Mental Health of People With Intellectual Disabilities
Mental Health of People With Intellectual Disabilities
The current issue updates the evidence base relating to the broader issues of the mental health of people with developmental and intellectual disabilities.
In the first review Zaja and Rojahn (pp. 441-444) present recent research on the facial emotion recognition in people with intellectual disabilities. Though facial and emotional recognition has been studied in autism there is not a great deal of research to the wider group of people with intellectual disabilities. There is, however, some evidence that people with intellectual disabilities have deficits in facial emotion recognition that cannot be fully accounted for by cognitive-intellectual abilities. In addition, cognitive processing strategies and genetic syndrome-specific differences in facial emotion recognition have been discovered in people with intellectual disabilities. A better understanding of the implications of poor facial emotion recognition can better inform interventions to improve adaptive social functioning in people with intellectual disabilities with a potential beneficial effect on their mental health.
Martorell and Tsakanikos (pp. 445-448) provide an enlightening review on the role of recent life events and traumatic experiences across the lifespan of people with intellectual disabilities. They are exploring the question as to whether these events are risk factors or triggering factors, including the differentiation between traumatic and life events. Although life events have been associated with a range of mental health problems, only limited research has attempted to clarify their role in the psychopathology of people with intellectual disabilities. In addition the differences between life events and traumatic experiences have been overlooked in this population. This is mainly because establishing a clear cutting point between the two types of events is not always possible. They rightly point out that identifying possible protective factors should have important clinical implications for the mental health of people with intellectual disabilities.
Søndenaa, Rasmussen and Nøttestad (pp. 449-453) offer a comprehensive review on the forensic issues affecting people with intellectual disabilities. This is an area of increasing interest and importance in recent years with developments in community care. People with intellectual disabilities and forensic issues have been seriously challenging service systems from a delivery and financial point of view. Successful responses are in high demand. There are differences between countries, even within the same countries, in policy and organization of services for offenders with intellectual disabilities. Recent research has contributed to considerable progress in our understanding of the characteristics of offenders with intellectual disabilities, their assessment and violence and sex offenders. More evidence-based studies are needed to examine the effectiveness of a range of service responses.
Aggressive challenging behaviour for people with intellectual disabilities remains one of the most complex clinical problems in terms of assessment and treatment interventions. It is very relevant to a person's mental health and it may be related to mental health problems. Benson and Brooks (pp. 454-458) describe and analyse critically recent studies on aggressive challenging behaviour for people with intellectual disabilities. They state that aggressive behaviour in adults often has multiple functions and that research on aggressive challenging behaviour requires assessment instruments that address the topography and severity of aggression. Greater access to effective, nonmedication treatments is needed as the use of psychotropic medication was shown to be ineffective in a recent large randomized controlled study. Nonmedication interventions, however, also need to demonstrate effectiveness using careful randomized controlled methodology.
Evaluation of community services for people with intellectual disabilities and mental health problems remains scarce as is demonstrated by Hemmings (pp. 459-462). In his critical appraisal of community services for people with both intellectual disabilities and mental health problems he suggests that the identification of the specific service components might be necessary, in the first instance, to determine what community services should be like for this population. Systematic methods of assessing which individual service components are essential for the provision of an effective and satisfactory service for people with intellectual disabilities and mental health problems should be employed. Research should focus on those with intellectual disabilities who have more severe mental health problems and involve a range of stakeholders as well as outcomes. Such research should also help to define which groups of people with intellectual disabilities and mental health problems are most likely to benefit from more intensive or assertive services, which have already been widely employed in adults with mental health problems but without intellectual disabilities.
The increased risk of mental health problems in children and adolescents with intellectual disabilities is further confirmed by recent studies reviewed methodically by Kolaitis (pp. 469-473). Early detection and adequate treatment are necessary to prevent chronic problems and also alleviate family burden. Attention should be given to the prevention of mental health problems and early recognition with better screening methods. Inequalities in the provision of services must also be addressed including specialist services. The lack of relevant studies from low and middle income countries is noted.
Little is known about the mental health of parents with intellectual disabilities. It is known that they are more susceptible to psychological distress, isolation and abuse while a significant proportion risk losing custody of their children. Recent studies indicate that these parents have an increased risk of psychopathology and mental health problems, which influence their ability to parent. O'Hara and O'Keeffe (pp. 463-468) highlight the service deficiencies for this very vulnerable group of people with intellectual disabilities. They correctly state that parents with intellectual disabilities have a right to specialist support to enable them to enjoy a normal family life. Access to appropriate services can be challenging due to a combination of factors including a lack of expertise and economic and other organizational difficulties.
Finally Walsh (pp. 474-478) addresses the evidence base on the health of people with intellectual disabilities detected in population surveys and healthcare service systems. The work of the Pomona group (website: http://www.pomonaproject.org ), partners in 17 European countries who have developed and applied a set of health indicators for people with intellectual disabilities, is also summarized. Health inequalities are apparent when people with intellectual and other disabilities are compared with their peers in the general population. Relatively few studies have been reported to date that apply health indicators to persons with intellectual disabilities. As Walsh rightly states it is likely that better definitions, measures and surveillance will yield comparable information to inform public health policy and clinical practice and thus address health inequalities, including mental health, as a priority. There is no health without mental health as has been pointed out by the World Health Organization and presented in a special edition of The Lancet.
People with both intellectual disabilities and mental health problems are among the most vulnerable and socially excluded in society. The presence of mental health problems can seriously affect their adaptation and quality of life. Although research on mental health aspect for people with intellectual disabilities continues to grow and to expand on both clinical and service related topics the same pertinent questions, as referred to in the last few issues of this publication, continue to be mostly unanswered, such as, Which types of treatment are both clinically and cost effective? What types of services work? How can we tailor services according to gender or culture?
