A Blind Spot? Screening for Mild Intellectual Disability and Borderline Intellectual Functioning in Admitted Psychiatric Patients: Prevalence and Associations with Coercive Measures

Abstract

BackgroundFailure to detect psychiatric patients’ intellectual disabilities may lead to inappropriate treatment and greater use of coercive measures.AimsIn this prospective dynamic cohort study we screened for intellectual disabilities in patients admitted to psychiatric wards, and investigated the use of coercive measures with these patients.MethodsWe used the Screener for Intelligence and Learning disabilities (SCIL) to screen patients admitted to two acute psychiatric wards, and assessed patient characteristics and coercive measures during their stay and over the last 5 years.ResultsResults on the SCIL suggested that 43.8% of the sample had Mild Intellectual Disability or Borderline Intellectual Functioning (MID/BIF). During their current stay and earlier stays in the previous 5 years, these patients had an increased risk of involuntary admission (OR 2.71; SD 1.28–5.70) and coercive measures (OR 3.95, SD 1.47–10.54).ConclusionsThis study suggests that functioning on the level of MID/BIF is very prevalent in admitted psychiatric patients and requires specific attention from mental health care staff.

Screening for intellectual disabilities and borderline intelligence in Dutch outpatients with severe mental illness

“…As can be seen, the SCIL results suggested that 20% of the patients had MID and 20% had BIF, resulting in a total of 40% of the patients being suspected to have MBID as indicated by a SCIL score of ≤19. In comparison, it was found that 43.8% of the patients scored ≤19 on the SCIL in the earlier study by Nieuwenhuis et al () among acutely admitted psychiatric patients. Results of the regular IQ tests suggested that over half of the patients were functioning on the level of MBID, as 58% had an IQ of 84 or lower, and one out of five patients (20%) might have had MID (see Figure ).…”

“…In this article, we will address these two groups together (i.e., patients with MID and BIF) by using MBID as an umbrella term. Based on the results of Nieuwenhuis et al (), the prevalence of (suspected) MBID among hospitalized psychiatric patients clearly appears to be elevated. On the basis of a normal distribution, one may expect that about 16% of the general population has an IQ below 85.…”

“…Recently, psychiatric patients admitted to two Dutch psychiatric admission wards were screened regarding their intellectual abilities (Nieuwenhuis, Noorthoorn, Nijman, Naarding, & Mulder, ). This screening was performed with the SCIL, which stands for Screener for Intelligence and Learning Disabilities (Kaal, Nijman, & Moonen, ; Nijman, Kaal, Van Scheppingen, & Moonen, ).…”

“…Because MBID in daily practice often remains unrecognized by mental health professionals (Nieuwenhuis et al, ), the treatment of and interaction with such patients is often inadequately adapted according to their needs and social as well as emotional development (Došen, ). This may result in reduced effectiveness of treatment and longer admission durations.…”

“…This may result in reduced effectiveness of treatment and longer admission durations. It may also lead to higher likelihood of being subject to coercive measures during admission (Nieuwenhuis et al, ). In addition, psychiatric patients with MBID have a higher chance of encountering various additional problems in life, such as having more difficulty finding employment or adequate housing.…”