SLIDE 1 Psychesch Gesondheet bei Menschen mat enger intellektueller Beeinträchtegung: Eng inklusiv approche
(Santé mentale des personnes en situation de handicap intellectuel: une approche inclusive)
Commission Consultative des Droits de l’Homme du Grand-Duché de Luxembourg
9, Novembre 2015
GERMAIN WEBER Universität Wien
Fakultät für Psychologie
SLIDE 2 Health a fundamental human right Equal
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Intellectual Disability
ICD-11 (from 2017 on): » Disorders of Intellectual Development (DID) Actually: » Intellectual Disability (EC) » Intellectual & Developmental Disability (Academia) » Learning Disability (UK)
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Mental Health Disorders in ID???
Intellectual Disability earlier terminology mental retardation idiocy Mental retardation viewed as a specific mental health disorder (compare ICD-9, DSM-III)
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A nihilistic approach
As a consequence:
- 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
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Intellectual Disability
Mental Health in people with intellectual disability (ID) ID: Psychiatry (Medicine) ID: Psychology (clinical psychology) ID: General health ID: Epidemiology ID: Mental health strategy
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Intellectual Disability & Epidemiology
Operational Definition ….significant limitation …. in intellectual functioning …. in adaptive behaviour Classification levels of ID IQ mild 50-70 moderate 35-49 severe 20-34 profound <20
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Epidemiology
General prevalence rate 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
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Disorders and conditions associated
Epilepsy: between 15% to 30% Sensory impairments: 10% to 33% Challenging behaviour: 6% to 14% Mental health problems: 30% to 40% adults (double) 40% children (four fold elevation)
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Intellectual Disability &
Medical Schools, Schools
»Research »Academic programs »Professional training ID: Gap in research and academic training tradition between Continental Europe and Anglo-Saxon countires
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European Health Indicators (ECHI) National Data on
Intellectual Disability European comparative health reports across EU member countries ECHI Project Health indicators General population Groups at risk Data of people with ID?
n.a.
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EU Pomona Project 2002-2004 2005-2008
Defining European health indicators for people with ID Testing the indicator set One of the indicators: mental health and behaviour problems
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Health Service Provisions
Planning for Health service provisions Responsibility: Typically Ministry of Health Planning for Disability Service Provisions Responsibility typically different from Ministry of Health
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Health for All WHO Europe (1998, 2005)
- Solidarity for the health in the
European region
- 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
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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
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Mental Health Strategy Why? What it is good for?
Issue of responsibility Issue of planning for resources Issue of allocating resources
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Inequalities Disparities
Pervasive structural inequities and social determinants of health are believed to be the primary cause of health disparities (WHO, 2011)
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Equal Opportunities
Discrimination
not living up to our moral and legal obligations to provide effective support for people with ID and mental health problems
»The moral obligations based
values as interdependent social beings »The legal obligations are set up in the UNCPRD: Articles 25, 26
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Article 25 Health
Pwd right to enjoyment of the highest attainable standard of health without discrimination
»Ensure access »gender-sensitive »Rehabilitation
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Article 25 Health
standard
specifically needed by pwd
- Provide health services as
close as possible to communities
- Require health professionals
to provide care of same quality to pwd
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Article 26 Habilitation & Rehabilitation
independence, full physical, mental, social and vocational ability
- Assessment of individual needs &
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
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Mental Health for All
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European Association for Mental Health in Mental Retardation, 2003 The Declaration of Rome 2003 – With Regard to the Promotion of Interest and Services for People with 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
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Declaration of Rome 2003
called on
Public authorities to review and analyse adequacy of mental heath care provision for pwID, support research 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, friends
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Mental Health Promotion and Mental Disorder Prevention A Policy for Europe (Jané-Llopis, E. & Anderson, P., 2005) Lisbon Strategy 2000 (goals to be obtained by 2010) The need for action in Europe:
- Develop country based action plans
- 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
- Actions recommended ……….
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Mental Health Strategies
- European Mental Health Action
Plan (WHO Europe, 2013)
- National Mental Health Strategies
- The Guide: Accessible Mental
Health Services for People with Intellectual Disabilities
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European Mental Health Action Plan
(WHO Europe, 2013)
The four core objectives:
- equal opportunity to realize mental
well-being throughout lifespan for 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
effective treatment
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European Mental Health Action Plan
(WHO Europe, 2013)
Three cross-cutting objectives:
- health systems provide good
physical and mental health care 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.