The current issue updates the evidence base relating to the broader issues of the mental health of people with developmental and intellectual disabilities.
In the first review Zaja and Rojahn (pp. 441-444) present recent research on the facial emotion recognition in people with intellectual disabilities. Though facial and emotional recognition has been studied in autism there is not a great deal of research to the wider group of people with intellectual disabilities. There is, however, some evidence that people with intellectual disabilities have deficits in facial emotion recognition that cannot be fully accounted for by cognitive-intellectual abilities. In addition, cognitive processing strategies and genetic syndrome-specific differences in facial emotion recognition have been discovered in people with intellectual disabilities. A better understanding of the implications of poor facial emotion recognition can better inform interventions to improve adaptive social functioning in people with intellectual disabilities with a potential beneficial effect on their mental health.
Martorell and Tsakanikos (pp. 445-448) provide an enlightening review on the role of recent life events and traumatic experiences across the lifespan of people with intellectual disabilities. They are exploring the question as to whether these events are risk factors or triggering factors, including the differentiation between traumatic and life events. Although life events have been associated with a range of mental health problems, only limited research has attempted to clarify their role in the psychopathology of people with intellectual disabilities. In addition the differences between life events and traumatic experiences have been overlooked in this population. This is mainly because establishing a clear cutting point between the two types of events is not always possible. They rightly point out that identifying possible protective factors should have important clinical implications for the mental health of people with intellectual disabilities.
Søndenaa, Rasmussen and Nøttestad (pp. 449-453) offer a comprehensive review on the forensic issues affecting people with intellectual disabilities. This is an area of increasing interest and importance in recent years with developments in community care. People with intellectual disabilities and forensic issues have been seriously challenging service systems from a delivery and financial point of view. Successful responses are in high demand. There are differences between countries, even within the same countries, in policy and organization of services for offenders with intellectual disabilities. Recent research has contributed to considerable progress in our understanding of the characteristics of offenders with intellectual disabilities, their assessment and violence and sex offenders. More evidence-based studies are needed to examine the effectiveness of a range of service responses.
Aggressive challenging behaviour for people with intellectual disabilities remains one of the most complex clinical problems in terms of assessment and treatment interventions. It is very relevant to a person's mental health and it may be related to mental health problems. Benson and Brooks (pp. 454-458) describe and analyse critically recent studies on aggressive challenging behaviour for people with intellectual disabilities. They state that aggressive behaviour in adults often has multiple functions and that research on aggressive challenging behaviour requires assessment instruments that address the topography and severity of aggression. Greater access to effective, nonmedication treatments is needed as the use of psychotropic medication was shown to be ineffective in a recent large randomized controlled study. Nonmedication interventions, however, also need to demonstrate effectiveness using careful randomized controlled methodology.
Evaluation of community services for people with intellectual disabilities and mental health problems remains scarce as is demonstrated by Hemmings (pp. 459-462). In his critical appraisal of community services for people with both intellectual disabilities and mental health problems he suggests that the identification of the specific service components might be necessary, in the first instance, to determine what community services should be like for this population. Systematic methods of assessing which individual service components are essential for the provision of an effective and satisfactory service for people with intellectual disabilities and mental health problems should be employed. Research should focus on those with intellectual disabilities who have more severe mental health problems and involve a range of stakeholders as well as outcomes. Such research should also help to define which groups of people with intellectual disabilities and mental health problems are most likely to benefit from more intensive or assertive services, which have already been widely employed in adults with mental health problems but without intellectual disabilities.
The increased risk of mental health problems in children and adolescents with intellectual disabilities is further confirmed by recent studies reviewed methodically by Kolaitis (pp. 469-473). Early detection and adequate treatment are necessary to prevent chronic problems and also alleviate family burden. Attention should be given to the prevention of mental health problems and early recognition with better screening methods. Inequalities in the provision of services must also be addressed including specialist services. The lack of relevant studies from low and middle income countries is noted.
Little is known about the mental health of parents with intellectual disabilities. It is known that they are more susceptible to psychological distress, isolation and abuse while a significant proportion risk losing custody of their children. Recent studies indicate that these parents have an increased risk of psychopathology and mental health problems, which influence their ability to parent. O'Hara and O'Keeffe (pp. 463-468) highlight the service deficiencies for this very vulnerable group of people with intellectual disabilities. They correctly state that parents with intellectual disabilities have a right to specialist support to enable them to enjoy a normal family life. Access to appropriate services can be challenging due to a combination of factors including a lack of expertise and economic and other organizational difficulties.
Finally Walsh (pp. 474-478) addresses the evidence base on the health of people with intellectual disabilities detected in population surveys and healthcare service systems. The work of the Pomona group (website: http://www.pomonaproject.org ), partners in 17 European countries who have developed and applied a set of health indicators for people with intellectual disabilities, is also summarized. Health inequalities are apparent when people with intellectual and other disabilities are compared with their peers in the general population. Relatively few studies have been reported to date that apply health indicators to persons with intellectual disabilities. As Walsh rightly states it is likely that better definitions, measures and surveillance will yield comparable information to inform public health policy and clinical practice and thus address health inequalities, including mental health, as a priority. There is no health without mental health as has been pointed out by the World Health Organization and presented in a special edition of The Lancet.
People with both intellectual disabilities and mental health problems are among the most vulnerable and socially excluded in society. The presence of mental health problems can seriously affect their adaptation and quality of life. Although research on mental health aspect for people with intellectual disabilities continues to grow and to expand on both clinical and service related topics the same pertinent questions, as referred to in the last few issues of this publication, continue to be mostly unanswered, such as, Which types of treatment are both clinically and cost effective? What types of services work? How can we tailor services according to gender or culture?
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