Mental health - research and statistics

Learning disability is often confused with mental health problems

Mental health problems refer to a range of emotional, psychological and psychiatric problems including depression, anxiety and schizophrenia. Mental health problems can affect anyone at any time and may be overcome with treatment, which is not true of learning disability.

You can find out more about about the difference between mental health and learning disability here

Approximately 40% of adults with a learning disability also have a mental health problem

It is estimated that the prevalence of mental health problems amongst adults with a learning disability is approximately 40% (McCarron et al. 2011; Cooper et al. 2007).

This is more than double the estimated point prevalence rate of mental health problems in the general population (Mind 2016a; McManus et al. 2009; Jacobi et al. 2004).

Children with a learning disability are also more likely to suffer from mental health problems than children without a learning disability, with approximately 36% of children with a learning disability also reported to have a psychiatric disorder (Emerson and Hatton, 2007).

Several pieces of research have specifically found elevated rates of attention difficulties, aggressive behaviour and social problems in children with a learning disability compared to their peers without a learning disability (Hackett et al. 2011; De Ruiter et al. 2007).

There are many reasons why people with a learning disability are more likely to experience poor mental health

There are a range of biological, social and psychological factors that put certain individuals at a greater risk of developing mental health problems. Although these risk factors may affect anyone, people with a learning disability have a greater chance of encountering these problems due to their disability (Royal College of Nursing 2010).

Four types of risk factor are discussed below:

1. Biology and genetics may increase vulnerability to mental health problems

A learning disability is caused by the way the brain develops. This in itself may increase vulnerability to mental health problems, although the reasons for this are unclear.

People with a learning disability also have an elevated risk of having some physical health problems. This can cause long-term pain which may lead to distress, irritability and anger, especially if not properly treated (Royal College of Nursing 2010). People with downs syndrome, for example, are known to have a far greater risk of developing dementia, which is in itself associated with mental health problems (RCN, 2010).

2. A higher incidence of negative life events

People with a learning disability are more likely to experience deprivation, poverty and other adverse life events earlier on in life (Emerson and Hatton 2007; Main and Pople 2011). They are also at risk of experiencing other potentially traumatic events, such as moving house or residence, injury and illness, unemployment and abuse and neglect (Hastings et al. 2004).

3. Access to fewer resources and coping skills

Research shows that compared to the general population, people with a learning disability are less likely to have the necessary skills and resources for coping with adverse events. Major transitions, such as leaving school or home, can be particularly stressful and anxiety provoking for people with a learning disability (Kaehne 2011).

People with a learning disability often have smaller social networks and/or fewer opportunities for creating friendships. This means they have less social support, and an increased risk of social exclusion and loneliness (Stacey and Edwards 2013). Social support is an established protecting factor for mental health problems, and loneliness a precursor to various psychological difficulties (Hagerty and Williams 1999).

4. The impact of other people’s attitudes

MacHale and Carey (2002) found that when a loved one of somebody with a learning disability died, support workers sometimes mistakenly saw their behavioural expressions of grief as challenging behaviour. If families, carers or professionals do not correctly identify the reason for the behaviour of a person with a learning disability, this might mean that they are not provided with appropriate support or service provision, which in turn might lead to mental health problems developing or worsening.

Every individual is different, but it is an interaction of factors – in particular a vulnerability to negative life events and reduced mechanisms for coping with these – that leads to people with a learning disability having an increased risk of developing mental health problems.

  • More than 40% of adults with a learning disability also have a mental health problem
  • The prevalence of mental health problems for people with a learning disability is double that of the general population
  • Studies suggest that around 40% of children with a learning disability have mental health problems and /or behaviours seen as challenging

Mental health problems in people with a learning disability are not always recognised or diagnosed

Before a person with a learning disability can access mental health treatments, their mental health problems need to be recognised. However, research by Taylor et al. (2008) has identified four reasons why mental health problems amongst people with a learning disability are not always recognised or diagnosed:

1. There is a gap between mental health services and learning disability services

Mental health and learning disability services are often separate, and do not always work together (Taylor et al. 2008). Additionally, mental health services are not always accessible to people with a learning disability. This can mean that there is a gap in provision for those who suffer from mental health problems and have a learning disability.

There is evidence suggesting that people with a learning disability miss out on government funded initiatives such as Improving Access to Psychological Therapies (IAPT) and memory clinics (Chinn et al. 2014; Kroese et al. 2013). 

On the other hand, those with more severe learning disabilities and mental health problems will most likely present to learning disability services. Therefore, it is important that front line workers in both these services are aware of the symptoms of mental health when presented by people with a learning disability.

