In a study published this week in the BMJ Open comprehensive, multidisciplinary assessments, using Australian diagnostic criteria for fetal alcohol spectrum disorder (FASD) were undertaken on a representative group of 99 young people incarcerated in Western Australia’s only youth detention facility.
Over a third (36%) of those assessed were found to have a diagnosis of FASD but only two had been previously diagnosed. As one of the researchers from the Telethon Kids Institute explained:
“These young people’s previous contacts with government agencies represented missed opportunities for earlier diagnosis and intervention, which could have prevented or mitigated their involvement with justice services – and more importantly may have permitted alternative community care with targeted health and educational interventions and rehabilitation.”
The 5th National Mental Health and Suicide Prevention Plan was recently released. It includes welcome and specific acknowledgement of the mental health inequalities faced by people with intellectual disability. It also includes a statement that implementation of the eight priority areas in the plan “requires specific and appropriate application” to people with intellectual disability and other groups with specific diverse needs. Thanks to Jim Simpson, Senior Advocate, NSW CID, for advocating for this outcome and sharing the news.
Below are key extracts from the plan. You can see the full plan here.
People with disability, particularly people with intellectual disability, experience higher rates of mental health problems and mental illness. It is estimated that people with intellectual disability are at least two to three times more likely to have a mental illness than the general population, yet people with intellectual disability experience significantly lower rates of treatment of mental health problems compared with the general population and many encounter significant barriers which prevent timely access to appropriate supports and services. People with intellectual disability also tend to be more vulnerable to the factors that can lead to the development of mental health problems. Mental illness in people with intellectual disability can also be overlooked for a range of reasons, including that the person may be unable to describe their experience and that their behaviours may be misattributed to their intellectual disability. People with intellectual disability and mental illness often have complex needs that require a coordinated approach across multiple service sectors. Integrated, accessible and person-centred supports and services are key to ensuring that people with disability, particularly people with intellectual disability, can experience better mental health and realise their potential.
The Fifth Plan sets out to achieve outcomes in eight priority areas that align with specific aims and policy directions in the National Mental Health Policy. These priority areas do not reflect all the aims and policy directions in the National Mental Health Policy but align with those that are well positioned for change in terms of both need and opportunity. The eight priority areas of the Fifth Plan are:
- achieving integrated regional planning and service delivery
- effective suicide prevention
- coordinating treatment and supports for people with severe and complex mental illness
- improving Aboriginal and Torres Strait Islander mental health and suicide prevention
- improving the physical health of people living with mental illness and reducing early mortality
- reducing stigma and discrimination
- making safety and quality central to mental health service delivery
- ensuring that the enablers of effective system performance and system improvement are in place.
Provision of Services under the National Disability Insurance Scheme Early Childhood Early Intervention Approach
On 3 October 2017, AADDM President, Jacqueline Small, appeared before the Joint Standing Committee on NDIS- ECEI approach. AADDM had made a submission that identified a range of concerns about service provision under ECEI (see aaddm.com.au/submissions). A full transcript is now available here.
Key messages included:
- There are weaknesses with the key-worker model/ECEI approach. We believe that the almost exclusive emphasis of the ECEI approach that has been implemented on supporting parents is leading to a reduction in much-needed educational and therapy services;
- Challenging behaviour seems not to be well understood or supported, despite it being an important predictor for longer term, poorer outcomes for the child, family and service providers.
- Substantial delays have been experienced in finding approval and access to services due to a range of issues with design and the early transition period.
- Referral to the NDIS ECEI should build on paediatricians’ and other health professionals’ expertise.
- A life-span perspective is important for the child and the family. This involves anticipatory guidance and intervention for those conditions associated with poor long-term outcomes, such as challenging behaviours and limited communication, and enhancement of resilience factors such as connection to community, support for siblings and education of families.
- There are significant gaps emerging, some of the early intervention services are no longer providing the services they were previously providing. Importantly, in New South Wales, all of the disability budget was rolled over to the NDIS, but that budget funded a range of services for which there will no longer be funding under the NDIS. So there will be significant loss of services.
Join us for the Australian Association of Developmental Disability Medicine Conference.
