In last month’s Shared Solutions, we discussed support and treatment for individuals with co-occurring disorders, specifically intellectual and developmental disabilities (I/DD) and substance abuse. In this post, we focus on I/DD and mental health, often referred to as a type of dual diagnosis.
Unlike a co-occurring disorder, when one condition may be caused by another condition, dual diagnosis refers to two different conditions that exist at the same time. For example, physicians would describe a person with heart disease and Alzheimer’s as having a dual diagnosis. (To review the difference between a co-occurring disorder and dual diagnosis, see the article, “What Is the Difference Between Dual Diagnosis vs. Co-occurring Disorders?”)
As an employment consultant, you may receive a referral from Vocational Rehabilitation for a new job seeker with a label of dual diagnosis. Research indicates that about 30-35 percent of all people with intellectual or developmental disabilities have a psychiatric disorder, according to The Diagnostic Manual-Intellectual Disability: A Textbook of Diagnosis of Mental Disorders in Persons with Intellectual Disability, (DM-ID-2). People with I/DD experience the same types of behavioral health disorders as people without disabilities. These can include depression, anxiety disorders, impulse control, personality disorders, and many more.
Unfortunately, when behavioral health needs go unrecognized, a common occurrence, job seekers and employees with this type of dual diagnosis can face barriers to employment. In other words, we as support professionals often define a person by their behavior rather than recognize that the behavior is a form of communication and not a symptom of their disability. It can be difficult to determine the underlying cause of behavioral difficulties because the individual may not have developed coping skills due to their cognitive and adaptive disabilities. Medical issues also might present challenging behaviors.
Behaviors Can Indicate the Presence of a Psychiatric Condition
In the presentation “Emerging Best Practices for People with an Intellectual/Developmental Disability Co-Occurring with Serious Mental Illness,” from the Substance Abuse and Mental Health Services Administration (SAMSHA), you will find a great deal of information, including a list from authors Mcgilvery and Sweetland of behavioral patterns that could indicate the presence of a psychiatric condition. As a professional working with job seekers, it will be helpful for you to be aware of these indicators.
- The behavior occurs in all environments; it is not just exhibited in specific settings.
- Behavioral strategies have been largely ineffective.
- The individual doesn’t appear to have control over their behavior.
- The individual doesn’t appear to be able to start or stop the behavior at will.
- There are changes in sleep patterns; increased, decreased, or disturbed sleep.
- The individual is experiencing excessive mood or unusual mood patterns.
- There are changes in the individual’s appearance and a decline in their independent living skills.
Now let’s consider medical issues, because these can also go hand in hand with behavioral problems that, in turn, could be misdiagnosed as a mental health issue. Examples of medical conditions to consider include:
- Gastrointestinal issues such as constipation, irritable bowel syndrome, GERD
- Endocrinology problems such as diabetes or thyroid disorders
- Neurological problems such as epilepsy or other movement problems
- Headaches, dental pain, hearing, and vision problems
Always Be Aware of Possible Issues
Best practice when supporting job seekers or employees with disabilities—whether it’s during Discovery, a job search, or on-the-job support—is to always be aware of possible issues in your observations and “dig deeper” when you do have concerns.
It is important to discuss concerns with the team (individual, family, support staff, VR counselor) in order to determine steps to obtain proper treatment. Treatment options for people with a dual diagnosis of I/DD and mental health might include modified psychotherapy, as one example. The reality is that families and individuals may find it challenging to find a mental health provider in their area who accepts Medicaid and who is also willing to provide services to the I/DD population. Talk to your VR counselor. They can help the individual and family identify appropriate mental health service providers.
Successful delivery of services requires a collaborative approach among service providers. In the presentation referenced above, Moseley found that mental health providers often believe they don’t have the skills to serve adults with a dual diagnosis. Also, I/DD providers don’t always understand the services that the mental health sector offers and vice versa. Thus, it’s important for providers to collaborate to ensure that services are based on the individual’s needs and not solely on the mental health or I/DD diagnosis.
- British Columbia Medical Journal: “The Other Dual Diagnosis: Developmental Disability and Mental Health Disorders”
- Mental Health and Developmental Disabilities National Training Center: Resources and Fact Sheets
- Substance Abuse and Mental Health Services Administration (SAMSHA): “Emerging Best Practices for People with an Intellectual/Developmental Disability Co-Occurring with Serious Mental Illness“
- Texas Health and Human Services: “Mental Health Wellness for People with Intellectual & Developmental Disabilities”
- The National Association for the Dually Diagnosed : “What is an IDD/MI Dual Diagnosis?“