Mental healthcare for adults with mild intellectual disabilities: population-based database study in Dutch mental health services

Abstract

Background Adults with mild intellectual disability (MID) experience more mental health disorders than the general population. However, mental healthcare may be insufficiently tailored to match their needs. Detailed information is lacking regarding care provided to people with MID in mental health services. Aims To compare mental health disorders and care provided to patients with and without MID in Dutch mental health services, including patients with missing MID status in the service files. Method In this population-based database study, we used a Statistics Netherlands mental health service database, containing health insurance claims of patients who utilised advanced mental health services in 2015–2017. Patients with MID were identified by linking this database with Statistic Netherlands’ social services and long-term care databases. Results We identified 7596 patients with MID, of whom 60.6% had no intellectual disability registration in the service files. Compared with patients without intellectual disability (n = 329 864), they had different profiles of mental health disorders. They received fewer diagnostic (odds ratio 0.71, 95% CI 0.67–0.75) and treatment activities (odds ratio 0.56, 95% CI 0.53–0.59), and required more interprofessional consultations outside of the service (odds ratio 2.06, 95% CI 1.97–2.16), crisis interventions (odds ratio 2.00, 95% CI 1.90–2.10) and mental health-related hospital admissions (odds ratio 1.72, 95% CI 1.63–1.82). Conclusions Patients with MID in mental health services have different profiles of mental health disorders and care than patients without intellectual disability. In particular, fewer diagnostics and treatments are provided, especially in those with MID with no intellectual disability registration, putting patients with MID at risk of undertreatment and poorer mental health outcomes.

Updates in the care of youths with intellectual disability and autism spectrum disorder

“…Children with ASD were 24% less likely to have care coordination and 23% less likely to have a medical home compared with kids with non-ASD emotional and behavioural disorders. Patients with IDD report negative experiences with mental health services, including poor accessibility and information provision [25 ▪▪ ], extensive use of pharmacotherapy, often without an appropriate psychiatric assessment and diagnosis [26 ▪ ].…”

“…Further issues are specifically related to the quality of care for patients with a combination of IDD, including borderline intellectual functioning, and mental health disorders in mental health services. Either the IDD or the mental health disorder may often be missed when symptoms are attributed exclusively to either of these specific disorders despite both states being present, so-called diagnostic overshadowing [25 ▪▪ ]. For this and other diagnostic issues, a considerable rate of hidden psychopathology is reported in persons with NDD, especially when major cognitive and communication issues are present [13 ▪ ].…”

“…These factors contribute to insufficient care and can result in chronic, more difficult-to-treat mental health issues. Research findings show that when compared with the general psychiatric population, people with IDD attending mental health services are younger, more often men, have different diagnostic profiles, receive fewer diagnostic and treatment activities, require more interprofessional consultations outside of the service, require more crisis interventions, and more psychiatric hospital admissions [25 ▪▪ ].…”