Mental Health and Intellectual Disability

Overview

It can be difficult to notice mental health difficulties in those with intellectual disability, although depends greatly on how the person is affected by their disability. Individuals with mild intellectual disability and good communication may display the same symptoms of mental illnesses as the general population, but it can be more difficult to identify in individuals with more severe intellectual disability. This is due to several reasons, including difficulties in communicating or expressing feelings and thoughts, co-occurring conditions and related medications, and sometimes difficulties obtaining historical medical and behavioural information.

Due to these reasons, identifying mental illness in people with intellectual disability relies heavily on information from supporters and caregivers, and any differences in the individual’s normal behaviour. Essentially, where in the general population a health professional might be using the presence of symptoms to assess a mental illness, an individual with intellectual disability may already display some symptoms as part of their standard behaviour, and instead a health professional will try to assess whether there is a significant change in their behaviour that may indicate a mental illness. Such may include changes in the intensity or frequency of behaviours, or the addition or elimination of behaviours.

As such, keeping a record of the behaviours of the person you support, including what is normal or not normal behaviour for them can be very helpful for health professionals if you or they suspect that the individual may be suffering from or developing a mental illness. It is also good to note any potential triggers or events that may have resulted in these changes in behaviour. It is important to note that while individuals with intellectual disability can become distressed by any of the same events as the general population (e.g. death of a friend/family member), they may also be more significantly affected by events that would not distress someone without intellectual disability (e.g. a well-liked paid support worker moving on).

Some important things to record are:

• Their range of emotions and how they are expressed.
• Their typical level of physical activity and dietary habits
• Their sleeping and self-care habits
• Social activities, regular activities, and interactions
• Communication style
• Routines and rituals
• Physical health
• Key relationships

When recording it is important to be as objective as possible; while our subjective interpretations can be important, being able to differentiate between the two is important for clinicians to come to accurate conclusions. For example, it can be tempting to say that an individual is sad all the time. But the observations that you used to come to this conclusion are equally as important; you know they are sad all the time because they are crying and withdrawn you’ve seen them cry at least once a day and where they used to be active and outgoing, they now stay in their room for 10 hours a day. These details can be very important for clinicians to tell the difference between some mental illnesses.

Depending on the individual, encouraging them to access support may be difficult. Some may not realise that there is something wrong, or that that they can get help, or that the issue will not get better on its own. They may also have anxiety around visiting health workers, going to new places or even leaving the house. In these circumstances it is generally best to get additional support for the individual to enable engagement with health services. Mental health services are most effective when the individual is ready for support and willing to engage.

Some possibilities to consider when an individual is unwilling to go to health services due to anxiety may include telehealth, home visits, or preparation in the form of walkthroughs using images or gradually exposing the person to the clinic environment. However, this is different to an individual not seeing the need for health services. If they don’t feel it necessary, consider whether it appropriate and ethical to inform their GP or health team, and continue to communicate with them.