Supporting individuals who are both developmentally delayed as well as diagnosed with a mental illness is, at best, a challenging proposition. However, as more & more individuals with developmental disabilities are successfully supported in their home communities it is this portion of
population, which is struggling. Frequently, it is combination of challenges that keeps them from being adequately served by either support system as they are shuttled back & forth in search of a "more appropriate" placement. To stop this scenario it is essential for ethical human service professionals to stop passing buck & develop a support system sensitive to both individuals cognitive limitations as well as their changes in mental health status. So what are keys to developing a successful plan? Those who have been effective list following 10 things as crucial: 1. Double-check your psychiatric diagnosis Because "science" of mental health diagnosis relies so heavily on self-report (usually not available or reliable in this population) it is extremely easy to misdiagnosis a psychiatric condition. Frequently when an individual is misdiagnosed medication prescribed to improve situation may actually be contributing to problems. 2. Be aware that many psychiatric conditions can "look" different in someone with a developmental disability. For instance, if you are observing a 30-year old man & he appears to be talking to himself that might be considered a psychiatric manifestation. On other hand, if you observing a 30 year old man with developmental delays (& therefore a cognitive age of 4) who is talking to himself he may simply be engaging in verbal rehearsal, a developmentally normal milestone at that developmental age (4). Bottom line -- be sure you know what you're dealing with.
3. Do your medication homework Because of complex nature of their diagnosis, these individuals tend to end up on multiple medications. As a support person, you need to be highly educated about possible side effects & interactions of these medications & constantly on alert. All too often, medication side effects are reported as "new" symptoms & "treated" with additional medication rather than simply reducing or eliminating medication causing side effect.
4. Find right doctor & psychiatrist to complement your team To successfully support individuals with a dual diagnosis you need a knowledgeable team. That includes both your doctor & your psychiatrist. To be effective they will need to be:
** familiar with developmental disabilities as well as mental health issues
** up to date on medications, medication side effects/interactions & new treatment options
** willing to research unusual symptom presentations &
** willing to listen to input from those who know person best -- namely you & your direct support staff.
5. Create flexible, well-trained support staff To be successful, especially in a community setting, an individual with a dual diagnosis will need to be surrounded by a support network that understands both nature of their mental health condition, how it interacts with their developmental disability, & how to adjust their support procedures during mental health episodes.
6. Collect & use behavioral data Individuals with mental health issues, especially mood disorders, tend to live in a highly emotional environment & draw all those around them into that atmosphere. In order to make sure that your team makes clear-headed logical decisions, it is essential to use objective behavioral measures to help gage level & intensity of changes. Over time, this data will also allow you to see patterns of behavior & then to anticipate coming mood changes so that mental health episodes are approached in a more prepared & conscious manner.
