Service problems and solutions for individuals with mental retardation and metal illness

Journal of Rehabilitation, Jan-March, 2003 by Jill L. VanderSchie-Bezyak

A 28-year-old male with mild mental retardation and several possible psychiatric disorders has fallen through the cracks of local service programs on several occasions. The suggested psychiatric diagnoses include major depression, antisocial personality disorder, bipolar disorder, and atypical affective disorder. Following his involvement with the local mental health center, this individual was referred to a residential care facility for people with mental retardation due to aggressive acts in the community. This facility provided a dual diagnosis program offering individual and group therapy, which proved relatively successful for the client. As a result of a few attempts to run from the facility, he was discharged to a different group home. This residential program did not provide psychiatric services, and the local mental health center failed to provide alternative treatment programs. The client became progressively more irritable, and after leaving the facility for two weeks, he lost his residential placement and was placed in a semi-supervised apartment. While living in this apartment, he participated sporadically in day treatment programs, but his alcohol abuse increased dramatically. After significant alcohol and drug abuse, he was admitted into the psychiatric unit of the hospital, and following discharge, he returned to the semi-supervised apartment. His behavior became increasingly bizarre, and he began to make threatening phone calls to government officials. Despite the severity of problems presented with this case, the local mental health and mental retardation services could not agree on a joint care plan, and each system identified the client as the primary responsibility of the other system. As a result, he was sent to the correctional system and was not provided with the treatment options, which he appeared to clearly need (Menolascino, Gilson, & Levitas, 1986).

Background Information

The case described above reveals how difficult it can be to provide services to individuals with a dual diagnosis of mental retardation and mental illness. In fact, this population still remains widely unrecognized, and professionals who do recognize it often refer to this combination of diagnoses as the "other dual diagnosis," because the term, "dual diagnosis," is often assumed to refer to the combination of mental illness and substance abuse (Bongiorno, 1996, p. 1142). Along with the difficulty in recognizing this population, the services to people with mental retardation and mental illness still remain separate and continue to diverge considerably (Nezu, 1994). Without proper recognition and collaboration from both systems, necessary treatment is not possible.

Historical Beliefs

Problems providing services to individuals with mental illness and mental retardation began as a result of previously held beliefs of professionals. For instance, little distinction is often made between mental retardation and mental illness, and individuals with mental illness and/or mental retardation are treated as a single population (Nezu, 1994). In addition, some professionals believe that individuals with mental retardation are immune to emotional and psychological problems as a result of the retardation. Fletcher (1988) reported, "The mildly retarded have been characterized as worry-free and thus mentally healthy. The severely retarded have been considered to express no feelings and therefore do not experience emotional stress" (p. 255). These beliefs have prevented individuals with both mental retardation and mental illness from receiving appropriate services.

Current Beliefs

Recent research has revealed that professional beliefs, such as those described above, are not valid. Individuals with mental retardation can indeed experience emotional and psychological problems. In fact, it is now typically mandated that people with mental retardation receive appropriate medical assessment, diagnosis, and follow-up treatment (Szymanski, 1994). As a result, fewer individuals with a dual diagnosis of mental retardation and mental illness go unnoticed.

Along with the trend toward providing proper treatment to individuals with mental retardation and mental illness, there are additional indicators of a growing awareness of dual diagnosis. For instance, professional organizations, such as the American Association on Mental Retardation and the American Psychological Association, have given increased attention to the co-occurrence of mental illness and mental retardation. The National Association for the Dually Diagnosed was also created to promote advocacy for these individuals (MacLean, 1993). In addition to the influence of professional organizations, there have been more frequent publications relevant to the treatment of psychiatric disorders for people with mental retardation. Journals including the American Journal of Mental Retardation and Research in Developmental Disabilities have published articles on this topic (MacLean, 1993). The current beliefs surrounding dual diagnosis and the growing awareness of this population have allowed for advancements in treatment and the provision of services, but there is still considerable room for improvement.