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Chapter 494chronic and more severe MH problems. 15, 16 The under-recognition of MID in combination with the observed indications of undertreatment in patients with MID in our study is therefore worrying. Undertreatment within MH services can lead to more chronic MH problems and may partly explain a high prevalence of MID in the long-stay wards, 16 but also contributes to high care use in general, illustrated by high primary care consumption 19and emergency department visits 20 by patients with combined MID and MH problems.Indeed, observed signs of undertreatment are more prominent in patients whose ID was unregistered. This undertreatment is reflected in shorter MH trajectories (252.9 vs 325.7 days) and fewer diagnostic (73.7 vs 79.7%) and treatment (59.9 vs 78.0%) activities compared to patients with no ID. A systematic review of studies in addiction care settings also indicated undertreatment in people with MID. 21 Compared to patients without ID, they were less likely to initiate and engage in treatment for substance abuse, were more likely to drop out, and treatment was often not adapted to their intellectual capacities. Research in patients with borderline ID (IQ 70–84) and MH problems showed that these patients also were less likely to receive treatment compared to adults with no ID. 22 In this light, the higher prevalence of MH hospital admissions (20.4%) and crisis interventions (32.9%) in our study, confirmed in earlier research, 15, 22 are extra disconcerting findings. Although these could also be reflections of more severe and complex MH problems experienced by patients with MID, following this reasoning we should also have observed longer MH trajectories and a higher occurrence of treatment activities in patients with MID. However, both these aspects are contradictory to our findings. Our results show that collaboration, reflected in the high number of interprofessional consultations, is often required in MH services, especially regarding patients with MID. Despite the fact that collaboration is seen as a tool to improve (mental) health care and may reduce hospital admissions and costs, 4, 15, 23-25 interprofessional collaboration and other forms of indirect patient care in MH services have never before been the subject of a database study. Katrien Pouls sHL.indd 94 24-06-2024 16:26