MENTAL HEALTH SERVICES FOR PERSONS WITH INTELLECTUAL DISABILITY

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MENTAL HEALTH SERVICES FOR PERSONS WITH
INTELLECTUAL DISABILITY
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Historical Difficulties

• Conflation of Mental Illness and Intellectual
  Disability - Fools and Mad
• Opt-out of direct service provision by the State
  resulting in
• Admission of large numbers of individuals with
  intellectual disability to Mental Hospitals
• 16 of Mental Hospital population in 1973
• 7 of Mental Hospital population in 2006
• De-Designation of Mental Hosptial Units
• Disparate services, with lack of co-ordination in
  service delivery and problems in planning
  comprehensive service developments
• No Catchmenting of service delivery

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STIGMATISATION

• Range of individual care needs obscured
• Lack of concepts relating to citizenship and
  rights
• Problems in normalisation and mainstreaming of
  services

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MENTAL HEALTH PROBLEMS IN INDIVIDUALS WITH ID

• Approximately 25,000 people on the NIDD
• People with mild ID under-represented
• Risk of Mental Health Problems
• Severe and Profound ID - 50 will have a mental
  health problem at some time in their lives
• Mild and Moderate ID - 20 25 will have a
  mental health problem at some time
• Total prevalence of Challenging Behaviour /
  Problem Behaviour
• 3,000 people nationally 12 of those on the
  NIDD
• Prevalence of Challenging Behaviour / Problem
  Behaviour with co-existing MH Problem
• 1,600 people nationally problems can be severe
  and intractable

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CHALLENGING BEHAVIOUR

• Challenging Behaviour
• Severe behaviour problems in individuals with ID
• Culturally abnormal behaviours of such intensity,
  frequency or duration that physical safety in
  jeopardy or access to community facilities denied
  or impossible
• Problem Behaviour
• Verbal or physical aggression, destructive
  behaviour, self-harming behaviour, sexually
  inappropriate behaviour.
• Considered a diagnostic category in ID by the
  RCPsych 2004

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MODERNISING MENTAL HEALTH SERVICES

• Past experience best described as syncopated
  equilibrium.
• 1966 Commissions of Inquiry into Mental Illness
  and Mental Handicap
• 1984 Planning for the Future
• 2001 Mental Health Act
• 2002 Mental Health Commission
• 2006 Vision for Change

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KEY SERVICE ELEMENTS FOR THE MENTAL HEALTH NEEDS
OF INDIVIDUALS WITH INTELLECTUAL DISABILITY
Prevention and Mental Health Promotion
Crisis Management for Mental Health Problems /
Challenging Behaviour
Early Detection of Mental Health Problems
Specialised MH Services
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INTERFACE BETWEEN SPECIALIST MENTAL HEALTH OF
TEAM AND OTHER SERVICES
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SPECIALIST MHID TEAM STAFFING

• Adults 2 Teams per 300,000 population
• Children Adolescents 1 Team per 300,000
  population
• Each Team to comprise
• 1 Consultant Psychiatrist
• 1 NCHD
• 2 Psychologists
• 2 Clinical Nurse Specialists
• 2 Social Workers
• 1 Occupational Therapist
• Administrative and Support Staff
• Each team to address both mental health needs and
  challenging behaviour

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LEGISLATIVE PROTECTION AND CONSENT

• Need to establish approved units under the 2001
  Mental Health Act
• Will ensure appropriate safeguards for compulsory
  admission, treatment procedures, use of
  seclusion, restraint etc
• Need to address issues of Capacity

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VISION FOR CHANGE RECOMMENDATIONS FOR MH
SERVICES FOR THOSE WITH ID

• Promotion and maintenance of mental well-being to
  be an integral part of service provision in ID
  Services
• All individuals with ID to be registered with a
  GP
• Process of service delivery for mental health
  care to individuals with ID to be the same as for
  all other citizens
• Detailed, standardised information on the mental
  health of individuals with ID to be gathered by
  the NIDD
• A national prevalence study of mental health
  problems, including challenging behaviour, to be
  carried out to inform service planning
• Specialist MHID Services to be catchment-based
  and provided by Multi-Disciplinary Team

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VISION FOR CHANGE RECOMMENDATIONS FOR MH
SERVICES FOR THOSE WITH ID (2)

• Two Specialist MHID Teams for adults with
  Intellectual Disability to be provided per
  300,000 general population
• One Specialist MHID Team for children and
  adolescents with Intellectual Disability to be
  provided per 300,000 general population
• A range of facilities and services to be put in
  place to provide a continuum of care including
  acute care, rehabilitation care, inpatient care
  and day care
• Close liaison between ID Services, Specialist
  MHID service and General Practitioner / Primary
  Care services in referral procedures, service
  delivery and follow-up
• One 10-bed National Forensic Unit to be provided
  with full range of services and facilities

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MENTAL HEALTH SERVICES FOR PERSONS WITH
INTELLECTUAL DISABILITY