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EDF, 12.07.2011
Persons with intellectual disabilities
and mental health problems
Filip Morisse & Leen De Neve
Psychiatric Centre Dr. Guislain and Caritas
1. Examples
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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…
1. Examples
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Obsessive-compulsive behaviour
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Symptoms of psychiatric disorders: delusions and
hallucinations,…
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Extreme mood swings
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Atypical behaviour problems: skin picking,
smearing, ruminating,…
2. Prevalence
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30 à 50 % (10% in normal population)
More with  level of ID
Atypical symptoms
Most occurring disorders:
1.
2.
3.
4.
Autismspectrumdisorders
Attachment problems
Mood and anxiety disorders
Psychotic disorders
3. Definition population: terms
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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
3. Definition population
Intellectual disability (ID) and
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Challenging behaviour (Emerson, 2001)
Dual diagnosis (NADD, 2011)
Clinical description in practice (Outreach
St-M, 2011)
3. Definition population
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“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)
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)
3. Definition:clinical description in
practice
Personal characteristics:
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Multiplication of vulnerabilities
Tendency to present socially desirable and
adapted
Behaviour problems as coping way to
survive
Difficult detection and diagnostics
3. Definition:clinical description in
practice
Characteristics of the environment:
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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
3. Definition:clinical description in
practice
Characteristics of the environment:
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Caregivers/family sometimes difficult in
regulating balance distance-closeness
Expects solid constructs solutions
Tendency to control, segregation,
institutionalisation
Human rights under pressure
4. Needs of support
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Basic Emotional Needs
✓
cognitive abilities
✓
social skills
…
It’s all about fine tuning: address people at
appropriate emotional level
Sensitive responsiveness
Variable => flexible support
4. Needs of support
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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
4. Needs of support
Closeness

Availability

Relapse base
4. Needs of support
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Regulate stimuli
- individual differences =>
observation
- well dosed
- reduction
- balance between rest and action
! be careful: narrowing environment
4. Needs of support
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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)
4. Needs of support
An environment that is:
- stimulating and inviting
- safe and with possibilities to
“refuel”
- flexible and variable
5. Systems of support in
Belgium
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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)
5. Systems of support
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1990: admissionstop for people with ID
in psychiatric hospitals
2011: still remaining population of
persons with ID in psychiatric centres
(+/- 800)
5. Systems of support
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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
5. Systems of support
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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
6. Bad
/
good practices
Care-facilities are Supply-driven
(package of support) and
segregated
Care-facilities are Demand-driven
(needs) and more inclusive
Different and separated
Models/framework & biased
interpretation:
- psychiatric: medical, controlling
- special education: emancipation /
empowering
Integration of the strenghts of each
model
Non-flexible way of being in a carefacility (once you’re there, you’re
staying there) and redirect people
to each other
Flexible use of care-facilities +
working together for these people:
creating a Circuit of Care: a
seamless transition between
care/cure facilities = partners
Cure OR Care
Cure AND Care
6. Bad
/
good practices
Restraint (in different ways) –
behaviouristic approach – high use
of medication
Search for less invasive, less
violent ways of approach, with a
multidisciplinary team, on a basis of
unconditional acceptance
Diagnosis as a label, in a
medical/psychiatric perspective
Diagnosis as a dynamic hypothesis,
in a multidisciplinary perspective
Priority to the professional staff, in
taking care (they’re taking over the
care)
Priority to the natural environment,
community in taking care
(professionals support where
needed)
6. Bad
/
good practices
Hospitalisation, taking away from
one’s own environment
Professionals go to the environment
= outreach (ambulant modules);
support in the natural environment
Forbid relationships, sexuality,
etc… because it is difficult
Search for possibilities, support
relationships, talk about it etc…
…