2. Assessment measures to detect mental health problems in people with a learning disability are not always well developed

Even if an individual is identified as having a learning disability, medical professionals can face considerable problems diagnosing mental health problems. Many people with a learning disability experience communication difficulties, which can make it more difficult to give an accurate diagnosis (Department of Health 2013).

3. Diagnostic overshadowing

Diagnostic overshadowing is where symptoms presented by someone with a learning disability are attributed to their learning disability rather than the true underlying problem (Mason and Scior 2004). This can mean that mental health problems go undiagnosed. Mason and Scior (2004) give 2 reasons why this might happen:

  • There can be a tendency to attribute behaviour to the most obvious potential cause, which in this case is a learning disability.
  • Medical professionals may consider mental health problems to be less important when considered next to a learning disability, so effectively ignore them.
4. Challenging behaviours

Staff supporting people with a learning disability “are likely to use a challenging behaviour rather than a mental health conceptual framework to understand problematic behaviours” (Taylor et al. 2008, p. 4). This could mean that underlying mental health problems are not recognised or not treated effectively. See our page about challenging behaviour for more information about this issue.

Broadly, there are two ways that we treat mental health problems: with medication or through talking therapies such as psychotherapy or cognitive behavioural therapy (CBT). The effectiveness of a treatment will depend on the individual and the type of mental health problem. For many people, a combination of medication and talking therapy is the best approach.

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Learning disability and mental health

Psychotherapy and other talking therapies can be effective for people with a learning disability, but more research is needed.

  • Cognitive behavioural therapy (CBT) is a talking therapy that can help you consider the relationships 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 abusive behaviour, symptoms of schizophrenia and post-traumatic stress disorder (PTSD) in people with a learning disability (Barrowcliff 2007; Murphy et al. 2010; Taylor et al. 2008; Kroese and Thomas 2006).
  • 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).

Other treatments

  • 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.

The evidence base for the effectiveness of psychotherapy and other talking therapies for people with a learning disability is small, although it is expanding. 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 (Bhaumik et al. 2011; Prout and Browing 2011).

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 2016). 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 (Thalitaya et al. 2011; Varghese and Banerjee 2011).

Antipsychotics are often used to manage behavioural problems in people with a learning disability, without any robust evidence that they are effective at doing so (Singh et al. 2005; Tyrer et al. 2008).  The inappropriate prescription of antipsychotics is problematic because they can have numerous side-effects, including drowsiness, weight gain, and a higher risk of developing diabetes (Royal College of Psychiatrists 2016; Varghese and Banerjee 2011). Varghese and Banerjee (2011) argue that antipsychotics can negatively impact on an individual’s quality of life if not properly monitored. Additionally, they warn that distress can often present in the form of challenging behaviour, which can be interpreted as medication non-response. In turn this could lead to unnecessary changes or escalations to medication.

See the Feeling Down report by the Foundation for People with Learning Disabilities (2104) for recommendations to improve the mental health of people with a learning disability. 

