According to the World Health Organization, mental health is a state of mental well-being that enables people to cope with the stresses of life, realise their abilities, learn well and work well, and contribute to their community. It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in.1
Mental health is also a basic human right and it is crucial to personal, community and socio-economic development. Just like physical health needs, mental ill health will be experienced differently by people and can require varying levels of support.
For a long time, it was believed that people with learning disabilities didn’t have mental health problems and this has been rightly dismissed in more recent years. In fact, people with learning disabilities have higher rates of mental health problems than those without learning disabilities. Schizophrenia has been estimated up to three times greater, when compared to non learning disabled peers. Dementia is much higher amongst older adults with learning disabilities and is associated with an earlier onset in some groups such as people with Down’s syndrome with onset from 30-40 years.
In addition, reported prevalence rates for anxiety and depression are at least the same as the general population, but some research suggests it is higher in people with learning disability depending on how depression and anxiety is defined.2
Sadly, the reality is that people with learning disability can think about, attempt and die by suicide.
Mental health problems can often be missed in people with learning disabilities because conditions or symptoms may present differently than in the general population. In addition, people with learning disabilities may not realise the significance of events, have trouble recalling information or not understand what is happening or being asked of them.
Their symptoms can be lost amongst other behaviours being displayed or the person may be non-verbal and have difficulty expressing themselves.
When conducting mental health assessments, be aware that an underlying physical health condition may be causing the problem such as epilepsy and hypothyroidism. It could even be something simple and obvious like pain or sleep problems, which can lead to changes in behaviours.3
During the assessment, it is therefore important to keep speech simple, jargon-free, and introduce one concept at a time. People with learning disabilities might also be suggestable and say what they think you want to hear to please you.3
It is important to communicate with the person first, not the carer, and this is a frequent complaint from people with learning disabilities. Make them feel valued and engage with them in a way they understand whether that be with audio, through pictures or simple language. Then ask the carer for extra information or to help with communication, but make sure you have consent.
Assessment tools that can help include:
Depression is characterised by low mood, tiredness and loss of energy. It can also have symptoms such as loss of self-confidence and self-esteem, difficulty concentrating and not being able to enjoy things that are usually pleasurable or interesting. Some people might also feel anxious all the time, experience feelings of helplessness, hopelessness, guilt and worthlessness.
There could be physical aches and pains and people might be thinking about suicide and death as well as self-harm.
Everyone gets anxiety at some point, but anxiety that becomes unbearable might require some support. Sometimes an event raises anxiety levels, but generally it’s likely to be a number of things that increase anxiety levels such as financial worries, meeting new people or feeling unsafe travelling home late at night.
Anxiety is a natural survival responses. It causes our mind and body to speed up to prepare us to respond to an emergency. Physical things that might happen include a rapid and/or irregular heartbeat, fast breathing, weakened/tense muscles, sweating, churning stomach/loose bowels, dizziness and dry mouth.
Anxiety also has a psychological impact, which can include trouble sleeping, lack of concentration, feeling irritable and an overlap with feeling depressed.
Psychosis is when people lose touch with reality and people can experience hallucinations. They may develop false beliefs and behave in an odd manner. There might also be difficulty in thinking clearly and losing interest in daily activities.
People with learning disabilities often experience discrimination and this can sometimes be misinterpreted as paranoia. Therefore, it is important to distinguish whether someone’s behavior is ‘normal’ for them or if there are changes in their personality.
Evidence suggests that there are higher rates of suicidal thoughts and desire to self harm in people with learning disabilities. Suicidal attempts can go unnoticed or are misconstrued such as if the person believes that an act might be lethal when it isn’t.
The suicide risks are in keeping with the general population. This includes a diagnosis of clinical depression, history of self-harm, unemployment, loneliness, an increased need for support from others, early onset mental illness, and being treatment resistive.
When looking at the signs be careful to understand what is significant to the person. This could be a new life event, a change of staff, or a change in a role or job.
A lot of us are uncertain on how to help people in crisis, but there are a lot of good resources available. This includes self help and allowing a person with learning disabilities to gain knowledge of their own mental health.
Professor Eddie Chaplin is Professor of Mental Health in Neurodevelopmental Conditions at the Institute of Health and Social Care, London South Bank University. Professor Chaplin specialises in the mental health of neurodevelopmental disorders.
This article is based on a recent webinar that can be viewed in our events section.
