Learning disability 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. You can find out more about the difference between mental health and learning disability here.
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 discussed below:
- 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
Every person is different, but people with a learning disability may be particularly vulnerable 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 deprivation, poverty, abuse 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 can become internalised, which can result in psychological distress (Ali et al., 2015; Pelleboer-Gunnink et al., 2019). Learn more about stigma and discrimination here.
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 rather than a mental health conceptual framework to understand problematic behaviours”.
Treating mental health problems in people with a learning disability
Some treatments are:
Cognitive behavioural therapy (CBT)
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 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 or both with psychotropic medicines. Learn more about STOMP here.