Public mental health service use by people with intellectual disability in New South Wales and its costs

Abstract

ental health disorders are the largest contributors to the non-fatal burden of disease in Australia 1 and are a leading cause of morbidity. Rates of mental health disorders are higher among people with intellectual disability than for the general population. [2][3][4][5] Nevertheless, the drivers of mental health service use by people with intellectual disability are unknown. Better understanding of their health needs is critical for responding to the recent finding by the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability of "systemic neglect in the Australian health system" of people with cognitive disability. 6 Personal characteristics associated with poorer access to mental health care in Australia include being female, being separated or divorced, being unemployed or receiving government support, having an affective disorder, a high level of psychological distress, several mental health disorders, or physical disorders, [7][8][9] and living in rural areas. [10][11][12] Predictors of mental health service use by people with intellectual disability, however, are relatively unexplored. Overseas research has identified predictors of emergency department presentation during a psychiatric crisis, such as milder severity of intellectual disability, living with family, not having a primary care physician or crisis plan, and having a history of emergency department visits or interactions with the criminal justice system. 13 Another study found that aggression and psychotropic polypharmacy predicted the number of inpatient admissions for adults with intellectual disability. 14 Knowing the predictors of mental health service use for people with intellectual disability in Australia could guide policy and service development.Further, the costs of mental health services for people with intellectual disability have not been investigated in detail. In Australia, mental health service costs are driven primarily by admitted patient care and community mental health services ($1.517 billion of the $1.722 billion in recurrent expenditure during 2015-16 [88%]). 15 We have previously reported that people with intellectual disability are more likely to present to emergency departments and to be re-admitted to hospital after a psychiatric admission than those without intellectual disability, 16 and that they use ambulatory mental health services more frequently, 17 which could increase costs. Knowing the drivers of service costs would allow development of targeted services for people with intellectual disability.As identifiers for people with intellectual disability are not used in Australian health service systems, mental health service use and costs cannot be determined by analysing routinely collected data. We have previously described our construction of a large linked data set for identifying people in New South Wales with intellectual disability. 18 In this study, we describe their population characteristics, and quantify and compare public mental health service use and costs for p...

Predictors and outcomes of recognition of intellectual disability for adults during hospital admissions: A retrospective data linkage study in NSW, Australia

“…People with intellectual disability have high health needs that require frequent use of acute health care services such as emergency departments and hospitalisations [ 1 , 2 ]. People with intellectual disability often experience poor quality of care and inefficiency of care in these settings [ 3 , 4 ], which contribute to reattendance at emergency departments, and readmission within close proximity to discharge [ 5 , 6 ].…”

Pattern of multimorbidity in middle‐aged and older‐aged people with mild intellectual disability in Australia

“…Respondents in both age-groups reported higher level of anxiety than the general Australian population, and prevalence of depression was higher than the general population in the older-aged group (Australian Bureau of Statistics, 2018b). Previous studies have found that up to a third of people with intellectual disability have a co-existing psychiatric illness (Mazza et al, 2020;Morgan et al, 2008), and are higher users of mental health services (Srasuebkul et al, 2021). Conditions that have previously been shown to be associated with intellectual disability at higher rates than the general population include schizophrenia and unspecified psychiatric disorders (Mazza et al, 2020).…”

Intellectual disability healthcare in Australia: Progress, challenges, and future directions

“…The intellectual disability health sector in Australia has strong roots in primary care, where a lot of early research and pivotal work around the utility of health assessments was undertaken (e.g., Lennox et al, 2010). More recent research has focused on understanding knowledge and skill gaps in our health workforce (e.g., Cashin et al, 2022) and describing how people with intellectual disability use our health system to inform service planning (e.g., Srasuebkul et al, 2021). Groundwork, including Medicare reimbursement and collation of evidence of effectiveness, has been laid to support routine application of comprehensive annual health assessments by GPs.…”