MENTAL HEALTH SERVICES FOR PERSONS WITH INTELLECTUAL DISABILITY

1. MENTAL HEALTH SERVICES FOR PERSONS WITH INTELLECTUAL DISABILITY

2. 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

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

4. 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

5. 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

6. 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”

7. 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

8. INTERFACE BETWEEN SPECIALIST MENTAL HEALTH OF TEAM AND OTHER SERVICES

9. 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

10. 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

11. “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

12. “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

13. MENTAL HEALTH SERVICES FOR PERSONS WITH INTELLECTUAL DISABILITY