World Mental Health Day 2017 Mental health issues in People with Intellectual Disability Dr Bhathika Perera (Consultant Psychiatrist) Dr Ken Courtenay (Consultant Psychiatrist) Dr Shakeel Islam (Specialty Registrar) Introduction How many General adult Psychiatrists?

What is Intellectual Disability ICD 10: Mental Retardation DSM V: Intellectual disability Deficits in intellectual functioning- reasoning, planning, abstract thinking, judgment, learning from experience IQ<2 sd 70 Deficits in adaptive functioning- fail to meet sociocultural and developmental standards for personal independence and social responsibility Onset during the developmental period Prevalence of 1- 2.6% (Maulik et al, 2011, Emerson 2003)

Defining severity of ID depending on IQ Mild - 50-69 (85%) Moderate - 35-49 (10%) Severe - 20-34 (4%) Profound - <20 (1%)

Defining severity of ID depending on adaptive behaviour skills Mild - Needs some support with complex daily living tasks compared to non ID peers – Ex- Shopping, home and child care organisation, money management. Moderate - Needs more support with above, Needs more support with personal care. Severe - Requires support for all activities of daily living. Requires supervision at all times. Profound - Dependent on others for all aspects of care

Cause of Intellectual disability- Many reasons, some of them are Cause of Intellectual disability- Many reasons, some of them are.. Some are not known Before birth During birth After birth Neural tube defects Iodine deficiency: hypothyroidism (cretinism) Rhesus incompatibility Infectious diseases Alcohol: foetal alcohol syndrome Drugs Radiation Heavy metals Trauma Hypoxia Hypoglycaemia Cerebral thrombosis Physical trauma Accidents Infectious diseases (meningitis, encephalistis) Chemical, e.g. lead Nutritional/metabolic

Mental Illness in People with ID How common is it? Studies have consistently shown that mental health issues are significantly high in people with ID compared to non-ID people. Here are some of the research......

Epidemiology of mental health problems: Significant levels of psychopathology among: 40% of a population-based sample of 454 Australian children with ID (Einfeld & Tonge 1996) 38% of a sample of 143 children with severe ID in Lothian, Scotland (Hoare et al. 1998) 50% of a sample of 123 children attending schools for children with severe ID in Southampton and the New Forest area of England (Cormack et al. 2000) Up to 17% of people with ID in the community will have challenging behavior (Ref: Allen, JIDR, 2008, Thakker et al, Advances in Mental Health ID, 2012)

According to the APMS (2014), Common mental health problems in, 13.4% - Above-average, 17.2% - Average, 25% - lower intellectual Raj, D., Stansfeld, S., Weich, S., Stewart, R., McBride, O., Brugha, T., … & Papp, M. (2016). Chapter 13: Comorbidity in mental and physical illness. In S. McManus, P. Bebbington, R. Jenkins, & T. Brugha (Eds.), Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital. 252. 2007 UK population-based study - 54% people with ID have a mental health problem. Cooper, S.A., Smiley, E., Morrison, J., Williamson, A., & Allan, L. (2007). Mental ill-health in adults with intellectual disabilities: Prevalence and associated factors. The British Journal of Psychiatry, 190, 27–35. 253. 36% among children with ID compared to 8% among children without ID. Increased prevalence - marked for ASD, ADHD and conduct disorders. Emerson, E., & Hatton, C. (2007). Mental health of children and adolescents with intellectual disabilities in Britain. The British Journal of Psychiatry, 191(6), 493–499

Epidemiology of mental health problems: Personality disorders (study of community sample): apprx 30% (Deb S, 1991) ADHD – Relative risk of 6.2

Risk factors for increased psychopathology in children and adolescents with ID Age Gender Social deprivation Number of potentially stressful life events, Mental health of the child's primary carer, Child management practices Many other risk factor for mental illness in people with ID.....

Physical health issues: ex- Epilepsy Aetiololgy of ID-Genetic syndromes/behavioural phenotypes etc Neurodevelopmental disorders Life experiences- Bullying, not been able to engage in activities their non ID peers do Neuropsychological deficits- Executive dysfunction Physical health issues: ex- Epilepsy Environmental factors Communication difficulties

Physical health issues in people with LD significantly high, this also increases the risk of mental health issues Epilepsy (20-50%) Cerebral palsy (15-40%) Visual impairment (10-30%) Hearing impairment (10-30%) Speech defects of any type (60-85%) Obesity – sedentary lifestyle, increased risk of diabetes

When to suspect mental illness: Any changes in behaviour, for example: loss of skills or needing more prompting to use skills social withdrawal irritability avoidance agitation loss of interest in activities they usually enjoy.

Symptom presentation Usually as in general population (mild) - behavioural signs may predominate Change in level of functioning Often non-specific Symptoms simpler Less able to describe symptoms

Information to people with ID- Need to be given in an accessible way Link to accessible information http://www.birmingham.ac.uk/research/activity/ld-medication-guide/downloads/medicine-information.aspx

Medications are important for people to get better from mental illness, however, studies have shown some people with ID may be taking medications without a clear reason.

STOMP campaign- Stop over use of Psychotropic medications

Hope this presentation helps to raise awareness of mental health issues in people with intellectual disability. Happy World Mental Health Day.