A comparison of different models to meet the mental health needs of adults with intellectual disabilities

Abstract

Purpose -There is ongoing discussion around how to structure psychiatric services to meet the needs of people with intellectual disability and co-morbid mental illness and several different models have been suggested. With research evidence lacking, there is a lack of consensus as to the best model of service provision. This paper aims to review the current knowledge in this area and discuss the salient issues.Design/methodology/approach -This is a review article summarising the current debate. Evidence from original research is presented and combined with opinion from clinical experience.Findings -The authors find a lack of robust research evidence to support any particular model of service provision. However, it seems to be increasingly accepted that purely generic models of care for people with intellectual disabilities and co-morbid mental illness are not appropriate. Integration of the expertise from specialist services within mainstream services is presented as potentially the most advantageous approach.Originality/value -This article will be of benefit to clinicians working in the field of intellectual disability and mental illness, and to managers and commissioners with responsibility for providing services. It will also be useful for those new to the discipline to gain an overview of the current issues and debate within service planning for this population.

The experiences of high intensity therapists delivering cognitive behavioural therapy to people with intellectual disabilities

“…Historically, specialist intellectual disability teams and mainstream mental health services in England have operated independently and there is currently a lack of consensus concerning the most appropriate service delivery model for this client group (Sheehan & Dimitrios, 2013). This study has highlighted some of the potential challenges of providing psychological treatments to people with intellectual disabilities within mainstream services, including when standardised protocols are delivered with minimal flexibility and when conceptual frameworks of recovery may differ between service models.…”

“…However, equality legislation and an increasingly diverse population mean services need to be able to deliver effective psychological treatments. Developing appropriate service models for people with intellectual disabilities is complex and research in this area is limited (Sheehan & Dimitrios, 2013). There is an argument that IAPT is appropriate for people with intellectual disabilities (FPLD, 2015), although the literature presents a mixed picture.…”

Debates about dedifferentiation: twenty-first century thinking about people with intellectual disabilities as distinct members of the disability group

“…Since 84% of people with intellectual disabilities have cooccurring physical and mental health problems, these effects often interact: the way antipsychotic medications lower epileptic seizure thresholds illustrates why this needs to be taken into account during treatment (Crocker, Proki c, Morin, & Reyes, 2014). Health services struggle with the way cognitive impairments affect subjective experience of pain or ill health and the ability to reflect and report it (Sheehan & Paschos, 2013). This includes difficulties in describing the location and type of physical or emotional pain in ways that support diagnosis.…”

Needs among persons with human immunodeficiency virus and intellectual and developmental disabilities in community mental health care: a cross‐sectional study

“…Individuals with ID are another growing population in the community following the deinstitutionalization movement in the 1990s and 2000s (Sheehan & Paschos ; Tang et al . ; Lemay ; Turygin et al .…”

“…Individuals with ID are another growing population in the community following the deinstitutionalization movement in the 1990s and 2000s (Sheehan & Paschos 2013;Tang et al 2008;Lemay 2009;Turygin et al 2014). Individuals with ID may have a particular vulnerability to HIV because of the impulse control deficits and impaired judgement that can accompany ID, contributing to limited awareness of risky sexual and drug use practices (De Beaudrap et al 2014;Brown & Jemmott 2002;Alford et al 1994;Rehm et al 2012).…”