Date: September 6-7, 2018
Venue: Aerial Function Centre, UTS , Broadway Sydney
AADDM Position Statement: The Importance of Physical and Mental Health for People with intellectual Disabilities in the Criminal Justice System
The AADDM Position Statement, The Importance of Physical and Mental Health for People with intellectual Disabilities in the Criminal Justice System, was released in May 2017. Dr Angus Buchanan, President Australasian Society for Intellectual Disability (ASID), recently indicated that ASID was endorsing the position statement. He commented that it was an “excellent position statement”.
In recognition that more than half of the people in the criminal justice system had a coexisting mental health problem, AADDM recommends a timely review by medical practitioners with access to advice from specialists in ID to determine appropriate treatment and management for anyone suspected to have a mental health problem. Furthermore, for any people with challenging behaviours, including all people for whom restrictive practices might be considered for safety, a positive behaviour support plan should be implemented under the guidance of a professional trained in developing positive behaviour support plans.
Please click here to view the position statement.
AAADM has released a new position statement – The Importance of Physical and Mental Health for People with Intellectual Disabilities in the Criminal Justice System. This position statement highlights that people with intellectual disability (ID) often experience psychosocial disadvantage and are significantly overrepresented within the Australian criminal justice system and have significantly higher rates of mental and physical health conditions that may not have been diagnosed or treated. A number of recommendations are made in the position statement that are intended to improve support for people with ID in the criminal justice system.
Please click here to view the position statement.
Associate Professor Lynette Lee MBBS MSc Health Policy PhD FACRM FAFRM(RACP) FRACMA FPFMANZCA
As one of eight people present at the very first meeting of what was to become AADDM, Associate Professor Lynette Lee has been championing the needs of people with Intellectual Disability (ID) for probably more years than she cares to admit. She has held senior roles in medical administration, clinical rehabilitation medicine, professional development and training, academics and in the disability sector, all the while pursuing improved healthcare for people with ID. Lyn was recently awarded her PhD for research on Demand planning for specialist medical services for adults with Intellectual Disability in NSW 2003 – 2043.
Lyn, with the support of a small band of rehabilitation physician colleagues developed the curriculum in the Australasian Faculty of Rehabilitation Medicine on Intellectual Disability and the first accredited training position solely in a Developmental Disability Service.
Recognising early on the need to contribute to the growing research interest Lyn developed a health assessment tool which she then used in her own database. Lyn has extensively investigated and reported on the health of people with ID who are living in the general community, ageing or living in institutions, and this has been used to positively influence health policy in New South Wales.
Lyn- we thank you for your tireless efforts as an advocate and clinician working to improve the health of people with Intellectual Disability.
For more information on the Bob Davis Award, please click here.
AADDM acknowledges the substantial contribution to the mental health and wellbeing of people with intellectual disability by the late Dr Helen Molony. Helen was a true pioneer of intellectual disability health services, and leaves a substantial legacy of service to people with intellectual disability, their families and mental health professionals.
Substantial mortality gap remains for people with intellectual disability compared to the general population
A recently published study by Trollor et al, 2017, (http://bmjopen.bmj.com/content/7/2/e013489) confirms that substantial health inequities remain for people with intellectual disability (ID). In a large population based cohort study in NSW that included 42 204 people with ID, median age of death of people with ID was 54 years, compared to 81 years in the general population, with 38% being due to potentially treatable conditions. Respiratory and neurological causes of death were particularly common, with the overall comparable mortality figure of 1.3.
This study is ground breaking in Australia given its size and that it systematically examines mortality in a large population of people with ID who use disability services. Although there are limitations to the study, the policy implications for health and disability services are undeniable. Whole of system responses are urgently required to address existing barriers to prevention, early detection and treatment of health conditions experienced by people with ID.
Please see the following 730 Report, aired on the ABC on February 7, 2017 – http://www.abc.net.au/news/2017-02-08/study-finds-intellectually-disabled-two-times-preventable-death/8248772, and NSW Council for Intellectual Disability to read more about their efforts to improve the health of people with ID (http://www.nswcid.org.au/).