Mental Health Intellectual Disability
Mental Health Intellectual Disability – Service Improvement Programme
The Service Improvement Programme Mental Health Intellectual Disability, applies to children and adults with an intellectual disability in the moderate to profound range where there is a concern about a moderate to severe mental disorder, for example a depressive disorder, a psychotic illness, a moderate to severe anxiety disorder that has not responded to intervention provided by the disability team, or Attention Deficit Hyperactivity Disorder.
The Programme is delivered as part of the HSE’s service provision and across government departments to ensure holistic, integrated person-centred mental health assessment and intervention for children and adults with an intellectual disability.
Individuals with an intellectual disability are four times more likely to develop a mental disorder, when compared to those of normal cognitive ability, due to a number of vulnerabilities to include communication difficulties, reduced coping strategies and social skills, high prevalence of neurodevelopmental disorders (ASD and ADHD), increased prevalence of genetic conditions, sleep disorders, social and economic deprivation, reduced education and occupational opportunities, high rates of adverse life experiences and carer fatigue and burnout.
Access to appropriate and early mental health intervention and treatment, has been shown to significantly improve outcomes for this patient population.
Prior to the development of the National Service Improvement Programme, mental health services for individuals with an intellectual disability were mainly provided by charitable/religious organisations. Children and adults attending these services for educational or occupational placement, received multidisciplinary intervention from these organisations. Psychiatrists employed through these organisations traditionally provided a service that extended from childhood through to older age. This led to gaps in mental health service provision nationally, where individuals not attending these organisations often had no access to disability or mental health support.
A Vision for Change, National Mental Health Policy Document 2006 aimed to end the gaps in mental health service provision nationally, by recommending geographically distinct, multidisciplinary catchment area-based services for children and adults with an intellectual disability.
Programme Aims and Objectives
The National Service Improvement Programme MHID was set up in 2017, to deliver on a Vision for Change recommendations. The NSIP aims to develop geographically distinct starter/baseline teams initially, of one Consultant Psychiatrist (CP), one Clinical Nurse Specialist (CNS), one Senior Psychologist and an Administrator. Additional multidisciplinary posts will be provided with further rounds of funding. The aim is that mental health services for individuals with an ID will be accessed and resourced similar to services for those of normal cognitive ability or mild ID, and in line with a Vision for Change and Sharing the Vision recommendations.
One of the first steps in developing a service is designing a Model of Service. The HSE National Model of Service for AMHS ID was launched in 2020. The HSE National Model of Service for CAMHS ID was launched by Minister Mary Butler in September 2022. Both MOS are available to view on the HSE website.
Implementation of the MOS for MHID is dependent on additional funding, to develop services nationally across all Regional Health Authority areas. There are currently ten CAMHS ID and nineteen AMHS ID teams staffed to baseline team level nationally. It is likely to take several years for the service improvement programme to be fully implemented.
GPs and those working in healthcare settings may find the clinical pathway outlined in the MOS useful to understand the referral process, where teams are now in place.
When the MOS is fully implemented, there will be 31 AMHS ID teams (one per 150000 population) and 16 CAMHS ID teams nationally (one per 300000 of the population), with a full complement of multidisciplinary staff to include a Consultant Psychiatrist, Non-Consultant Hospital Doctors, Psychology (senior and basic grade), Speech and Language Therapy, Occupational Therapy, Social Work a Clinical Nurse Specialist and an Administrator.
Access to MHID services
Mental Health Services for individuals with an intellectual disability, include both Child and Adolescent Mental Health Services Intellectual Disability (CAMHS ID) and Adult Mental Health Services Intellectual Disability (AMHS ID). CAMHS ID is a specialist mental health service providing assessment and intervention for children up to the age of eighteen years, living in a defined geographical catchment area. Individuals over the age of eighteen years attend the AMHS ID service in the same catchment area, with arrangements in place for a smooth transition of care for children on reaching their eighteenth birthday.
MHID services are distinct and separate but closely linked to catchment area-based disability teams, who provide an interdisciplinary social care approach to support the person’s disability. Children and adults with an ID can access mental health support for a mild to moderate mental disorder from primary care or disability teams. A moderate to severe mental disorder is defined as functional impairment across two areas on account of the mental disorder as opposed to the disability.
It is best practice for an individual to be linked with their disability team and to be receiving intervention, prior to referral to a MHS.
Access and referral pathways to MHID teams are outlined in the HSE National Model of Service for both CAMHS and AMHS ID teams.
MHID teams accept referrals from General Practitioners and CAMHS or AMHS Consultant Psychiatrists. Referrals for paediatric patients are accepted from Consultant Paediatricians when there is a concern about a moderate to severe mental disorder. A psychological assessment report will be requested on receipt of the referral, to determine if the individual has an ID in the moderate to profound range. The team may request additional reports to include Occupational Therapy, Speech and Language Therapy and Positive Behaviour Support, if available.
Scope of the National Service Improvement Programme
The National Service Improvement Programme for MHID is a HSE Mental Health Programme, it applies across the age range (child and adult). It is focused on individuals with a moderate to profound intellectual disability, who have a comorbid moderate to severe mental disorder.
Individuals with intellectual disability across the lifespan have very complex needs. The NSIP for MHID works closely with other HSE Clinical Programmes, where collaborative and integrated care solutions are needed to deliver the best mental health clinical services to individuals with ID and their families. This includes work with other clinical programmes in disability, primary care, paediatrics and collaboration with generic child and adult mental health services.
Goals for 2025
- To further implement the HSE National Model of Service for AMHS and CAMHS ID, by developing teams nationally to baseline levels of staffing initially, (one WTE Consultant Psychiatrist, 1 Clinical Nurse Specialist, 1 Senior Psychologist or equivalent and 1 Administrator) for a population of 150000 for adults and 300000 for children with intellectual disability. This will support improved access for individuals with an intellectual disability to a geographical, catchment area based mental health service. The National MOS for AMHS and CAMHS ID provides a framework for the development of high quality, evidence based, person centred mental health services that are integrated and accountable for the work that they do.
- To recruit and retain skilled staff in MHID services, by supporting workforce development, providing opportunities for professional growth and enhancing digital and estate infrastructure within budgetary constraints.
- To improve timely access to mental health services for children and adults with an intellectual disability and mental disorder.
- To develop and enhance integrated care pathways between primary care, disability teams, generic mental health services, and acute hospital services.
- To establish a single point of access for referrals for all children with an intellectual disability in collaboration with disability services, primary care, and generic mental health services. This will improve referral pathways, reduce wait times, and ensure that children are seen at the ‘right time, in the right place by the right team.
- Participate in the integration of digital technologies in CAMHS and AMHS ID services nationally, including the roll out of electronic patient records in paediatric mental health and acute hospital services.
- To introduce and begin collecting Key Performance Indicators (KPIs) on teams resourced to baseline level. KPIs will provide information on activity levels across teams, highlight areas of increased demand and identify priorities for resourcing.
- Regular meetings with the National Oversight Group, to support the implementation of the Model of Service for CAMHS and AMHS ID.
Contact us
National Clinical Lead MHID Dr Louise Sharkey
Email: MHIDSIP@hse.ie