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

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

Additional barriers to multi-system services. The separation between the mental health and mental retardation service systems creates several barriers to service delivery for individuals with dual diagnosis. As previously mentioned, these two systems have operated independently for years, competed for limited funds, and taken responsibility for a client population with a single diagnosis. As a result, barriers to multi-system services are quickly established and clients may not receive necessary services (Woodward, 1993). Professionals in the mental health and mental retardation systems are often reluctant to implement change, despite the need to provide collaborative services. Individuals often remember the energy that went into building the systems, obtaining adequate funding, and providing necessary training, and they are not willing to implement a change (Woodward, 1993). An additional barrier to multi-system services is that individuals with dual diagnosis are often not a population with an ascribed status in either system. Their challenging behaviors make them undesirable clients, and they are often moved from one system to another (Woodward, 1993). In order to provide effective services, professionals must work through problem areas and create a more collaborative form of treatment.

Primary vs. secondary disorders. Along with the difficulty in formulating collaborative treatment plans, individuals with dual diagnosis often receive a primary and secondary diagnosis, which further complicates the provision of services. It is often difficult to determine which disability is primary for individuals with dual diagnosis. For example, if an individual with mental retardation, who displays psychotic symptoms, lost his home and job, did the mental retardation increase his vulnerability to deterioration in functioning or did the psychotic symptoms precipitate these events? This ambiguity of primary and secondary diagnoses is often associated with inadequate mental health services for people with mental retardation (Reiss, 1993). Typically, individuals only receive services for the primary diagnosis, and as long as funds are limited, services for a secondary diagnosis are often not provided (Reiss, 1993). The requirement to define disabilities as primary or secondary hinders the provision of services to individuals with dual diagnosis.

Lack of Professional Training. In addition to problems surrounding diagnosis, many professionals also lack the training necessary to work with individuals with dual diagnosis. For instance, professionals in the field of mental retardation rarely receive formal assessment training outside of their field, and as a result, they are unprepared to recognize mental health problems (Patterson, Higgins, & Dyck, 1995). Likewise, mental health professionals are often ignorant of problems surrounding people with mental retardation. In fact, many psychiatrists have shown little interest in mental retardation, and advances made in understanding and treating mental disorders have not included individuals functioning below a normal developmental level (Szymanski, 1994). Professionals in each field must educate and train each other in order to provide effective treatment for individuals with dual diagnosis.