MENTAL HEALTH SERVICES FOR PERSONS WITH INTELLECTUAL DISABILITY

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 Admission of large numbers of individuals with intellectual disability to Mental Hospitals 16% of Mental Hospital population in % of Mental Hospital population in % of Mental Hospital population in 2006 De-Designation of Mental Hosptial Units De-Designation of Mental Hosptial Units Disparate services, with lack of co-ordination in service delivery and problems in planning comprehensive service developments Disparate services, with lack of co-ordination in service delivery and problems in planning comprehensive service developments No Catchmenting of service delivery No Catchmenting of service delivery

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

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 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 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 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 1,600 people nationally – problems can be severe and intractable

CHALLENGING BEHAVIOUR  “Challenging Behaviour” Severe behaviour problems in individuals with ID 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 impossibleCulturally 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. Verbal or physical aggression, destructive behaviour, self-harming behaviour, sexually inappropriate behaviour. Considered a diagnostic category in ID by the RCPsych 2004 Considered a diagnostic category in ID by the RCPsych 2004

MODERNISING MENTAL HEALTH SERVICES  Past experience best described as “syncopated equilibrium” Commissions of Inquiry into Mental Illness and Mental Handicap 1966 Commissions of Inquiry into Mental Illness and Mental Handicap 1984 “Planning for the Future” 1984 “Planning for the Future” 2001 “Mental Health Act 2001 “Mental Health Act 2002 Mental Health Commission 2002 Mental Health Commission 2006 “Vision for Change” 2006 “Vision for Change”

Prevention and Mental Health Promotion Early Detection of Mental Health Problems Crisis Management for Mental Health Problems / Challenging Behaviour Specialised MH Services KEY SERVICE ELEMENTS FOR THE MENTAL HEALTH NEEDS OF INDIVIDUALS WITH INTELLECTUAL DISABILITY

INTERFACE BETWEEN SPECIALIST MENTAL HEALTH OF TEAM AND OTHER SERVICES Intellectual Disability Services MDT Comprehensive Social Care Individual At Home – No ID Service GP Primary Care Service Individual At Home – Day ID Service GP Primary Care Service Specialist Mental Health Multidisciplinary Team Full Range of Service Facilities Acute and Rehab Beds, Day Services etc. Individual Residing in ID Service Accommodation GP Primary Care Service

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 Consultant Psychiatrist 1 NCHD 1 NCHD 2 Psychologists 2 Psychologists 2 Clinical Nurse Specialists 2 Clinical Nurse Specialists 2 Social Workers 2 Social Workers 1 Occupational Therapist 1 Occupational Therapist Administrative and Support Staff Administrative and Support Staff  Each team to address both mental health needs and challenging behaviour

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 Will ensure appropriate safeguards for compulsory admission, treatment procedures, use of seclusion, restraint etc  Need to address issues of Capacity

“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

“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

MENTAL HEALTH SERVICES FOR PERSONS WITH INTELLECTUAL DISABILITY