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General introduction 171 Concerns regarding the quality of (primary) mental healthcare for persons with mild intellectual disabilitiesResearch shows an increase in people with complex MH problems consulting their GP. 17 This will most probably include people with MID as well, although exact numbers are unknown. Adequate primary MH care is essential to prevent diagnostic delay and ensure appropriate treatment and timely referral to other care providers, such as general MH services.13 However, there are several reasons for concern regarding the quality of (primary) MH care for people with MID. The reasons in the Netherlands align with concerns internationally. 17-20First, although GPs acknowledge their role in MH care, they do not always feel equipped to provide the necessary care to the general population with MH problems 21, 22 and feel even less competent providing care to people with a combination of MH problems and ID. 23 In addition, they experience poor access to (specialized) MH services for their patients. 23 24 Previous research shows that long-term MH conditions, like psychosis and depression, are poorly managed in primary care, and psychotropic prescriptions exceed the number of reported MH problems, suggesting inappropriate treatment for people with ID. 6, 25Second, both MID and MH problems may be missed in primary care. Previous research shows that the MID may stay unnoticed in primary care because the MID is never officially established or not recognized by the GP. 26 The MID can therefore not be taken into account in the patient’s communication and the GP’s assessment of potential MH problems. In addition, when the MID is known, the risk of diagnostic overshadowing appears; the MID or the MH problems may be missed when symptoms are attributed exclusively to either of these specific disorders, though both states are present. 27, 28Furthermore, after patients’ referral to MH services by the GP, the quality of MH care to people with MID is not assured. People with MID may be excluded from certain treatments or even any care at all, because the MH service has insufficient expertise19 or because treatment modalities are not adapted to people with ID. 29 This is concerning, considering that 27 to 67% of patients in MH services are suspected of having MID, depending on the Katrien Pouls sHL.indd 17 24-06-2024 16:26