Mental health services for people with intellectual disability in the UK Dr Bhathika Perera Consultant Psychiatrist in Intellectual disability Haringey- North London, UK 15th November 2018 1
London Borough of Haringey
London borough of Haringey
Mental health and mental illness in people with ID Haringey CCG London CCGs National % ID + Mental Health 14.1% 10.8% 8.1% % No ID + Mental Health 1.3% 1.1% 0.9% % ID + Dementia 1.2% 1.4% % non-ID + Dementia 0.4% 0.5% 0.7% % ID + Depression 11.1% 11.4% 13.2% % non-ID + Depression 8.3% 12.2% Very high risk of mental illness/mental health issues in people with ID
Case 22 year old man, Moderate ID, Autism, behavioural difficulties, hearing voices when 17-18 years- ?diagnosis of Schizophrenia Main stream mental health services- Treated with antipsychotic medications, antianxiety medications, different psychological interventions, OT assessments ID services- ADHD, Anxiety disorders- Treatment of ADHD, extra support to go to college, confidence building, support family, Starting an apprenticeship
Case 22 year old man, Moderate ID, Autism, behavioural difficulties, hearing voices when 17-18 years- ?diagnosis of Schizophrenia Main stream mental health services- Treated with antipsychotic medications, antianxiety medications, different psychological interventions, OT assessments ID services- ADHD, Anxiety disorders- Treatment of ADHD, extra support to go to college, confidence building, support family, Starting an apprenticeship
Mental Health services for people with ID Community services Community mental health services for people with ID Community Forensic services for people with ID Inpatient services Inpatient ID services for Mental disorder/challenging behaviour Inpatient ID Forensic services 9
Community Mental health services- Adults NHS Social services Integrated teams (Health and Social care) Psychiatrists in ID, Trainee doctors, Psychologists, LD nurses, Occupational therapists, Speech and Language therapists, Physiotherapists, Music/drama therapists , other allied health care staff. Social workers and other support staff. 10
Community Mental health services- Adults Referrals – Health professionals, Other Id services, self referrals Eligibility – Mild- Profound, only Moderate to Profound Over 18 Registered with a local GP 11
Mental health pathways Mental illness pathway Challenging behaviour pathway Dementia pathway Autism pathway ADHD pathway Others Mental illness pathway- undiagnosed depression 12
Community Mental health services- Children with ID Not well organised Child and adolescent mental health services Paediatricians Children and adolescent ID teams Under resourced
Integrated vs non-integrated Advantages Mental disorders- associated with social care issues Multidisciplinary approach Budgets Reduce admissions to psychiatric units Holistic approach Disadvantages Different models of working - Health care vs Social care Different targets Difficulty understanding each others roles Blurred working boundaries Difficulties in accessing training Lack of clinical governance structure Entry criteria may be different between health and social care 14
Intensive Support Teams Management of challenging behaviour and prevent admission
Other support in the community Day centres/Day opportunities Education- Colleges Voluntary schemes Employment Hospital Liaison services Reasonable adjustments in various settings
Inpatient services for people with ID Significant efforts to prevent admissions Main stream mental health beds Specialist ID inpatient units Approximately 2,500 people with ID or Autism in hospitals in England- 2017 Good relationship between community team and inpt team 17
Offenders with ID & mental disorders Inpatient forensic units for people with ID- Low, Medium and high secure Community Forensic services 18
Looking after people with ID and mental disorders Families Care providers (residential, supported living, shared living etc) 19
Community provisions- challenges Lack of providers Lack of skilled staff Governance/safe guarding within provider organisations 20
Works cited Bhathika Perera, Ken Courtenay, (2018) "Mental health services for people with intellectual disability in the United Kingdom", Advances in Mental Health and Intellectual Disabilities, https://doi.org/10.1108/AMHID-03-2018-0017
Thank you Twitter @bathika Email- Bhathika.Perera@nhs.net