900 Min
In Practice
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Mental health disorders change the way people think, feel and behave, and include:
- Schizophrenia
- Mood disorders including bipolar disorder and depression
- Anxiety disorders
- Eating disorders
- Personality disorders
- Attention deficit hyperactivity disorder (ADHD).
The prevalence of mental health disorders in people with a learning disability remains the subject of heated debate. Depending on whether the studies have included all behaviour that challenges as evidence of a mental illness, results range from 10 to 40 per cent. This has fuelled a widely held view that the prevalence is three to five times that of the general population, rising depending on the setting. In institutionalised settings the rate is thought to be higher at between 30 and 50 per cent. This is further reason to move people from hospital settings into the community.
Diagnosis
The diagnosis of a mental health disorder in people with a learning disability is often difficult and contentious and requires specialist input, and a different approach to that taken with the general population. This is because mental health disorders and behaviour that challenges may present differently in a person with a learning disability.
People who have a learning disability may find it hard to articulate their symptoms. Input from family and carers can be critical in the process. In the case of a care setting, staff may change repeatedly. This can be a challenge if the support workers describing the history of a person’s symptoms do not know them very well.
Pharmacy professionals are well placed to encourage the person, their carers, family and support workers to look for any changes in sleeping pattern, appetite, mood, sociability, or anything else that may provide a clue to a deterioration in the mental health of the person with a learning disability, and discuss what they should do if they spot anything.
Stigma remains a problem for people who have a learning disability and are suffering from mental health disorders, just as it does for other patient groups. Pharmacy professionals can help to tackle this stigma by increasing their own knowledge about mental health issues and taking steps to raise awareness in the community by supporting mental health campaigns, such as Mental Health Awareness Week, with posters in the pharmacy or by going into a school or college and hosting a stand or running a session on mental health.
Management
The management of mental health disorder in people who have a learning disability should follow the same guidance as the general population, available from the National Institute for Health and Care Excellence (NICE).
It is often unclear what condition is being treated from a list of medicines alone, so it is important not to make assumptions about diagnoses that could offend the person or their carers.
People with a learning disability may have a greater susceptibility to side effects of medicines used to treat mental health disorders. Therefore, rapid increases and reductions in doses of psychotropic medicines should be avoided as much as possible. If you see rapid changes of doses, you should contact the prescriber to confirm that these are intended and necessary.
There will be some people with a dual diagnosis of a learning disability and schizophrenia, where the use of antipsychotic medicines is indicated. Pharmacy professionals will need to be able to support these people to achieve the best outcomes from their medicines.
Further information
- For more information and access to all the learning disabilities activities, visit: cppe.ac.uk/learningdisabilities.
- Access the CPPE learning disabilities e-challenge at: cppe.ac.uk/e-challenge.
Now you've completed part four of this learning disabilities module, move onto part five: