Mental Health Care for Canadians with Developmental Disabilities

Article excerpt

Abstract

My research focuses on the promotion of mental health and the treatment of mental health problems in people with developmental disabilities. People with developmental disabilities are at high risk for developing mental health problems or serious challenging behaviours at some point in their lives. Research is needed to address these mental health concerns by studying programs that can promote mental health in people with developmental disabilities, die experiences of parents of people with developmental disabilities, and the training needs of graduate students in psychology to provide mental health care to clients with developmental disabilities. More generally, Canadian psychology has an important role to play in mental health promotion for individuals with developmental disabilities.

Keywords: developmental disability, intellectual disability, autism spectrum disorders, mental health

Approximately 1-3% of the population has a developmental disability (DD), which includes individuals with intellectual disabilities and/or autism spectrum disorders (American Psychiatric Association, 2000; Ouellette-Kuntz & Paquette, 2001). Individuals with DD are at high risk for developing mental healdi problems and have poorer prognosis dian typically developing individuals. In Great Britain for instance, 36% of children with DD also meet criteria for a co-occurring mental healtìi problem, a prevalence rate five times greater than in peers without DD (Emerson & Hatton, 2007), and similar rates are found in adults with DD (Cooper, Smiley, Morrison, Williamson, & Allan, 2007). Mental healdi disorders are important predictors of poor overall health in individuals with DD (Linehan, Noonan Walsh, van Schrojenstein Lantman-de VaIk, & Kerr, 2004).

As a result of the sizable population base and level of need, it is important to conduct research that investigates protective factors that bolster mental health, and there is a need for new and more effective treatment options mat rectify problems when they arise. My program of research comprises three streams that study: (a) interventions that can improve mental health in people with DD, (b) families who care for people with DD, and (c) mental health services and training that can increase access to mental health care for people with DD.

Research on Interventions

One efficient way of targeting mental healdi risk is to identify programs that serve a protective role by promoting mental health before problems arise. More specifically, I have been involved in studying Special Olympics, a sport organisation for children and adults with DD, which has long been noted by parents and professionals as a program that can enhance the self-esteem, confidence, independence, and socialization of participants (Klein, Gilman, & Zigler, 1993). My research was among the first in Canada to quantitatively examine psychological benefits of involvement, studying athlete participation in Special Olympics over a 3-year period, and finding positive changes in athletes' self-concept, and adaptive and maladaptive behaviours (Weiss & Bebko, 2009). This research identified specific program characteristics (e.g., the number of competitions and years in the program) that related to addete psychological well-being (Weiss, Diamond, Demark, & Lovald, 2003). Empirically identifying variables of import has led to a renewed focus on ensuring that sport programming results in positive psychological benefits for athletes with DD, and has informed program developers about the aspects of the program that should be emphasised (e.g., focusing on creating more opportunities for local level competitions).

Research on Families

If we are interested in prevention and intervention for people with DD, it is integral that research be directed toward understanding and supporting parents, who are significant agents in maintaining the mental health of their children across the life span. Parents are often responsible for making decisions on their children's behalf, accessing new services, and dealing with changes in child mental healdi and behaviour. Research has shown that parents can experience considerable distress in managing their children's mental health problems across the life span (Weiss, Cappadocia, MacMullin, Viecili, & Lunsky, in press), and that an intervention that helps these children (e.g., Special Olympics) can also function as a source of support for parents (Weiss, 2008; Weiss & Diamond, 2005). By more fully understanding the needs of parents who care for people with DD, we can devise effective interventions that will help parents stay mentally healthy and improve the mental health of their children.

More recently, I have directed my attention toward understanding the experience of caregiving in parents of individuals with DD and mental health problems when individuals with DD are in psychiatric crisis. Through collaborations with the Dual Diagnosis Program at the Centre for Addiction and Mental Health (led by Dr. Yona Lunsky), this research has contributed to our understanding of the psychological impact that caregiving can have on families of individuals with DD who have mental health problems (Weiss & Lunsky, 2011), caregiver perceptions of the health care system (Weiss, Lunsky, Gracey, Canrinus, & Morris, 2009), and the changing health service needs and barriers to service utilization across the life span (Weiss & Lunsky, 2010; Weiss, Slusarczyk, & Lunsky, 2011). This work has resulted in a novel measure to quickly assess family crisis, which is now being used at a number of specialized DD programs in Ontario as part of the standard intake and evaluation process (Brief Family Distress Scale; Weiss & Lunsky, 2011).