References

  • Barnes, J. and Summers, S. (2011) ‘Using systemic and psychodynamic psychotherapy with a couple in a community learning disabilities context: a case study,’ British Journal of Learning Disabilities, 40: 259-265.
  • Barrowcliff, A. (2007) ‘Cognitive-behavioural therapy for command hallucinations and intellectual disability: a case study,’ Journal of Applied Research in Intellectual Disabilities, 21: 236-245.
  • 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.
  • Bhaumik, S., Gangadharan, S., Hiremath, A. and Russel, P. (2011) ‘Psychological treatments in intellectual disability: the challenges of building a good evidence base,’ The British Journal of Psychiatry, 198: 428-430.
  • Chinn, D., Abraham, E., Burke, C., & Davies, J. (2014) IAPT and Learning Disabilities. Research report by Foundation for People with Learning Disabilities and King’s College London. Available online.
  • Crocker, A., Prokic , A., Morin, D. and Reyes, A. (2014) ‘Intellectual disability and co-occurring mental health and physical disorders in aggressive behaviour,’ Journal of Intellectual Disability Research, 58(11): 1032-1044.
  • De Ruiter, K. P., Dekker, M. C., Verhulst, F. C., and Koot, H. M. (2007) ‘Developmental course of psychopathology in youths with and without intellectual disabilities,’ Journal of Child and Adolescent Psychiatry, 48: 498-507.
  • Department of Health (2013) Learning disabilities - positive practice guide. Available online.
  • Emerson, E. and Hatton, C. (2007) ‘The mental health of children and adolescents with learning disabilities in Britain,’ British Journal of Psychiatry, 191(1): 439-499.
  • Foundation for People with Learning Disabilities. (2014) Feeling Down: Improving the Mental Health of People with Learning Disabilities. Available online.
  • Hackett, L., Theodosiou, L., Bond, C., Blackburn, C. and Lever, R. (2011) ‘Understanding the mental health needs of pupils with severe learning disabilities in an inner city local authority,’ British Journal of Learning Disabilities, 39(1): 327-333.
  • Hagerty, B. and Williams, R. (1999) ‘The effects of sense of belonging, social support, conflict, and loneliness on depression,’ Nursing Research, 48(4): 215-219.
  • Hastings, R, Hatton, C., Taylor, J., and Maddison, C. (2004) ‘Life events and psychiatric symptoms in adults with intellectual disabilities,’ Journal of Intellectual Disability Research, 48(1): 42-6.
  • Jacobi, F., Wittchen, H.U., Holting, C., Hofler, M., Pfister, H., Muller, N. and Lieb, R. (2004) ‘Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS),’ Psychological Medicine, 34: 1-15.
  • 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.
  • Kaehne, A. (2011) ‘Transition from children and adolescent to adult mental health services for young people with intellectual disabilities: a scoping study of service organisation problems,’ Advances in Mental Health and Intellectual Disabilities, 5(1): 9 -16.
  • Kroese, B., Rose, J., Heer, K. and O’Brien, A. (2013) ‘Mental health services for adults with intellectual disabilities - what do service users and staff think of them?,’ Journal of Applied Research in Intellectual Disabilities, 26: 3-13. 
  • MacHale, R. and Carey, S. (2002) ‘An investigation of the effects of bereavement on mental health and challenging behaviour in adults with learning disability,’ British Journal of Learning Disabilities, 30(3): 113-117.
  • Main, G. and Pople, L.  (2011) Missing out: a Child Centred Analysis of Material Deprivation and Subjective Well-being. The Children's Society. Available online.
  • 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.
  • Mason, J. and Scior, K. (2004). ‘“Diagnostic overshadowing” amongst clinicians working with people with intellectual disabilities in the UK,’ Journal of Applied Research in Intellectual Disabilities, 17, 8-90.
  • McCarron, M., Swinburne, J., Burke, E., McGlinchey, E., Mulryan, N., Andrews, V., Foran, S. and McCallion, P. (2011) Growing Older with an Intellectual Disability in Ireland in 2011: First Results from The Intellectual Disability Supplement of The Irish Longitudian Study on Ageing. School of Nursing and Midwifery, Trinity College Dublin. Available online.
  • McManus, S., Meltzer, H., Brugha, T., Bebbington, P. and Jenkins, R. (2009) Adult Psychiatric Morbidity in England, 2007 - Results of a Household Survey. The Health and Social Care Information Centre. Available online.
  • Mind (2016a) Mental Health Facts and Statistics. Webpage.
  • Mind (2016b) Cognitive Behavioural Therapy (CBT). Webpage.
  • Murphy, G., Sinclair, N., Hays, S.-J., Heaton, K., Powell, S. et al. (2010) ‘Effectiveness of group cognitive-behavioural treatment for men with intellectual disabilities at risk of sexual offending,’ Journal of Applied Research in Intellectual Disabilities, 23: 537-551.
  • Prout, H. and Browning, B. (2010) ‘Literature review: psychotherapy with persons with intellectual disabilities: a review of effectiveness research,’ Advances in Mental Health and Intellectual Disabilities, 5(5): 53-59.
  • Royal College of Nursing (2010) Mental Health Nursing of Adults with Learning Disabilities: RCN Guidance. Available online.
  • Royal College of Psychiatrists (2016) Antipsychotics. Webpage.
  • Singh, A., Matson, J., Cooper, C., Dixon, D. and Sturmey, P. (2005) ‘The use of risperidone among individuals with mental retardation: clinically supported or not?,’ Research in Developmental Disabilities, 26: 203-218.
  • Stacey, J. and Edwards, A. (2013) ‘Resisting loneliness' dark pit: a narrative therapy approach,’ Tizard Learning Disability Review, 12(18): 20-27.
  • Taylor, J., Lindsay, W. and Willner, P. (2008) ‘CBT for people with intellectual disabilities: emerging evidence, cognitive ability and IQ effects,’ Behavioural and Cognitive Psychotherapy, 36(6): 723-733.
  • Thalitaya, M., Udu, V., Nicholls, M., Clark, T. and Prasher, V. (2011) ‘POMHS 9B - antipsychotic prescribing in people with a learning disability,’ Psychiatria Danubina, 23(1): 50-56. 
  • Tyrer, P., Oliver-Africano, P., Ahmed, Z., Bouras, N., Cooray, S. et al. (2008) ‘Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: a randomised controlled trial,’ Lancet, 371: 57-63.
  • Varghese, S., and Banerjee, S. (2011) ‘Psychotic disorders in learning disabilities - outcome of an audit across community teams,’ British Journal of Learning Disabilities, 39(2): 148–153.

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