Clinical services associated with psychiatry usually revolve around the treatment of disorders and problems that adversely impact the mental health and well-being of an individual that in turn influences that person’s capacity to function and maintain themselves within society (Holland, 1999). People with an intellectual disability are often referred to Psychiatrists as their carers look for clinical insights and assistance with the management of challenging behaviours often masquerade as mental disorders.
The response of psychiatrists within the western nations is varied, some refuse to treat this population, considering their needs most appropriately managed by a psychological approach eg disability or human services provision, Others, such as UK Psychiatrists view this group of people as requiring the skills and expertise of psychiatric and mental health professionals.
2.3.1 Psychiatry of Learning Disability (UK)
Specialists in the Psychiatry of Learning Disability will have completed basic general psychiatric training and a further specialisation in learning disability (equivalent to specialisation in adult, child, older age psychiatry). Some may have qualified in both learning disability and another psychiatric speciality. Their particular skills relate to the diagnosis, treatment and management of psychiatric disorder in people with an intellectual disability or developmental disability who have limited communication, or where the presentation of differs from that in the typical adult. The RCP Council Report (1996), “Meeting the Mental Health Needs of People with Learning Disability,” recommended the development of specialist mental health teams to ensure collaborative and coordinated responses to the needs of adults with dual diagnosis. The RCP argues that mental health service provision to adults with an intellectual disability must operate within an extensive network of care that must include components of health, social care, education and non-government agency involvement (RCP, 2000). The RCP recommends that there is a minimum of one consultant per 100,000 of the general population. This psychiatrist typically leads a multidisciplinary team.
The RCP argues that appropriate community based treatment service should ideally involve dedicated ay and inpatient services, as well as out patient services. Local collaboration with need to be intimated involved. An adequate range of service responses includes secure facilities (RCP, 2000).
Psychiatrists have an important contribution to make to the mental health needs of adults with an intellectual disability. They are often gatekeepers to a range of required services and a multidisciplinary team would be incomplete without their contribution. Dialogue with the RANZCP should be contemplated with the view to discussion regarding the applicability and relevance of the RCP approach to adults with an intellectual disability to the
Queensland/Australian setting.
o
Models
Analysis of service provision to adults with an intellectual disability, who have co-existing mental health needs at both the national and international level, does not identify preferred models of service delivery. Most international service responses reflect generic or specialist approaches. The generic approach has resulted in various services operating within mainstream mental
health or disability service provision. For example, in the United Kingdom, many National Health Service Trusts provide dedicated inpatient beds for adults with an intellectual disability within psychiatric services that cater for the general population.
A range of specialised approaches can be identified across the UK although there is a significant amount of variation in how the models are implemented and the roles and
responsibilities of staff employed (Bouras & Szymanski, 1997). Specialised services may use the medical model (eg employ a psychiatrist and or nurses to provide clinical services and support or alternatively adopt of model of service provision that is more oriented towards the social construct of disability). The specialist approach argues for a continuum of care. For example, there are a number of NHS Trusts that coordinate an integrated service that involves an inpatient treatment and assessment unit and a community outreach service that prevents admission, supports community living options and follows people post discharge.
By comparison, the USA and Canada have preferred to adopt other models include
collaborative approaches including university affiliated clinical services that integrate training and education. Additionally the USA and Canada have developed interagency committees use triage functions to provide appropriate service responses.
2.4.1 Model Options
Please refer to the continuum of eleven Model Options at the end of this chapter. Key features of the range of models have been presented in the following eleven model options/types. The following comments related to each model option and should be read in conjunction with the eleven Model options. Dot points provide different options regarding how such models could be operationalised within the Queensland setting.
Further examples and service descriptions of a range of international service initiatives that have adopted these configurations or models are included in the Appendices of Chapter Three.
Option One:
University Affiliated Dual Diagnosis
Service
Background
This model is best demonstrated through consideration of the USA Centres of Excellence in Developmental Disabilities Education, Research and Services that have been described in this chapter. These centres are located in major cities and can be found in every state and territory in the USA and tend to provide lifespan services to children and adults with developmental disability.
Mission
Collaboratively funded, community-based university affiliated multidisciplinary training and
service provision model that includes assessment, state of the art diagnosis, and treatment
Service Provision
Includes developmental assessment and treatment clinics, providing consultation, technical assistance, continuing education and capacity building for local care providers and families. Access to inpatient treatment and assessment beds is necessary. Some Centres, and other similar models/initiatives in Canada also incorporate an Interagency Referral Committee (IRF) The Centre coordinates the IRF. Participating agencies use their current identification and intervention procedures. When a client emerges for which these measures are not effective, a referral to the interagency referral committee can be made. At this meeting participants decide on appropriate assessment or intervention options. Services may be provided by the Centre or participating agencies.