Page 15 - Demo

General introduction 131 An illustrative patient case that inspired me to undertake this thesisAs ID physician, I met Bob (fictitious name), a 30-year-old man with mild intellectual disabilities (MID), in 2018. Bob had a difficult childhood, with a chronically depressed mother and a father who was often absent, being an international truck driver. He started living on his own at the age of 17. A few months after his father passed away, he had his first depressive episode at the age of 19. In the following 10 years, he was hospitalized several times for depressions, delusions, poor self-care, and substance abuse. In the discharge papers, he was described as an unmotivated patient who did not adhere to therapy. In between the admissions, he lived alone in an apartment, worked on and off in construction, had no contact with his mother, had hardly any friends, and developed financial debts. His MID was not diagnosed until after the third admission at the age of 25. After the last admission, in 2018, he came to live in a group home of the intellectual disability (ID) facility for which I worked. Since then, things have slowly improved. Bob seems to thrive in the clarity and structure of the group and the proximity of guidance and support. Although he sometimes has trouble adhering to the house rules and uses cannabis now and then, his mental health is stable. His use of psychotropics has largely phased out, contact with his mother has been restored, and his finances are back in order. He works five days a week at a sheltered workplace, is saving for his motorcycle licence, and, in the long term, he wants to live more independently. At first glance, this appears a success story. However, it had me puzzled. Why did Bob have struggle for so long before receiving the care and support he needed? Could more tailored care and support at an earlier stage of his life, upstream so to speak, have prevented the need for more intensive forms of mental health (MH) and ID care? Would his life story then have unfolded differently, more positively? Bob’s story, and many similar life stories that I encountered in my medical practice as ID physician, inspired and motivated me to start this research and, quoting Desmond Tutu, to go upstream and find out why these people are falling in.Katrien Pouls sHL.indd 13 24-06-2024 16:26