The ESTIA Centre
| DOI | https://doi.org/10.1108/13619322200000014 |
| Published date | 01 June 2000 |
| Pages | 15-18 |
| Date | 01 June 2000 |
| Author | Nick Bouras,Geraldine Holt,Theresa Joyce |
| Subject Matter | Health & social care |
The ESTIA Centre
Nick Bouras
Professor of Psychiatry, Guy’s Hospital
Geraldine Holt
Consultant Psychiatrist, Guy’s Hospital
Theresa Joyce
Consultant Psychologist
South London & Maudsley NHS Trust
Case Study
eople with learning disabilities are
a very heterogeneous population, ranging from those
having severe to mild learning disabilities. Prevalence
estimates have indicated that people with learning
disabilities (LD) are considerably more at risk of
mental illness than the general population. This is
because most of the risk factors for mental health
problems are highly prevalent in this population due
to genetic, biochemical, early experience, psychosocial
stressors and cognitive/behavioural problems. These
influences mean that it is often difficult to assess
whether presenting behaviours are the result of an
organic condition, a mental illness, environmental
influences, or some combination of all three.
Improving the mental health of individuals with LD
will help them pursue valued options and social roles
in daily life, and experience a better quality of life.
The recognition of mental health problems in
people with LD is particularly difficult, due partly to
linguistic limitations, which often make it difficult for
the individual to describe mental symptoms, and
partly to diagnostic overshadowing (ascribing the
symptoms of mental illness to the person’s life-long
LD). Case recognition is therefore a complex task
requiring a high level of knowledge about their
manifestations of mental illness. Failure to meet needs
often occurs because the problem is never recognised.
Recent developments, however, include improved
techniques for the characterisation of psychiatric
symptoms in people whose intellectual and verbal
ability is limited (Prosser et al., 1998).
The issue of challenging behaviour (CB) and its
relation to mental illness is particularly relevant to
people with learning disabilities as behaviours, which
come to be regarded as challenging, might be related
Pat times to mental health problems. This does not
imply necessarily that CB is a manifestation of mental
illness. Mental illness is only one possible explanation
for challenging behaviour (Emerson, Moss & Kiernan,
1999). Recent work by the same authors has shown a
relationship between the presence of CB and
symptoms of mental illness. In particular, symptoms,
which could indicate depression, were four times as
prevalent in those with severe challenging behaviour
compared to people without challenging behaviour.
The differentiation, however, between mental
illness and challenging behaviour is important, as each
requires a different emphasis in terms of service
response. People with challenging behaviour (in the
absence of a mental illness) are most likely to have
severe/moderate learning disabilities and have
challenging behaviour due to the contribution of a set
of circumstances including poor environment,
communication difficulties and learned responses and
these may be accentuated by staff/carers lacking the
skills to intervene effectively.
People with mental illness tend to be more able.
They may require specialist assessment and treatment
including admission (Holt & Joyce, 1999). Although
there will be some overlap between challenging
behaviour and mental illness for some clients, and
these individuals require components of both
approaches, it is important to recognise that the same
service response will not meet the needs of both groups.
The Estia (Evaluation, Services, Training,
Interventions and Assessment) Centre is a new
development which aims to bring together clinical
services, training for staff, and academic research
into relevant issues for people with mental health
needs which could be either mental illness or CB.
The Mental Health Review Volume 5 Issue 2 June 2000 ©Pavilion Publishing (Brighton) 2000 15
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