Page 29 - Demo

Primary mental healthcare: a scoping review272Introduction General practitioners (GPs) are increasingly confronted with patients with both intellectual disabilities (IDs) and mental health disorders (MHDs), caused mainly by a growing need for care and support for people with mild to borderline intellectual disabilities (IQ 55-85) arising from our increasingly complex society. 1 Patients with ID have greater healthcare needs with higher levels of morbidity and premature mortality than patients without ID, 2, 3 a situation to which insufficient quality of healthcare is a substantial contributor. 2 Patients with co-existing MHD form an extra vulnerable group in this context. Although research shows that MHDs are three to four times more common in people with ID than in the general population, 4, 5 primary and secondary care provided to these patients is insufficient. 6-8 This is the consequence of inadequate identification of IDs and MHDs, communication difficulties, atypical presentation of disorders, and a lack of assessment tools and treatment modalities specifically adapted to people with ID. 9-11 But also the poor accessibility to (mental) health services for patients with ID is described as an important contributing factor. 12, 13 Consequently, patients with both ID and MHD are at risk of developing more severe or chronic MHDs, are prescribed more psychotropic medication, and use more services. 14In many countries, GPs are often the first care providers contacted by these patients. Their care provision constitutes both a demand-driven approach in assessment, treatment, and follow-up of symptoms and disorders, and a more proactive approach aimed at prevention by identifying risk factors and providing health education. Adequate primary care, including both these approaches, is essential for patients with both ID and MHD to prevent diagnostic delay and ensure appropriate and timely referral and early personalised treatment. 15Although studies are increasingly published on expanding knowledge and skills within mental healthcare and ID care, 16, 17 reported practices are mostly small scale and lack an orientation on primary care. This is surprising and Katrien Pouls sHL.indd 27 24-06-2024 16:26