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.
It is estimated that mental health problems amongst adults with a learning disability is quite common, approximately 40%. This is more than double the 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.
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 particular a vulnerability to negative life events and might not have the mechanisms for coping with these. This leads to people with a learning disability having an increased risk of developing mental 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).
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).
Biological - 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.
Fewer resources - 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. Social support is an established protecting factor for mental health problems, and loneliness a precursor to various psychological difficulties. (Hagerty and Williams 1999).
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 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).
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. (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 (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).
Need more information?
People with learning disabilities experience health inequalities compared with the general population; these include a shorter life expectancy, higher level of health needs and a higher proportion of health needs which fail to be met by services.
See the Feeling Down report by the Foundation for People with Learning Disabilities (2014) for recommendations to improve the mental health of people with a learning disability.