Learning disability and mental health
Learning disability A learning disability is to do with the way someone's brain works. It makes it harder for someone to learn, understand or do things. is often confused with mental health problems.
Mental health problems can affect anyone at any time and may be overcome with treatment, which is not true of learning disability. Find out more about the difference between mental health and learning disability.
Evidence suggest that mental health problems may be higher in people with a learning disability than in those without a learning disability.
Some studies suggest the rate of mental health problems in people with a learning disability is double that of the general population (Cooper, 2007; Emerson & Hatton, 2007; NICE, 2016). The estimated prevalence of mental health disorders range from 15-52%, depending on the diagnostic criteria used (Cooper et al., 2007; Emerson & Hatton, 2007; Hatton et al. 2017; McCarron et al. 2017).
There are many reasons why people with a learning disability are more likely to experience poor mental health
Four types of risk factor are:
- Biology and genetics may increase vulnerability to mental health problems
- A higher incidence of negative life events
- Access to fewer resources and coping skills
- The impact of other people’s attitudes.
Increased risk of developing mental health problems
Every person is different, but people with a learning disability may be particularly vulnerable Being vulnerable means being at risk of harm, or that you need special care because of your age or disability. to negative life events and might not have the mechanisms for coping with these.
The accumulation of negative life events over the life course results in higher levels of stress, which can increase risk of developing mental health problems (Bond et al., 2019).
This can result in changes in behaviour such as distress, irritability and agitation (NICE, 2016).
Biological factors - Pain, physical ill health and taking multiple types of medication can all contribute to poor mental health (Joint Commissioning Panel for Mental Health 2013; NICE, 2016). Some genetic syndromes are associated with specific mental health problems (e.g. Prader Willi syndrome) (Joint Commissioning Panel for Mental Health, 2013).
Negative life events - People with a learning disability may be more likely to experience Experience is when you have learned or tried something before. deprivation, poverty, abuse Abuse is when someone bullies you and does or says something to you that makes you feel hurt, upset or scared. and other negative life events earlier on in life (NICE, 2016).
Fewer resources – Lack of social support and reduced coping skills are associated with depression and anxiety in people with a learning disability (Austin et al., 2018; Bond et al., 2019). This can increase the stress and burden felt by people with a learning disability when they are exposed to negative life events (Bond et al., 2019).
Other people’s attitudes – Stigma and
discrimination
Discrimination is when someone is treated differently (usually in a bad way) because of things like their disability or their religion.
can become internalised, which can result in psychological distress (Ali et al., 2015; Pelleboer-Gunnink et al., 2019). Learn more about stigma and discrimination.
Why mental health problems are not always recognised
- There is a gap between mental health services and learning disability services.
- Assessments to detect mental health problems in people with a learning disability are not always well developed.
- When symptoms presented by someone with a learning disability are attributed to their learning disability, rather than the true problem.
- Staff supporting people with a learning disability “are likely to use a
challenging behaviour
Challenging behaviour can be when someone hurts themselves, hits or pinches someone else, or breaks something. Some people might behave like this because they are upset or because people do not understand them.
rather than a mental health conceptual framework to understand problematic behaviours”.
Treating mental health problems in people with a learning disability
CBT is a talking therapy that can help you consider the
relationships
Relationships are about the people in your life. You might have different types of relationships like friendships, family relationships, or a boyfriend or girlfriend.
between your thoughts, emotions, behaviours and physiology.
It involves learning a variety of strategies to help influence the way you think. There is some evidence of CBT being effectively used to treat symptoms of anger, sexually aggressive behaviour, post-traumatic stress disorder (PTSD), low self-esteem and depression (Cohen & Harvey, 2016; Koslowski et al., 2016; Stenfert Kroese et al., 2016; Evans & Allez, 2018).
However, there is a lack of conclusive evidence demonstrating the effectiveness of CBT (Unwin et al., 2016).
Psychodynamic therapy is a longer-term therapy that gives you the opportunity to explore and analyse your emotions and reactions.
It tends to focus on your relationships with other people and often includes considering things that happened to you as a child. It is less focused on learning strategies and more of a safe space to explore difficult emotions.
