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EDF, 12.07.2011. P ersons with intellectual disabilities and mental health problems Filip Morisse & Leen De Neve Psychiatric Centre Dr. Guislain and Caritas. 1. Examples. Aggression: yelling, screaming, scratching, hitting, biting, destroying, self-injurious behaviour,… ( fight) - PowerPoint PPT Presentation
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EDF, 12.07.2011
Persons with intellectual disabilitiesand mental health problems
Filip Morisse & Leen De NevePsychiatric Centre Dr. Guislain and Caritas
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…
1. Examples
Obsessive-compulsive behaviour
Symptoms of psychiatric disorders: delusions and hallucinations,…
Extreme mood swings
Atypical behaviour problems: skin picking, smearing, ruminating,…
2. Prevalence
30 à 50 % (10% in normal population) More with level of ID Atypical symptoms Most occurring disorders:
1. Autismspectrumdisorders
2. Attachment problems
3. Mood and anxiety disorders
4. Psychotic disorders
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
3. Definition population
Intellectual disability (ID) and
Challenging behaviour (Emerson, 2001) Dual diagnosis (NADD, 2011) Clinical description in practice (Outreach
St-M, 2011)
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)
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: 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: 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: 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
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
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
Regulate stimuli
- individual differences => observation
- well dosed
- reduction
- balance between rest and action
! be careful: narrowing environment
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)
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
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
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
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
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 practicesCare-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 care-facility (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…
…
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