ENHANCING SERVICES TO PEOPLE WITH DUAL DIAGOSES OF
DEVELOPMENTAL DISABILITIES AND MENTAL ILLNESS

Many individuals who have multiple challenges such as a developmental disability, mental illness, physical challenges, behavioral challenges, substance abuse or other noted problems are not always supported effectively.   Misdiagnosing individuals with multiple needs and/or dual diagnosis of developmental disabilities and mental illness (hereafter “dual diagnosis”) is rampant.  Additionally, some individuals having a dual diagnoses are often noted as behaviorally challenged without recognition of an underlying mental health issue. Currently, effective treatment for these individuals is sorely lacking in some states.

People with disabilities are similar to the general population.  We are a complex mixture of strengths and challenges and no one system can meet all our needs.  The same holds true for people with disabilities – no one system can meet all of their needs and we must be able to cut across governmental department boundaries to ensure competent and effective services.  

It is important in the midst of these issues to stop the “hyphen” debate.  It does not matter which side of the hyphen, i.e., DD or MI, the person is on.  What matters is that this is a person with characteristics, individual dreams, and needs that must be met within a holistic system, not one built in silos, divisions or bifurcations that cause lack of appropriate response. 

 It is necessary for stakeholders to come to the table and to decide on a common goal and a common approach that offers flexible funding, wraparound supports, and community support that endorses the concept that individuals are citizens first and consumers second. 

1. Access to competent and effective community based services for individuals with dual diagnosis.

a.   Because of the multiple complex challenges of persons with dual diagnosis and other behavioral issues, there are few community-based practitioners who are well versed in developing and providing services. 

b.      Hospitals, community health centers and other health providers often lack the expertise and/or staff to provide an adequate assessment of the multiple factors impacting dually diagnosed individuals.

c.       There is a lack of training at all professional levels of the mental health and health care system to evaluate symptoms and challenges, including differential diagnoses and treatment of mental health issues experienced by individuals with developmental disabilities.

d.      Little to no training is provided in medical school or ancillary health professions about the symptoms, behaviors and health needs of people who are considered multiply challenged.

e.       There is a lack of hospitals with psychiatric units or behavioral health units that are capable of treating or serving individuals with developmental disabilities who also exhibit mental health and/or behavioral challenges.   

2. Lack of training

   1. There is little training available which focuses on the topic of dual diagnoses and/or behavioral challenges.

   2. There is not a known “Center of Excellence” where professionals can obtain information or resource help.

   3. A standard body of knowledge about managing multiple, complex problems needs to be developed and shared so that both professional and paraprofessionals can be educated regarding symptoms, behaviors and treatment.

   4. Therapy techniques used for persons with a typical IQ, including those diagnosed with a mental illness, are often not transferable to clients diagnosed with lower IQs. Transference/counter-transference is only one of the subjects needing to be addressed.

3. Congregate Living

   1. Many behavior problems and exacerbation of mental health issues arise when people are being forced to share space, especially bedrooms.

   2. Inadequate reimbursement from the state literally forces providers to congregate individuals with disabilities into one residence creating an almost insurmountable amount of behavioral challenges. 

 At a minimum:

                                                              i.      a psychiatric diagnosis should be the result of a thorough psychiatric evaluation and through the use of standardized psychopathology screening tools,

                                                            ii.      a psychiatric diagnosis should be the basis for the use of psychoactive medication,

                                                          iii.      medications prescribed should correspond to known standards of effectiveness,

                                                          iv.      people should be are monitored for drug side effects on a regular, systematic basis,

                                                            v.      people should receive the fewest psychoactive medications possible at the lowest effective dosage possible, and there is

                                                          vi.      there should be a system for regular review.

 Is there a Create a Center of Excellence to draw from National/International Research and examples of Best Practice?  Could this Center be responsible for identifying assessment instruments, best practice use of technology, and assisting in establishing minimum standards of practice?

 How can states Ensure the implementation of best practices based on a recognized quality standard and outcomes tool that utilizes evidence-based practices as a foundation?

Are there assessment tools that may be used to differentiate between symptoms/observed behaviors associated with mental illness and those than may be maladaptive behaviors or the result of underlying medical condition