Commission Consultative G ERMAIN W EBER des Droits de l’Homme Universität Wien du Grand-Duché de Fakultät für Psychologie Luxembourg 9, Novembre 2015 Psychesch Gesondheet bei Menschen mat enger intellektueller Beeinträchtegung: Eng inklusiv approche (Santé mentale des personnes en situation de handicap intellectuel: une approche inclusive)
Health a fundamental human right Equal opportunities
Intellectual ICD-11 (from 2017 on): Disability » Disorders of Intellectual Development (DID) Actually: » Intellectual Disability (EC) » Intellectual & Developmental Disability (Academia) » Learning Disability (UK) 3
Mental Health Intellectual Disability Disorders in ID??? earlier terminology mental retardation idiocy Mental retardation viewed as a specific mental health disorder (compare ICD-9, DSM-III) 4
A nihilistic As a consequence: approach • All additional mental health issues viewed as related to the biological aetiology of mental retardation • As you cannot cure mental retardation you cannot cure mental health disorders in people with ID • Nihilistic view with respect to specific diagnostic tools and therapies 5
Intellectual Mental Health in people with Disability intellectual disability (ID) ID: Psychiatry (Medicine) ID: Psychology (clinical psychology) ID: General health ID: Epidemiology ID: Mental health strategy 6
Intellectual Operational Definition Disability ….significant limitation & Epidemiology …. in intellectual functioning …. in adaptive behaviour Classification levels of ID IQ mild 50-70 moderate 35-49 severe 20-34 7 profound <20
Epidemiology General prevalence rate of ID Mild (across all ages, total population): 30 per 1,000 more males: 1.6:1 more disadvantaged socio- economic background Moderate to profound (IQ < 50): 3 to 4 per 1,000 more males (1.2:1) increase in prevalence till school leaving 8
Disorders and Epilepsy: conditions between 15% to 30% associated Sensory impairments: 10% to 33% Challenging behaviour: 6% to 14% Mental health problems: 30% to 40% adults (double) 40% children (four fold elevation) 9
Intellectual Disability » Research & » Academic programs Medical Schools, Schools » Professional training of Psychology ID: Gap in research and academic training tradition between Continental Europe and Anglo-Saxon countires 10
European Health European comparative Indicators (ECHI) health reports across EU National Data on member countries Intellectual Disability ECHI Project Health indicators General population Groups at risk Data of people with ID? n.a. 11
EU Pomona Project Defining European health 2002-2004 indicators for people with 2005-2008 ID Testing the indicator set One of the indicators: mental health and behaviour problems 12
Health Service Planning for Health service Provisions provisions Responsibility: Typically Ministry of Health Planning for Disability Service Provisions Responsibility typically different from Ministry of Health 13
Health for All • Solidarity for the health in the WHO Europe European region (1998, 2005) • Better mental health • Multi-sectoral strategy • Health in settings • Quality management of health services • Highly qualified staff • Role of research & knowledge to enhance health • Define concepts and strategies for health for all 14
Strategy Setting goals, determining actions to achieve goals, mobilizing resources to execute the actions Or how the ends, goals will be achieved by the means, resources Strategy is about shaping the future and is the human attempt to get to desirable ends with available means 15
Mental Health Strategy Why? What it is good for? Issue of responsibility Issue of planning for resources Issue of allocating resources 16
Inequalities Disparities Pervasive structural inequities and social determinants of health are believed to be the primary cause of health disparities (WHO, 2011) 17
Equal not living up to our moral and Opportunities legal obligations to provide or effective support for people Discrimination with ID and mental health problems »The moral obligations based on classical, humanistic values as interdependent social beings »The legal obligations are set up in the UNCPRD: Articles 25, 26 18
Article 25 Pwd right to enjoyment of the highest attainable standard of Health health without discrimination of disability »Ensure access »gender-sensitive »Rehabilitation 19
Article 25 • Same range, quality and standard Health • Provide health services specifically needed by pwd • Provide health services as close as possible to communities • Require health professionals to provide care of same quality to pwd 20
Article 26 • Maintain maximum of independence, full physical, mental, Habilitation social and vocational ability & • Assessment of individual needs & Rehabilitation strengths • Support participation and inclusion in the community: voluntary and available • States parties to promote the development of initial and continuing training for professionals and staff working in h&r 21
Mental Health for All
European The Declaration of Rome 2003 – Association for With Regard to the Mental Health in Promotion of Interest and Mental Retardation, Services for People with 2003 Intellectual Disabilities with Mental Health Needs Michael Seidel Journal of Policy and Practice in Intellectual Disabilities Volume 1 Number 2 pp 103–104 June 2004 23
Declaration of Rome Public authorities to review and analyse 2003 adequacy of mental heath care provision for pwID, support research called on More engagement by mh professionals in the area of ID&MH Strengthen efforts for interdisciplinary work in mh care provision, including mh training More research, healthy mental development Raising awareness mhid relatives, 24 friends
Mental Health Promotion Lisbon Strategy 2000 (goals to be obtained by and Mental Disorder 2010) Prevention The need for action in Europe: A Policy for Europe • Develop country based action plans ( Jané-Llopis, E. & Anderson, P., 2005) • 10 Action areas Action 5: • Different groups are at increased risk for mental disorders across Europe: people low socio- economic backgrounds, ethnic minority groups, migrant, refugees, homeless people, disabled people , …. • Improve the mental health and decrease the risk for mental disorders in populations at risk • Increase the social inclusion for groups at risk 25 • Actions recommended ……….
Mental Health • European Mental Health Action Strategies Plan (WHO Europe, 2013) • National Mental Health Strategies • The Guide: Accessible Mental Health Services for People with Intellectual Disabilities 26
European The four core objectives: Mental Health • equal opportunity to realize mental Action Plan well-being throughout lifespan for (WHO Europe, 2013) everyone, most vulnerable most at risk • human rights valued, protected and promoted • mental health services accessible and affordable in the community • entitled to respectful, safe and 27 effective treatment
European Three cross-cutting objectives: Mental Health • health systems provide good Action Plan physical and mental health care (WHO Europe, 2013) for all • mental health systems work in well-coordinated partnerships with other sectors • mental health governance and delivery are driven by good information and knowledge. 28
• Promoting mental health Austria • Preventing mental disorders (suicide) National Mental Health Plan • Fight stigmatization , discrimination 10 strategic goals • Fair, appropriate financial resources 2013 • Good primary care services 1999 first national mandatory • Appropriate support vulnerable p-o-l mental health plan • Community based services pwsmhp • User participation future planning • Reliable epidemiological data • Evaluate impact of measures 29
Australia 5 Priority Areas Fourth National • Social inclusion and recovery Mental Health Plan • Prevention and early intervention An agenda for • Service access, coordination and collaborative government action in mental health continuity of care 2009–2014 • Quality improvement and innovation • Accountability – measuring and reporting progress ��������������������� • App. Partnership approach ��������������������� 30 �������������������� • App. Indicators to monitor
Australia Intellectual disability Fourth National • mental health problems are also more Mental Health Plan likely to occur in association with An agenda for collaborative government disability, including intellectual disability action in mental health (p. 33) 2009–2014 • people with intellectual disability are at increased risk of experiencing a mental illness, yet this is often overlooked and access to appropriate treatment for both disabilities is limited (p. 70) ��������������������� ��������������������� 31 ��������������������
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