Why we need MHID teams
People with an intellectual disability experience very poor mental health compared to the general population (Deb et al., 2001), with common mental disorders occurring around two to three times more often. 4 in every 10 people with intellectual disability experience a mental illness in their lifetime (Cooper et al., 2007).
An MHID team is a specialist adult mental health service specifically for adults with an intellectual disability. It is a multi-disciplinary team, with clinicians who have the appropriate training and experience to better assess and treat this population, taking into account their specific needs.
An MHID service is a distinct and separate service but aims to complement and be closely linked to, the services provided by primary care, disability services and community mental health teams, who provide health and social care services for people with intellectual disability.
Individuals living with mental illness are usually supported by the MHID team for limited periods of time to provide specialist mental health assessment and intervention. As the person’s mental health improves the MHID team will plan discharge back to primary care with a recovery plan for staying well and how to access the team again if needed.
Over the last several years the HSE, in partnership with voluntary disability services, are continuing to establish MHID teams across the country, evolving this service in line with A Vision for Change (2006) and the more recent, Sharing the Vision, A Mental Health Policy for Everyone (2020), both of which were published as blueprints for future mental health services.
National Model of Service
People with intellectual disability should be able to access support from mental health services in the same way as the general population, within a framework which is multi-disciplinary and catchment area- based. Team members should have appropriate training and expertise, and teams should be suitably resourced.
To support achieving this, the HSE has developed a National Model of Service, which proposes a framework for providing specialist mental health services for people with an intellectual disability. It recognises the strengths of existing services while acknowledging the challenges that must be faced. It was developed following extensive consultation with clinicians, service users, families and service providers, and innovation and international best practice reviews.
The document was led on by the offices of the National Mental Health of Intellectual Disability (MHID) Clinical Developmental Lead and Service Improvement Lead.
Aim of the Model
The primary aim of the model is to improve the mental health service experience and outcomes for people with an intellectual disability and their supporters.
It aims to achieve this by providing national guidance and clarification on how integrated, person-centred MHID services can be delivered consistently across the country, in line with best-practice standards, while defining what a good MHID service should look like.
The Model of Service represents the HSE’s commitment to improve standards and quality in the provision of mental health services to people with intellectual disability.
What the Model includes
The Model of Service represents a ‘One Stop Shop’ to bring together all the different strands of information that are needed to better understand how to improve MHID services in Ireland.
Examples of what is included in the model are:
- The roles and responsibilities of the different MHID team members.
- How to work collaboratively with other mental health, disability and primary care services to achieve the best care for service users in a community-wide context.
- A template of advice on the delivery of a person-centred approach to managing some of the service boundary issues.
- Detailed care pathways for service users as they journey through the service, and information on the type and level of care that can be expected by a service user when entering a modelled care service.
- A number of vignettes to help provide clarity.
- A look at the comprehensive range of interventions provided, including the use of inpatient settings where necessary.
- The considerations needed for speciality populations of service users.
- Recommended governance for MHID teams.
- Legal and ethical considerations under which an MHID team needs to operate.
Summary of key recommendations
Recommendations for the MHID Model of Service follow similar international models. It is imperative that MHID services capture the work they do, and use evidence-based practice.
The model’s main recommendations are:
- Mental health services for people with intellectual disability should be provided by a specialist mental health of intellectual disability (MHID) team that is catchment area-based. The multidisciplinary MHID teams should be provided on the basis of two per 300,000 population for adults with intellectual disability.
- These services should be distinct and separate from, but closely linked to, the multidisciplinary teams in Intellectual Disability Services, who provide a health and social care service for people with intellectual disability.
- The core multidisciplinary team to deliver mental health services to adults with intellectual disability and a mental health problem and or challenging behaviour (where there is some suspicion of mental illness) should comprise key individuals from the disciplines of psychiatry, psychology, nursing, social work, occupational therapy (OT) and speech and language therapy (SaLT), in addition to an administrator.
- The transition of care between child and adult MHID services is vital.
- Model of service should be reviewed and updated where appropriate, within a two-year timeframe.
- Although this model provides national guidance, it is not a prescriptive approach but rather a flexible guide. Teams should decide how best to encompass national standards, but also how to adopt the model as necessary, based on local requirements and geography.