Intellectual Disability and Mental Health Nursing Flashcards
What do we mean by ‘mental disability’?
his was the definition as per DSM-IV-TR and is defined as
Significantly subaverage general intellectual functioning… accompanied by significant limitations in adaptive functioning in at least 2 of the following areas: communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health and safety occurring before age 18 (APA 2000)
Definition as per DSM 5 note change from mental retardation to intellectual disability (ID)
ID involves impairments of general mental abilities that impact adaptive functioning in 3 domains or areas,. These domains determine how well an individual copes with everyday tasks.
• The conceptual domain includes
skills in language, reading, writing, math, reasoning, knowledge and memory.
• The social domain refers to
empathy, social judgement, interpersonal communication skills, the ability to make and retain friendships and similar capacities
• The practical domain centres upon
self-management in areas such as personal care, job responsibilities, money management, recreation and organising school and work tasks.
Both definitions require an IQ of …
and state national average
Both definitions require an IQ of 70 (+ or – 5%) (National averages = 85-114)
What are the four sub-average intellectual functioning IQ levels?
- MILD 50-69 2. MODERATE35-49
3. SEVERE 20-34 4. PROFOUND below 20
Is it all about the IQ? What else is measured?
Diminishment of adaptive behaviour, assessment is according to levels of support needed and these can be labelled as intermittent (i.e. assistance with budgeting/meal planning), limited (i.e. has some social/work skills but requires frequent support with supervision, budgeting and living assistance), extensive (i.e. can perform tasks with assistance but not independently) or pervasive, unable to perform day to day functions and requires full assistance.
Why do people with intellectual disability have higher rates of mental illness than the general population?
Studies identified higher rates of MI with people with ID with theory suggesting this is because of limitations affecting communication abilities, processing skills, cognitive functioning and social skills. Consider recovery principles, strengths, hope and resilience, many people with ID for whatever reason, may not have these attributes.
Other impairments include, hearing, visual, epilepsy and socio economic factors such as poor housing, employment opportunities, restricted social roles and poverty, all the things identified by diathesis stress and environmental models in mental illness.
Also consider difficulties with assessment and accuracy not only around self-reporting but the propensity for diagnostic overshadowing and attributing behaviours to the ID rather than any other underlying cause.
Section 4 of the Mental Health (Compulsory Assessment & Treatment) Act 1992 states that people cannot be invoked under the Act by virtue of Intellectual Disability alone. If someone with an ID presents with a mental disorder, can they be placed under the MHA for compulsory treatment? Explain the reason for your answer.
Yes because the MHA works to assist people manage their mental disorder and as people with ID are just as susceptible to MI (if not more) then they are afforded the same rights as any other citizen accessing healthcare. You cannot use the MHA to lock somebody away because they are presenting with challenging behaviour as a result of their ID alone. This is the challenge associated with diagnostic overshadowing and we must consider what is driving the behaviour.
What communication factors does the nurse have to consider when assessing someone with an ID for both physical and mental health?
- Limited capacity for conversation, primary disability, hearing/speech impediments
- Problems generalising speech and will seek familiar contexts such as home i.e. voices come from the TV
- Shyness and confusion, use repetitive (echolalic) speech
- Acquiescence, saying yes to please
People with Intellectual disability often present with individualised behaviours and rituals. Why is it important to determine these for assessment.
Is their behaviour a departure from their usual presentation. This is why the functional inquiry is so important, what is usual, what is unusual. So we need to assess what behaviours are peculiar to the client both previous to and following onset of mental illness. We can then track to see if self-harm behaviour for instance is as a result of the development of mental illness and treat accordingly.
Reiss et al (1982) coined the term ‘diagnostic overshadowing’. What does this mean?
Attributing behaviours solely to the ID or without looking for other underlying causes. For example aggressive behaviour is because they don’t understand rather than considering reasons for behaviour such as pain, anxiety or mood fluctuation.
What implications can diagnostic overshadowing have for planning and implementing care?
Poorly devised care planning and not addressing the underlying problem
Causes of dual disability MH and ID?
Heredity (i.e. Downs Syndrome 1:700 births)
Alterations in embryonic development
Complications in pregnancy
Environmental and teratogenic influences (i.e. limited opportunity)
Post natal medical complications (i.e. encephalitis)
Trauma and injury (including drugs and alcohol)
30-50% idiopathic