There is some evidence of psychodynamic therapy being effectively used with people with learning disability for a variety of issues including relationship difficulties, sexual offending behaviour, social withdrawal, anger and aggression. (James and Stacy 2014; Beail 2013; Barnes and Summers 2011).
Family therapy has been found to be useful when a family member with a learning disability has mental health and/or behavioural problems.
For example, Marshall and Ferris (2012) argue that such family therapy can reduce the strain on family caregivers.
A number of small-scale studies have shown that interventions can be effective if they are tailored to the individual.
However, large-scale reliable studies into the effectiveness of different talking therapies with people with a learning disability are needed (Koslowski et al., 2016; Hamers et al., 2018)
Medication works, but can be used inappropriately.
Antipsychotics are a range of medications used to treat severe mental health problems, such as schizophrenia and bipolar disorder (Royal College of Psychiatrists, 2019).
There is no doubt that such medication can be an effective treatment for psychotic symptoms in people with a learning disability. However, evidence also suggests that antipsychotics are often inappropriately prescribed for people with a learning disability (Perry et al., 2018; Branford et al., 2019).
In 2015, Public Health England estimated that between 30,000 and 35,000 adults with a learning disability were prescribed psychotropic medication (antipsychotics, antidepressants, or both) by their GP, when they did not have the conditions the medications were for.
A national project has been set up to stop the overuse of these medications, called STOMP. STOMP stands for Stopping Over-Medication of People with a learning disability,
autism
Autism is a disability. Autistic people find it difficult to understand what other people think and feel. They also find it difficult to tell people what they think and feel. Everyone with autism is different.
or both with psychotropic medicines. Learn more about STOMP.
Research references
Here you'll find full referencing for the Mencap research Research is a way of finding out information which could come from books, or asking people what they think. and statistics pages.
Ali, A., King, M., Strydom, A., & Hassiotis, A. (2015). Self-reported stigma and symptoms of anxiety and depression in people with intellectual disabilities: Findings from a cross sectional study in England. Journal of Affective Disorders, 187, 224-231.
Austin, K. L., Hunter, M., Gallagher, E., & Campbell, L. E. (2018). Depression and anxiety symptoms during the transition Transition means changing from one thing to another. Transition sometimes means things like when you change from having children's social care to adult social care. to early adulthood for people with intellectual disabilities. Journal of Intellectual Disability Research, 62(5), 407-421.
Barnes, J. and Summers, S. (2011) ‘Using systemic and psychodynamic psychotherapy with a couple in a
community
A community is the people and places in an area.
learning disabilities context: a
case study
A case study is a piece of writing that tells people more information about someone's experience.
,’ British Journal of Learning Disabilities, 40: 259-265.
Beail, N. (2013) ‘From denial to acceptance of sexually offending behaviour: a psychodynamic approach,’ Advances in Mental Health and Intellectual Disabilities, 7(5): 293-299.
Bond, L., Carroll, R., Mulryan, N., O'Dwyer, M., O'Connell, J., Monaghan, R., Sheerin, F., McCallion, P. and McCarron, M., (2019). The association of life events and mental ill health in older adults with intellectual disability: results of the wave 3 Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing. Journal of Intellectual Disability Research, 63(5), pp.454-465. Available online (accessed 09/07/19).
Branford, D., Gerrard, D., Saleem, N., Shaw, C., & Webster, A. (2019). Stopping over-medication of people with intellectual disability, Autism or both (STOMP) in England part 1–history and background of STOMP. Advances in Mental Health and Intellectual Disabilities, 13(1), 31-40.
Cohen, G., & Harvey, J. (2016). The use of psychological interventions for adult male sex offenders with a learning disability: a systematic review. Journal of sexual aggression, 22(2), 206-223.
Cooper, S.A., Smiley, E., Morrison, J., Allan, L., & Williamson, A. (2007) Prevalence of and associations with mental ill-health in adults with intellectual disabilities. British Journal of Psychiatry. 190, 27-35.
Evans, L., & Allez, K. (2018). Cognitive behaviour therapy for low self-esteem in a person with a learning disability: a case study. Advances in Mental Health and Intellectual Disabilities, 12(2), 67-76.
