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Microsoft powerpoint - clinical audit
Physical disability, complex communication
Hagiliassis, N., Gulbenkoglu, H., DiMarco, M., Larkin, H.,
Watson, J., Iacono, T., & Young, S.
A project being undertaken by Scope Specialist Services
in collaboration with the Centre for Developmental
Disability Health Victoria, Monash University.
The Bridging Project has as its mission to progress the
knowledge and resource base to ensure that individuals
with complex communication and mental health needs
To examine the prevalence and nature of mental
health problems for people with physical disabilities
To examine the kinds of specialist and generic mental
health services being accessed by people with
complex communication and mental health needs.
Background – Mental Health in Australia
Mental health is one of the leading causes of burden of
disease and injury in Australia, and is associated with
higher rates of health risk factors, poorer physical health,
and higher rates of deaths from many causes including
The 1997 National Survey of Mental Health and Wellbeing
reported that 18% of adults had a mental disorder in the
12 months preceding the survey (ABS, 1997).
Background – Intellectual Disability and
Growing interest in the mental health needs of people with
Reported prevalence of mental health problems among adults
with ID varies widely between 10 and 39% (Deb et al., 2001).
Prevailing view is that people with ID experience a higher rate
of mental health problems than people without ID.
The extent and nature of psychosocial stressors experienced
Heightened ‘vulnerability’ to psychosocial stress (Deb et al., 2001).
Research is “all but silent” (DiMarco, 2001).
Reason to suspect a higher rate of mental health problems among people
with physical disabilities and complex communication needs.
Child population; generalisablility of these data to adult
Jenkins & Gulbenkoglu (1998).
11% of people with physical and multiple disabilities identified as
experiencing a mental health condition, with depression (38%) and
anxiety (17%) occurring most common.
People with physical disabilities may experience a
quantitatively and qualitatively distinct cohort of
Complex communication needs associated with physical
disability can be a substantial hurdle to the accurate
identification and treatment of mental health issues.
The range of assessment approaches and tools, that are
used as a standard part of a psychiatric evaluation are
not easily accessed by people with complex
390 client ‘central files’ audited to determine:
whether the person had a psychiatric diagnosis in the last 12 months
the kinds of services that were being accessed in support of any
Of the 390 files, 55 files were audited to determine the extent and
nature of prescription of psychotropic medications.
Audit information augmented by information provided by Specialist
Ethics approval obtained from the Scope Ethics Advisory Committee;
all data collected in a de-identified way.
Total number of people included in sample
Number of people with diagnosed mental health condition
Percentage of people with disabilities with diagnosed mental
Percentage of people from general community with diagnosed
mental health condition (Source: ABS, 1998)
How does this compare with the general population?
1- Australian Bureau of Statistics 2- National Institute of Mental Health
3- American Psychiatric Association 4 - de Girolamo & Dotto (2000)
Generalised anxiety disorder
What kinds of services are being accessed?
Private Service Provider e.g., Psychiatrist
1 Australian Bureau of Statistics
What is the extent of psychotropic medication use?
Number of people without formal diagnosis
Number of people on psychotropic medication 17 (31%)
Present study suggests the overall prevalence of mental health c
for people with physical disabilities is 11%, in contrast to the rate of
mental health conditions for the general community of 18%, as reported
onal Survey of Mental Health and Wellbeing
Lower rate of mental health issues for people with physical disabilities and
Methodological limitations of the present study.
Consistent with traditional belief that that people with disabilities may be
‘sheltered’ from everyday psychosocial stressors.
More likely that actual rate is closer to, or higher than, general population, but
there is an ‘under-identification’ phenomenon.
Review of medications also suggests under-identification of mental health
issues: of 55 people, 1 person with formal diagnosis, but 10 people on
antidepressant or antipsychotic medications.
Possible reasons for under-identification phenomenon:
Misperception that people with disabilities somehow do not posses the
intellectual or personal capacity to be affected by everyday psychosocial
stressors and, therefore, are not vulnerable to psychiatric illness.
Diagnosis of psychiatric illness in people with disabilities is fraught with
difficulties, compounded by complex communication needs.
Phenomenon of symptom masking, that is, when a symptom that is
normally ascribed to a psychiatric illness is attributed as a behavioural
Poor early detection of psychiatric illness, with mild to moderate cases
People with disabilities less likely to be seen by generic mental health
services (22%) as compared with the general population (38%; ABS,
People with disabilities likely to use specialist services for a mental
Likelihood of using generic or specialist health services for a mental
health problem may be related to type and nature of mental health
disorder, client characteristics, perceived service role and capacity,
service accessibility, client preferences.
Addressing the under-identification phenomenon through attitudinal change,
d training, improved screening and identification processes,
early detection and intervention, and greater focus on identification of mild-
Further research into the types of psychosocial stressors experienced by
people with physical disabilities and complex communication needs, and the
impact of these stressors on mental health outcomes.
Development of assessment tools that are accessible to people with
complex communication needs and that reflect the range of needs of
Bridging the divide between generic and specialist health services, while
acknowledging value and contribution from each.
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