CHALLENGES OF A “DUAL DIAGNOSIS”

AUGUST 2012

www.advocacydenver.org

INTRODUCTIONCo-Occurring ConditionsIntellectual Disability and Psychiatric

Disorders‘Most Vulnerable Population’High RiskNeed for Integrated Treatment

PRESENTERS:

Catherine Strode, MPAHealth Care Advocacy Program and Outreach Coordinator

Sarah Avrin, Ph.D., DirectorAurora Center for Life Skills

DUAL DIAGNOSIS DEFINITIONSCo-existing ConditionsSubstance Abuse and Mental IllnessIntellectual Disability and Mental Illness “Dually Diagnosed”

INCIDENCE Three to Four Times Higher Than General

Population30 to 40% of ID Population Rate May be UnderestimatedSymptoms Misinterpreted‘Overshadowed’ By Intellectual Disability

COMMON MYTHS

All Behavior Due to Disability Psychotherapy Ineffective Medication Is ONLY Treatment

RISK FACTORS

Individuals With ID Are Highly VulnerableImpaired Cognition, Impaired

CommunicationOrganic Brain DamageChromosomal PredispositionPsychosocial Factors

PREVALENCE OF MENTAL DISORDERS

Anxiety Disorders Most CommonMore Schizophrenia Spectrum DisordersMore Phobic DisordersPresentation At Younger Age (Morgan, Leonard,

Bourke, Jablensky, BJPsych 2012)

CASE SCENARIO Medicaid/SSDI Client – 21 years oldFetal Alcohol Syndrome, Intellectual

Disability (IQ 55)Anxiety Disorder and Schizoaffective

DisorderPhysical AggressionRemoved From HomeMultiple Hospitalizations (Psych Unit)

BEHAVORIAL CRISIS

Verbal OutburstsActs of Physical AggressionSelf-InjuryProperty DestructionImpulsive Acts

HUMAN COSTS

Emotional TraumaLoss of OpportunityLoss of Potential Family Disruption

DIAGNOSIS IS DIFFICULT

• “Overshadowing” • Application of DSM-

IV• Disability Masks

Criteria• Behaviors

Misunderstood

Misinterpretation of Symptoms

COMMUNICATION CHALLENGES

VERBAL LIMITATIONS

ACCESS TO CARE CHALLENGES

Providers Unfamiliar With Needs of Individuals With ID

Provider Clinics Inappropriate SettingsProviders Need Information From CaregiversProviders Don’t Accept Medicaid

SYSTEM SILOS

Separate SystemsDifferent TrainingDifferent PerspectivesBehavioral Management VS. Mental Illness

Treatment

SERVICE NEEDS

Coordinated CareIntegration of Clinical and BehavioralCollaboration of ProvidersMore Trained Emergency Personnel

TREATMENT APPROACHES

Psychiatric ServicesCounselingBehavior TherapiesFamily TreatmentCase ManagementPsychotropic medications

GAPS IN “DUAL DIAGNOSIS” TREATMENT

Insurance CoverageLack of Interagency ApproachLack of Short Term Care BedsLack of Short Term FacilitiesLack of Provider Education

PROFILE OF INTEGRATED TREATMENT

Comprehensive ApproachMultiple InterventionsInterdisciplinary team

AURORA CENTER FOR LIFE SKILLS

Team ApproachWide Range of ServicesPsychology, Case Management, Vocational,

Psychiatric Supports

QUESTIONS?

Ask Dr. Sarah Avrin, Director Aurora Center for Life Skills

RESOURCESThe National Association for People With Dual Diagnosiswww.thenadd.org1-800-331-5362Research:Bhaumik, S., Tyrer, F., McGrother, C., & Ganghadaran, S.

(2008). Psychiatric service use and psychiatric disorders in adults with intellectual disability. Journal of Intellectual Disability Research, 52, 986-995.

Deb, S., Thomas, M., & Bright, C. (2001). Mental disorder in adults with intellectual disability. Journal of Intellectual Disability Research, 45, 495-505.

RESOURCES (CONTINUED) (Florida Developmental Disabilities Council, 2010).Morgan, V., Leonard, H., Bourke, J., & Jablensky, A. (2008).

Intellectual disability co-occurring with schizophrenia and other psychiatric illness: population-based study. The British Journal of Psychiatry, 193, 364-372.

(New Jersey Department of Human Services Dual Diagnosis Task Force Report, 2008)

Quintero, M., & Flick, S. (2010). Dual Diagnosis: When mental illness and developmental disabilities co-occur. Social Work Today, Sept./Oct. Issue.

Shook, N. (2005.) The Other Dual Diagnosis. Wisconsin Council on Developmental Disabilities.