Mental health problems in people with learning disabilities: prevention, assessment and management

Context

People of all ages with all levels of learning disabilities can be affected by mental health problems. When a person is not able to describe or express their distress, and when they have coexisting physical health problems, their mental health problems can be difficult to identify. This leads to mental health problems remaining unrecognised, which prolongs unnecessary distress. Psychosis, bipolar disorder, dementia, behaviour that challenges, and neurodevelopmental conditions such as autism and attention deficit hyperactivity disorder are all more common than in people without learning disabilities, and emotional disorders are at least as common. Some causes of learning disabilities are associated with particularly high levels of specific mental health problems (for example, affective psychosis in Prader–Willi syndrome and dementia in Down's syndrome).

When people with learning disabilities experience mental health problems, the symptoms are sometimes wrongly attributed to the learning disabilities or a physical health problem rather than a change in the person's mental health. Indeed, their physical health state can contribute to mental ill health, as can the degree and cause of their learning disabilities (including behavioural phenotypes), biological factors (such as pain and polypharmacy), psychological factors (such as trauma) and social factors (such as neglect, poverty and lack of social networks).

Population-based estimates suggest in the UK that 40% (28% if problem behaviours are excluded) of adults with learning disabilities experience mental health problems at any point in time. An estimated 36% (24% if problem behaviours are excluded) of children and young people with learning disabilities experience mental health problems at any point in time. These rates are much higher than for people who do not have learning disabilities.

This guideline covers the identification, assessment, treatment and prevention of mental health problems in children, young people and adults with any degree of learning disabilities. In addition, there are recommendations on support for family members, carers and care workers.

The guideline covers all settings (including health, social care, educational, forensic and criminal justice settings).

People with learning disabilities have many needs both as individuals and related to their learning disabilities. This guideline only addresses their needs in relation to mental health problems.