EDF, 12.07.2011

1. EDF, 12.07.2011 Persons with intellectual disabilities and mental health problems Filip Morisse & Leen De Neve Psychiatric Centre Dr. Guislain and Caritas

2. 1. Examples • Aggression: yelling, screaming, scratching, hitting, biting, destroying, self-injurious behaviour,… (fight) • Nagging, physical complaining • Running away, fugue, restlessness,… (flight) • Regression-depression: withdrawal, no more energy, staying in bed, loss of skills • Problems in eating, sleeping,… • Criminal behaviour: offending, sexual assault, robbery, stealing…

3. 1. Examples • Obsessive-compulsive behaviour • Symptoms of psychiatric disorders: delusions and hallucinations,… • Extreme mood swings • Atypical behaviour problems: skin picking, smearing, ruminating,…

4. 2. Prevalence • 30 à 50 % (10% in normal population) • More with  level of ID • Atypical symptoms • Most occurring disorders: • Autismspectrumdisorders • Attachment problems • Mood and anxiety disorders • Psychotic disorders

5. 3. Definition population: terms • Behaviour problems, behavioural disorders, problem behaviour, emotional problems • Conduct disorder (CD), oppositional-defiant disorder (ODD) • Difficult to understand behaviour • Psychic/psychiatric problems/ disorders • Mental health problems / needs • Co-occurring disorders

6. 3. Definition population Intellectual disability (ID) and • Challenging behaviour (Emerson, 2001) • Dual diagnosis (NADD, 2011) • Clinical description in practice (Outreach St-M, 2011)

7. 3. Definition population • “Challenging behaviour: culturally abnormal behaviour(s) of such intensity, frequency or duration that the physical safety of the person or others is placed in serious jeopardy, or behaviour which is likely to seriously limit or deny access to the use of ordinary community facilities“ (Emerson, 2001)

8. 3. Definition population • “Dual Diagnosis is a term applied to the co-existence of the symptoms of both intellectual disabilities and mental health problems. Mental health problems are severe disturbances in behaviour, mood, thought processes and/or interpersonal relationships… the presence of behavioural and emotional problems can greatly reduce the quality of life of persons with intellectual disabilities” (NADD, 2011)

9. 3. Definition:clinical description in practice Personal characteristics: • Multiplication of vulnerabilities • Tendency to present socially desirable and adapted • Behaviour problems as coping way to survive • Difficult detection and diagnostics

10. 3. Definition:clinical description in practice Characteristics of the environment: • Tendency to overestimate and to over-ask • Structures and systems of support often inadequate • Inappropriate support because of indiscriminate and biased interpretation of emancipation/integration paradigm

11. 3. Definition:clinical description in practice Characteristics of the environment: • Caregivers/family sometimes difficult in regulating balance distance-closeness • Expects solid constructs solutions • Tendency to control, segregation, institutionalisation • Human rights under pressure

12. 4. Needs of support • Basic Emotional Needs ✓ cognitive abilities ✓ social skills … • It’s all about fine tuning: address people at appropriate emotional level • Sensitive responsiveness • Variable => flexible support

13. 4. Needs of support • Respect & Unconditional Acceptance • Closeness: - sensitive responsiveness - give an answer to signals of pleasure and displeasure - basic needs - adjust tension/anxiety (inner rest) - care for safety

14. 4. Needs of support Closeness  Availability  Relapse base

15. 4. Needs of support • Regulate stimuli - individualdifferences => observation - well dosed - reduction - balancebetween rest and action ! becareful: narrowing environment

16. 4. Needs of support • Structure: time and space • To bound where it is necessary - boundaries = safety - balance between necessary boundaries and indispensible opportunities/chances to get grip on one’s own life (QOL)

17. 4. Needs of support An environment that is: - stimulating and inviting - safe and with possibilities to “refuel” - flexible and variable

18. 5. Systems of support in Belgium • History: - before 1967: care for adults with ID at home or in psychiatric hospitals - from 1967: specific services for adults with ID: pedagogic places (however: a lot of adults with ID & additional behaviour problems stay in the psychiatric hospitals)

19. 5. Systems of support • 1990: admissionstop for people with ID in psychiatric hospitals • 2011: still remaining population of persons with ID in psychiatric centres (+/- 800)

20. 5. Systems of support • Facilities for people with ID (VAPH) - ‘Care’ (right to adequate support, living) - Diverse range (nursing home, home for working people, daytime activities centre, living alone with support, living at home with support, etc…) - Mostly supply-driven, with professional staff, taking over care… - Low inclusion / still segregated - Low community based

21. 5. Systems of support • Psychiatric centre - ‘Cure’ (right to mental health / treatment) - Still strong residential, medical system - Units with “remaining”-population (PVT): discrimination ! - Specific Units for treatment of people with ID

22. 6. Bad / good practices

23. 6. Bad / good practices

24. 6. Bad / good practices