Adults with intellectual disabilities and mental health disorders in primary care: a scoping review

Abstract

Background: General practitioners (GPs) are increasingly confronted with patients with both intellectual disabilities (ID) and mental health disorders (MHD). Currently, the care provided to these patients is found to be insufficient, putting them at risk of developing more severe MHD. Improving the quality of GP care will improve the whole of mental healthcare for this patient group. Therefore, an overview of the content and quality of care provided to them by the GP might be helpful. Aim: To provide an up-to-date literature overview of the care provided by GPs to patients with ID and MHD, identify knowledge gaps, and inform research, practice, and policy about opportunities to improve care. Design: Scoping review. Method: Pubmed, PsychINFO, Embase, and grey literature were searched for publications concerning patients with ID, MHD, and primary care. Selected publications were analysed qualitatively. Results: One hundred publications met the inclusion criteria. Five overarching themes were identified: GP roles, knowledge and experience, caregiver roles, collaboration, and a standardized approach. The results show GPs’ vital, diverse, and demanding roles in caring for patients with both ID and MHD. GPs experience problems in fulfilling their roles, and gaps are identified regarding effective GP training programmes, applicable guidelines and tools, optimal collaborative mental healthcare, and corresponding payment models. Conclusion: The improvement required in the current quality of GP care to patients with ID and MHD can be achieved by bridging the identified gaps and initiating close collaborations between care professionals, policymakers, and organizational managers.

Primary mental healthcare for adults with mild intellectual disabilities: a Dutch database study

“…People with mild intellectual disability (MID), characterised by a significant deficit in intellectual and adaptive functioning [ 1 ], suffer from more mental health (MH) disorders compared to people without intellectual disability (ID) but often do not receive appropriate mental healthcare [ 2–8 ]. General practitioners (GPs) are often the first point of contact for people with MH problems and are gatekeepers to specialised mental healthcare services [ 9 ]. Prevalence studies in primary care with a specific focus on mental health in people with MID are scarce and focus on established MH disorders only, implicating a lack of knowledge on MH-related complaints (problems presented, no established diagnoses) in primary care.…”

“…There are several reasons for concern. First, the identification of both MH disorders and MID are problematic [ 2 , 9 , 10 ]. Second, people with ID experience general health disparities, including mental health, because of barriers to providing timely, appropriate, and effective primary healthcare [ 6 ].…”

“…Second, people with ID experience general health disparities, including mental health, because of barriers to providing timely, appropriate, and effective primary healthcare [ 6 ]. Long-term conditions, like psychosis and depression, are poorly managed in primary care and psychotropic prescriptions exceed the number of reported MH disorders, suggesting inappropriate prescriptions [ 2 , 5 , 9 ]. Finally, GPs themselves indicate a lack of knowledge and feel insecure about providing the care needed [ 9 , 11 ].…”

Advances for future working following an online dramatherapy group for adults with intellectual disabilities and mental ill health during the COVID‐19 pandemic: A service evaluation for Cumbria, Northumberland Tyne and Wear NHS Foundation Trust

“…Patients with intellectual disabilities are understood to have greater healthcare needs with higher levels of morbidity and premature mortality than patients without an intellectual disability (Carey et al, 2016 ; Heslop et al, 2014 ). Research shows that mental health diagnoses are three–four times more common in people with intellectual disabilities than in the general population, with both primary and secondary care at times insufficient due to inadequate identification of a disability, a mental health issue, communication difficulties, atypical presentation of disorders and/or a lack of appropriate assessment tools and treatment methods (Pouls et al, 2021 ). As a consequence, this population is often at risk of developing more severe or chronic mental health difficulties, given more psychotropic medications and often use more services than the general population (Hassiotis et al, 2008 ).…”

STOMP and STAMP campaigns: success or failure?

“…This suggests that awareness raising, guidance and exhortation alone are not sufficient to bring about significant change, especially where care is complex and shared between many organisations and services. Furthermore, many GPs are not confident to rationalise or review complex prescriptions for psychotropic medication that they did not initiate 5. In addition, neither primary nor secondary care have the resources or time to properly address inappropriate prescribing.…”