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Austria National Mental Health Plan 10 strategic goals 2013
1999 first national mandatory mental health plan
- Promoting mental health
- Preventing mental disorders (suicide)
- Fight stigmatization , discrimination
- Fair, appropriate financial resources
- Good primary care services
- Appropriate support vulnerable p-o-l
- Community based services pwsmhp
- User participation future planning
- Reliable epidemiological data
- Evaluate impact of measures
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Australia Fourth National Mental Health Plan
An agenda for collaborative government action in mental health
2009–2014
5 Priority Areas
- Social inclusion and recovery
- Prevention and early intervention
- Service access, coordination and
continuity of care
- Quality improvement and innovation
- Accountability – measuring and
reporting progress
- App. Partnership approach
- App. Indicators to monitor
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Australia Fourth National Mental Health Plan
An agenda for collaborative government action in mental health
2009–2014 Intellectual disability
- mental health problems are also more
likely to occur in association with disability, including intellectual disability (p. 33)
- 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)
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Australia Outcome, Indicators
- Proportion of front line workers within
given sectors who have been exposed to relevant mental health education and training (indicator)
- There is an adequate level and mix of
services through population based planning and service development across sectors (outcome)
- Proportion of services publicly reporting
performance data (indicator)
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Mental Health in people with ID
- Experience mental ill health at a rate which
exceeds that of general population: 2 to 3 times more likely (Bouras & Hold, 2010, Cooper et.al., 2007)
- Vulnerability to mental disorder is complex – an
interplay between DID and other medical, social and psychological disorders
- Access to mental health care falls short of what is
required to meet the needs of this population
(Hudson & Chan, 2007)
- Stakeholders agree that substantial improvement
in access to mental supports and services is required
- Need of coordinated approach across multiple
service sectors including mental health, health and disability
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Steps & Areas for change on a national and local level
- In many countries development of accessible
mental health services for PwID lag behind internationally accepted practices (Evans et al., 2012)
- Much needs to be done at a policy, resource and
provider level before mental health services are fully accessible for PwID
- However, change begins with the individual
mental health professional and the local service
- Encouraging reasonable adjustments to practice
and services, the development of expertise and capacity, and adopting a culture of accessibility
- Such steps can have a major impact on the mental
health and well-being of PwID
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Australia 2014
Offers a framework for mental health professionals to improve the accessibility and quality of mental health care for people with DID
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Guiding Principles for Mental Health Services for People with DID
- Human Rights Framework
- Inclusion
- Person-Centered Approach
- Promoting Independence
- Recovery-Oriented Practice
- Evidence-Based
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Key Components of Accessible Mental Health Services
- Adaptation of Clinical Approach
- Access to Mental Health Services
- Access to Specialized Intellectual
Disability Mental Health Services
- Identification of Care Pathways
- Training and Education for Professionals
- Multidisciplinary Approach and
Interagency Collaboration
- Data Collection and Evaluation
- Inclusion in Policy Development
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Implications for Mental Health Services
Developing mental health services that are accessible for people with ID can be achieved:
- a. Making adaptations to existing
services
- b. Utilizing collaborative and multi-
disciplinary approaches
- c. Providing appropriate education and
training
- d. Introducing new systems
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Implications for Mental Health Services
Implications for:
- All mental health service providers
- Primary health care
- Public mental health services
- Private mental health services
- Specialized intellectual disability mental
health services Individual and organizational provisions and arrangements
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Tools for Inclusive Practice
- Assessment and diagnostic tools
- Best practice models and strategies:
- Tools and resources for consumers, family
and carers
- Advocacy services and guardianship
(supported decision making)
- Research and academic organizations
- Training and education
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41 The Guide
Accessible Mental Health Services for People with an Intellectual Disability A Guide for Providers
https://3dn.unsw.edu.au/the-guide
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Conclusions
Inclusive Mental Health Strategies for People with Intellectual Disabilities are underpinned and fuelled by » a human rights approach » advances form research in mental health and intellectual disability
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Conclusions
- Interface between mental health and
mental health policy
- mental health policy documents refer to
people with ID
- Curricula of medical schools, schools of
psychology should consider groups with high risk of health disparities (e.g. people with ID and their mental health needs)
- Curricula and training for mental health
professionals should consider groups specific groups with high prevalence rates for mental disorders
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Recommendation
Time to promote an European Agenda for Mental Health Action Plans for People with an ID When and where?
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2017 September 21st – 23rd 11th European Congress of Mental Health in Intellectual Disability Luxemburg
European Association on Mental Health in Intellectual Disability www.EAMHID.lu
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Thank you!!
germain.weber@univie.ac.at
And ……………
