1. 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?

2. 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 % (Maulik et al, 2011, Emerson 2003)

3. Defining severity of ID depending on IQ
Mild (85%)
Moderate (10%)
Severe (4%)
Profound - < (1%)

4. 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

5. 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

6. 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......

8. 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)

9. 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 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–
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

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

11. 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.....

12. 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

13. 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

14. 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.

15. 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

16. Information to people with ID- Need to be given in an accessible way
Link to accessible information

19. 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.

20. STOMP campaign- Stop over use of Psychotropic medications

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