A Disability Caregiver Caring for Those with Developmental Disabilities and Mental Illness

• There is a correlation between developmental disabilities and mental illness. 
• A reciprocal relationship exists between the two. 
• A disability caregiver needs to best understand this complex relationship in order to appropriately treat the two and advocate for this patient population.
  

Many times, disability caregiver fail to understand the differing characteristics of developmental disabilities (DD) and mental illness.  Even though they are two separate diagnoses, a correlation exists between the two.   

With the increasing number of mental health issues among individuals with DD, it is sometimes difficult to differentiate the two, and is easy to misunderstand defining characteristics. It is also difficult to be aware that there is a defining relationship that exists between the two and that one reciprocally affects the other.   

However, the differences must be distinctive so proper understanding, treatment options, and medical interventions can be made accurately for this special population to receive the care they need and deserve.

The Differences

Many times, a disability caregiver fail to understand the differing characteristics of developmental disabilities (DD) and mental illness.  Even though they are two separate diagnoses, a correlation exists between the two.   

With the increasing number of mental health issues among individuals with DD, it is sometimes difficult to differentiate the two, and is easy to misunderstand defining characteristics.

One needs to be aware that there is a defining relationship that exists between the two and that one reciprocally affects the other.   

However, the differences must be distinctive so proper understanding, treatment options, and medical interventions can be made accurately for this special population to receive the care they need and deserve. 

Developmental Disabilities 

According to the Centers for Disease Control (CDC), developmental disabilities consist of a group of conditions due to impairments related to physical, learning, language, or behavioral areas.

These often begin during the developmental period but can also occur due to life events or traumatic injuries.  

These conditions have the potential to impact day-to-day functioning, and usually last throughout a person’s lifetime. These individuals are typically diagnosed when a patient is younger than 18 years of age and the diagnosis stays with the patient for a lifetime. 

Mental Health Issues

Mental health issues and illnesses may not be lifelong, but temporary occurrences or episodes. 

These issues can include mood disorders, anxiety disorders, and psychotic disorders that can change an individual’s thought processes and perceptions. Mental illness can begin in early childhood or may not present itself later as an adult.

Correlation Between Developmental Disabilities and Mental Illness

Individuals with DD are more prone to develop mental health issues across their lifespan.  In various studies, it has been found that psychotic disorders, mood disorders, anxiety disorders, and challenging behaviors are all increasingly seen in those with DD. 

The Relationship

As a disability caregiver caring for those with disabilities, the relationship that exists between disability and mental health issues can be complex.  The way mental health issue(s) present themselves is unique and dynamic.

Assessment

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is used as the basis for diagnosing a mental health disorder and classification of each disorder that includes criteria for making a diagnosis.   

Biological, psychological, and social elements need to be assessed as these can contribute to the mental health of these individuals. Be mindful that the inner experience of a person with DD can be difficult to understand due to having trouble expressing their thoughts and feelings.

When behaviors increase in intensity but have been present with the individual for a long time, it is difficult to diagnose.    

For example, say an individual always throws a plate on the floor to indicate they want food. Suddenly they have started throwing the plate on the floor more forcefully and more frequently, not just for food purposes.  

Does increase indicate they have a new mental health problem, or is it possibly a part of the same problem?  Diagnosing mental health issues accurately in those with DD involves various information from different resources.   

Identifying Characteristics of Dual Diagnosis as a Disability Caregiver

According to Hocking-Walker, P.’s 2015 article titled Co-Occurring Developmental Disabilities and Mental Health Problems, the impact of dual diagnosis exhibits the following characteristics: 

• complicated medical and psychiatric needs, with services provided to the individual but the service is frequently moved from one service to another with many of the services not being appropriate and beneficial to the individual  
• chronic medical and psychiatric problems which could have been easier to treat if caught earlier 
• over-medicated individuals because providers voiced they are “better managed” that way 
• failure of services due to service agencies feeling ill-equipped to provide adequate support 
• minimal to no support offered to help individuals manage life in the community which can lead to situations with law enforcement, jail, or being placed in psychiatric hospitals 
• denial of housing services because of their needs being “too complicated”-  life on the streets for this vulnerable group of individuals increases their risk of violence and exploitation  
• rejection by family and caregivers leaving these individuals without any support and are subject to homelessness 
• lost opportunities to be productive citizens due to failures in the system 
• out of control behaviors due to minimal to no help being offered 

Treatment and Medical Interventions

A disability caregiver assisting individuals with DD and mental health issues, needs to know various treatments and modalities are used to provide effective outcomes.   

Over the past 25 years, much of the care has shifted from state hospitals to various community settings. This shift has increased the need for both medical and mental health services in the community.   

One of the greatest problems that has been noted with community settings is that these services typically lack necessary training of both medical and psychiatric professionals.   

Survey, Issues in treating patients with intellectual disabilities, conducted by Werner and colleagues in 2013, indicated that 90.2% of psychiatrists experience feelings of inadequacy and insufficient training to treat those with DD. 

Evidence suggests that if the problems of this population are addressed appropriately, results can be positive. Progression instead of regression, can be achieved in a collaborative manner.   

Keys to Effective Treatment and Management By a Disability Caregiver:

• correctly identifying the cause of the behavioral problems and addressing them appropriately is the first step 
• accurate diagnosis is based on team meetings and discussions 
• look for changes in baseline of both medical and behavioral issues 
• discuss the changes with those who know the individual best (family and Direct Support Professional staff) 
• rule out medical versus psychiatric issues 
• assess for regression in previous skills, speech, behavior, or normal activities  

Five Guiding Principles for Disability Caregivers

In the same study by Hocking-Walker, P., these are the five guiding principles to care for those with dual diagnosis: 

• They still people FIRST with strengths as well as weaknesses 
• Dual diagnosis is common but under-identified  
• It can be difficult and complex but are understandable to those with knowledge in these areas  
• It is challenging, but can be improved by adequate care 
• Mental health issues among this population are improved best by not separating the treatments for a DD versus a mental health treatment and are best accomplished by working together conjunctively

The Bottom Line

Working with individuals that exhibit characteristics of both DD and mental illness can be challenging and frustrating, yet extremely rewarding at the same time.

Due to the difficult cause and effect relationship, assessment is crucial in determining what need or desire the behavior is trying to meet and how the individual need can be met.

Regardless, these individuals deserve efficient quality care to ensure that both DD and mental illness are being evaluated collectively in providing the most desirable patient outcomes. 

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