
Pages224-236
Published date10 July 2017
DOIhttps://doi.org/10.1108/JMHTEP-10-2016-0050
AuthorJo Jones,Kiran Jeenkeri,Peter Cutajar
Subject MatterHealth & social care,Mental health,Mental health education
Psychiatry and intellectual disabilities:
navigating complexity and context
Jo Jones, Kiran Jeenkeri and Peter Cutajar
Abstract
Purpose The paper is a review, for the general adult mental health practitioner, of the issues to consider
when managing a mental health presentation of a person with intellectual disability (PWID). The paper aims to
discuss these issues.
Design/methodology/approach A neurodevelopmental model is outlined to assist practitioners in
unravelling the wide range of potential factors relevant to intellectual disabilities (IDs). This includes an
emphasis on complexity and interdisciplinary formulation within an individuals context, and implications of
the current policy changes.
Findings In practice, managing the mental health of PWID can be challenging within usual mainstream
services; there is more to consider than is usual for the general population.
Originality/value The paper provides general mental health practitioners with a framework for a greater
depth of understanding of the issues involved in the management of people with intellectual disability (ID). This
includes discussion of the current policy context in ID, and some of its limitations.
Keywords Mental health, Intellectual disabilities, Assessment and treatment
Paper type Conceptual paper
Introduction
A number of studies have demonstrated an increased prevalence of psychiatric disorders in
people with an intellectual disability (ID) compared to the general population (Cooper et al., 2007;
Smiley et al., 2007). A point prevalence of 40 per cent was reported in a detailed large scale study
in Scotland (Cooper et al., 2007). A two-year incidence of mental illness in a study in Greater
Glasgow was 16.7 per cent. From this population, some are likely to present to generic adult
mental health (AMH) services, and in some areas the preferred pathway may be within AMH.
The servicemodel for treatment of person with intellectualdisability (PWID)and psychiatric illness is
a matter of debate as reviewed by Sheehan and Paschos (2013). The government paper Valuing
People Now (Department of Health, 2009) required services in England to become more
responsive to the needs of those with mild intellectual disabilities (IDs). The Royal College of
Psychiatrists(2012) produced a report to guide goodpractice in enabling access to mentalhealth
services. It proposed a care pathway including collaboration between ID teams and AMH.
Nationally, following investigations into care at the Winterbourne View and similar hospital units
(NHS England,2014), a service model has been described(Association of Directorsof Adult Social
Services, Local Government Association, NHS England, 2015) to transform services for PWID,
including for mental health conditions,over a three-year period. This includesthe expectation that
mainstream mental health services willadapt to meet their needs. Managing patients with ID can
be a challenge within general mental health services, and practitioners may find that the issues
involved in the care of this heterogeneous group are more complex than usual. Mental health
patientsmay have physical ill-health, and dualdiagnosis with substance misuseis common. Whilst
substance misuseis less frequent in patients withID, the pattern of other complexitiesis different,
and co-morbidities may be present. Indeed, the term dual diagnosisin ID is used more
commonly to refer to the co-occurrence of mental illness and ID. The need for more training in
Received 18 October 2016
Revised 12 December 2016
Accepted 8 February 2017
The authors would like to thank
Uday Siddharti for assistance in
preparation of Figure 1.
Jo Jones is a Consultant
Psychiatrist and an Associate
Postgraduate Dean at the
Department of Intellectual and
Developmental Disability
Services, Nottinghamshire
Healthcare NHS Trust,
Nottingham, UK.
Kiran Jeenkeri and
Peter Cutajar are both based at
the Department of Intellectual
and Developmental Disability
Services, Nottinghamshire
Healthcare NHS Trust,
Nottingham, UK.
PAGE224
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THE JOURNAL OF MENTALHEALTH TRAINING, EDUCATION AND PRACTICE
j
VOL. 12 NO. 4 2017, pp.224-236, © Emerald Publishing Limited, ISSN 1755-6228 DOI 10.1108/JMHTEP-10-2016-0050

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