1. 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

2. London Borough of Haringey

3. London borough of Haringey

4. 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

7. Case
22 year old man, Moderate ID, Autism, behavioural difficulties, hearing voices when 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

8. Case
22 year old man, Moderate ID, Autism, behavioural difficulties, hearing voices when 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

9. 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

10. 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

11. 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

12. Mental health pathways
Mental illness pathway
Challenging behaviour pathway
Dementia pathway
Autism pathway
ADHD pathway
Others
Mental illness pathway- undiagnosed depression 12

13. Community Mental health services- Children with ID
Not well organised
Child and adolescent mental health services
Paediatricians
Children and adolescent ID teams
Under resourced

14. 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

15. Intensive Support Teams
Management of challenging behaviour and prevent admission

16. Other support in the community
Day centres/Day opportunities
Education- Colleges
Voluntary schemes
Employment
Hospital Liaison services
Reasonable adjustments in various settings

17. 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

18. Offenders with ID & mental disorders
Inpatient forensic units for people with ID- Low, Medium and high secure
Community Forensic services 18

19. Looking after people with ID and mental disorders
Families
Care providers (residential, supported living, shared living etc) 19

20. Community provisions- challenges
Lack of providers
Lack of skilled staff
Governance/safe guarding within provider organisations 20

21. 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,

22. Thank you -