People with disorders of intellectual development (DID) have higher rates of common morbidity, communication difficulties and serious conditions such as epilepsy; they also have specific patterns of health needs associated with the aetiology of their disability. Unfortunately, this combination of need is mirrored by a consistent picture of poor uptake of health promotion initiatives, inadequate care for serious morbidity, unrecognised health needs and poor access to healthcare. Consequently, there is a disparity between the health of people with DID and that of the general population. Psychiatrists can address this disparity in clinical practice by focusing on these patients’ mental health, epilepsy management and the impact of behaviour on health. They can also influence health planning and service development.
Inequalities in health status
The achievement of good health is an appropriate goal for all, including, of course, people with DID. This brings particular challenges, as this is a heterogeneous population with varying needs, who receive a similarly complex array of healthcare provision. Furthermore, the impact of societal and environmental factors on health status is arguably greater in this group. The imperative to remove the disparity between the health of people with DID and that of the general population is strong, because improved health is likely to improve quality of life, both of individuals and of their families. In this chapter we make the premise that the general health of people with DID can be improved by addressing those areas in which disparities in health and in healthcare provision are evident. These include:
• a difference in health because of
• increased mortality
• increased morbidity
• more commonly experienced negative determinants of health such as poverty;
• a difference in healthcare because of
• unequal access to services
• inequality of services.
To focus on how health improvements can be made, we consider here the following five areas: the disparity in health; health needs; barriers to healthcare; healthcare provision in primary care; and addressing the disparity.