Research on Training

Individuals with DD often struggle to access appropriate mental health care in Canada and internationally as a result of systemic barriers and a lack of capacity to provide service (Ouellette-Kuntz et al., 2005). This health inequity is partly attributed to a lack of sufficiently trained mental health professionals who are able and willing to provide this population with care (e.g., Burge, Ouellette-Kuntz, McCreary, Bradley, & Leichner, 2008).

In order to begin to address this inequity, I conducted a national study of clinical and counselling psychology graduate training in DD (Weiss, Lunsky, & Morin, 2010). While graduate students from CPA accredited Clinical and Counselling Psychology graduate programs clearly note valuing training in DD, and most believe that it will contribute to their skills as psychological service providers in the future, they also feel that the level of their training in DD is inadequate. This need for more training was found in graduate students regardless of whether they planned to work with children, youth, or adults, but was most pronounced in adult-focused students. We also identified predictors of graduate student interest in working in the field of DD, showing that having community and school-based contact with individuals with DD is related to a desire to work with the population in the future (Viecili, MacMullin, Weiss, & Lunsky, 2010). It is hoped that this kind of research will facilitate discussions on how to improve graduate program curricula and build the capacity required to provide mental health care across the life span to people with DD.

Conclusion

There are many ways that psychologists can support Canadian citizens who have DD. Conducting research into programs that promote mental health, into the needs of parents as they provide care, and into the training needs of future psychologists are just a few ways to address the critical mental health care gap that currently exists for this population. There is also a tremendous need for psychologists to be able to provide timely assessments into DD and mental health problems, and provide evidence-based interventions to address mental health disorders when they arise, across the life span. More broadly, the research and practice of psychology can be instrumental in informing decision makers to shape policies in ways that will support individuals with DD in our country, and consequently in improving their well-being and mental health.

[Sidebar]

Résumé

La présente recherche porte sur la promotion de la santé mentale et le traitement des problèmes de santé mentale chez les personnes ayant une déficience développementale. Ces personnes présentent un haut risque de développer des problèmes de santé mentale ou d'avoir des problèmes de comportement à un moment ou l'autre de leur vie. Il faut effectuer des recherches pour trouver des solutions à ces préoccupations en étudiant les programmes qui peuvent favoriser la santé mentale chez les gens ayant une déficience développementale, en définissant l'expérience des parents d'enfants ayant une déficience développementale, et en établissant les besoins en formation des étudiants des programmes d'études supérieures en psychologie afin d'être en mesure de fournir des soins de santé mentale aux personnes ayant une telle déficience. De façon plus générale, la psychologie au Canada a un r]]&#xl2C960;

Mots-clés : déficience développementale, déficience intellectuelle, troubles de spectre autistique, santé mentale.

[Reference]

References

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Weiss, J. A., Lunsky, Y., & Morin, D. (2010). Psychology graduate student training in developmental disability: A Canadian survey. Canadian Psychology, 51, 177-184. doi:10.1037/a0019733

Weiss, J. A., Slusarczyk, M., & Lunsky, Y. (2011). Individuals with intellectual disabilities living with families and in psychiatric crisis: Who uses the emergency department and who stays home? Journal of Mental Health Research in Intellectual Disabilities, 4, 158-171. doi: 10.1080/19315864.2011.599013

Received September 19, 2011

Revision received September 26, 2011

Accepted September 27, 2011

[Author Affiliation]

JONATHAN A. WEISS

York University

[Author Affiliation]

This article was supported by a New Investigator Fellowship from the Ontario Mental Health Foundation.

Correspondence concerning this article should be addressed to Jonathan Weiss, PhD, C. Psych, Assistant Professor, Department of Psychology, York University, Behavioural Science Building, 4700 Keele Street, Toronto, ON, M3J 1P3. E-mail: jonweiss@yorku.ca

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