Glover, G., Williams, R., Branford, D., Avery, R., Chauhan, U., Hoghton, M., & Bernard, S. (2015). Prescribing of psychotropic drugs to people with learning disabilities and/or autism by general practitioners in England. Available as a PDF online (Accessed: 05/08/2019).
Hamers, P. C. M., Festen, D. A. M., & Hermans, H. (2018). Non‐pharmacological interventions for adults with intellectual disabilities and depression: a systematic review. Journal of Intellectual Disability Research, 62(8), 684-700.
Hatton, C., Emerson, E., Robertson, J., & Baines, S. (2017). The mental health of British adults with intellectual impairments living in general households. Journal of Applied Research in Intellectual Disabilities, 30(1), 188-197. Available as a PDF online (Accessed: 08/07/19).
James, C. and Stacey, M. (2014) ‘The effectiveness of psychodynamic interventions for people with learning disabilities: a systematic review,’ Tizard Learning Disability Review, 19(1): 17-24.
Joint Commissioning Panel for Mental Health (2013) Guidance Guidance means being given clear instructions to be able to do something well. for commissioners of mental health services for people with learning disabilities. Available as a PDF online (accessed 15/08/2019).
Koslowski, N., Klein, K., Arnold, K., Koesters, M., Schuetzwohl, M., Salize, H. J., & Puschner, B. (2016). Effectiveness of interventions for adults with mild to moderate intellectual disabilities and mental health problems: systematic review and meta-analysis. The British Journal of Psychiatry, 209(6), 469-474.
Marshall, K. and Ferris, J. (2013) ‘Utilising behavioural family therapy (BFT) to help support the system around a person with intellectual disability and complex mental health needs: a case study,’ Journal of Intellectual Disability, 16(2): 109-118.
McCarron, M., Haigh, M., McCallion, P., McCallion, P., Carroll, R., Burke, E., McGlinchey, E., O’Donovan, M.A., McCausland, D., Sheerin, F. and O’Dwyer, M., (2017) Health, Wellbeing and Social Inclusion: Ageing with an Intellectual Disability in Ireland. Dublin: School of Nursing and Midwifery, Trinity College Dublin. Available as a PDF online (Accessed: 08/07/19).
National Institute for Health and Care Excellence (NICE) (2016). Mental health problems in people with learning disabilities: prevention, assessment and management. Available as a PDF online (accessed 08/08/19).
NHS The NHS is the National Health Service. The NHS gives free healthcare to everyone in the UK and includes things like your GP (doctors) surgery and hospitals. England (2019) Stopping over medication of people with a learning disability, autism or both (STOMP). Visit webpage (accessed 08/08/19).
Pelleboer-Gunnink, H. A., van Weeghel, J., & Embregts, P. J. (2019). Public stigmatisation of people with intellectual disabilities: a mixed-method population
survey
A survey is when someone asks you to answer some questions.
into stereotypes and their relationship with familiarity and discrimination. Disability and rehabilitation, 1-9.
Perry, B.I., Cooray, S.E., Mendis, J., Purandare, K., Wijeratne, A., Manjubhashini, S., Dasari, M., Esan, F., Gunaratna, I., Naseem, R.A. and Hoare, S., (2018) Problem behaviours and psychotropic medication use in intellectual disability: a multinational cross‐sectional survey. Journal of Intellectual Disability Research, 62(2), pp.140-149.
Royal College of Psychiatrists (2019) Antipsychotics. Visit webpage (accessed 08/08/19).
Stenfert Kroese, B., Willott, S., Taylor, F., Smith, P., Graham, R., Rutter, T., Stott, A. and Willner, P., (2016). Trauma-focussed cognitive-behaviour therapy for people with mild intellectual disabilities: Outcomes of a pilot study. Advances in Mental Health and Intellectual Disabilities, 10(5), pp.299-310.
Unwin, G., Tsimopoulou, I., Kroese, B. S., & Azmi, S. (2016). Effectiveness of cognitive behavioural therapy (CBT) programmes for anxiety or depression in adults with intellectual disabilities: A review of the literature. Research in developmental disabilities, 51, 60-75.