ABSTRACTS - World Psychiatric Association

SS15.
PROCESSES OF INCLUSION FOR PEOPLE
WITH INTELLECTUAL DISABILITY AND MENTAL
HEALTH PROBLEMS
(organized by the WPA Section on Psychiatry
of Intellectual Disability)
SS15.1.
INTELLECTUAL DISABILITIES AND EUROPEAN
PROGRAMS ON SOCIAL INCLUSION FOR MENTAL
HEALTH
L. Salvador-Carulla
PSICOST Research Association, Jerez de la Frontera, Spain
Social exclusion is a major public health risk that affects the mental
health of a very large number of people across the European Union
(EU). It can impede access to services and resources such as housing
and employment. Solidarity and social cohesion are hallmarks of the
European Union, as stated in the EU Green Paper on Mental Health
in Europe and the Lisbon Conference. Recently, work in the EU has
focused on developing methods to improve social inclusion of people
with mental illness or at risk of mental illness. These programs are
aimed at fostering recovery and promote the opening of opportunities
in the community for people with psychiatric disorders, and to promote
mental health and resiliency in this population. These programs
do not adequately consider the problems of the persons with intellectual
disabilities and mental health problems who may account for
33% of all people with intellectual disabilities. The ongoing programs
at the EU and their implications for intellectual disabilities are
reviewed. The POMONA project, an EU project on health indicators
of people with intellectual disabilities, is presented as an example.
SS15.2.
HOW SHOULD SERVICES RESPOND TO PEOPLE
WITH INTELLECTUAL DISABILITIES WHO ARE
SUSPECTED, CHARGED, OR CONVICTED
OF A CRIMINAL OFFENCE
T. Holland
Department of Psychiatry, University of Cambridge, UK
Challenging behaviour is common among people with intellectual
disabilities (ID), and sometimes results in contact with the criminal
justice agencies. In England, provisions are in place when people
with ID are interviewed as suspects. Courts may seek guidance with
respect to fitness to plead and, on issues relating mitigation and sentencing,
if a person with ID is found guilty. Data are presented on the
prevalence and nature of offending by people with ID and on the care
pathways of people with ID in the criminal justice and/or health systems.
Issues such as fitness to plead, vulnerability at police interview,
and the ability to form intent, are considered. People with ID are
over-represented in the criminal justice system, but whether the
police are called in the event of challenging behaviour appears arbitrary.
When diverted from the criminal justice system, people with ID
can become trapped in distant secure settings for prolonged periods
of time. In the UK, government policy has emphasised the importance
of the diversion of people with mental disorder from the criminal
justice system to receive treatment. This is problematic for people
with ID, as the focus might more appropriately be on the management
of risk in the community rather than treatment in hospital.
SS15.3.
FROM “THERAPEUTIC” SEGREGATION TO SOCIAL
INTEGRATION
E. Farnetani, M. Bertelli
University of Siena; WORK 2000, Arezzo; Italian Society for
the Study of Mental Retardation/Intellectual Disability, Italy
When people with severe intellectual disabilities (ID) grow older and
their family loses capacity to keep them at home, institutionalisation
still represents the most frequent solution. Providing housing support
is not the most difficult problem to address. Of greater concern is the
availability of support service for the maintenance or the development
of life skills. Thus, the disorder-unspecific approach of old asylum
type institutions should give way to the individualised intervention of
community centres. In the area of Valdichiana (Tuscany, Italy) the
Work 2000 cooperative is putting into effect a programme of inclusion
and quality of life (QoL) enhancement for people with ID through
group homes integrated with the local mental health service net. The
present study aims at evaluating the impact of this new intervention
on the health care cost of the person with ID, on carers’ subjective
burden of care, and on clients’ QoL. Cost includes any kind of health
service (i.e., general practitioner or specialist visit, emergency, hospitalisation,
nursing), drugs, and care. Preliminary results indicate a
reduction of both general health care cost and carer’s burden of care,
and an improvement of clients’ QoL. Flexible housing models of community
integration seem to be usefully applicable to people with ID.
SS15.4.
A HOUSING SERVICE AS A THERAPEUTIC
INSTRUMENT FOR PEOPLE WITH SEVERE
INTELLECTUAL DISABILITY
M. Bertelli, L. Lombardi, A. Paoli, I. Masciavè
AMG Centre for Research and Evolution, Florence, Italy
In the last decade, an international movement of deinstitutionalisation
has developed, along with the worldwide cultural and scientific
revision of the concept of mental retardation. The most innovative
aspect is the consideration of the person in his wholeness, in his unitary
development, and in reference to the life-span. There is no evidence
that mental functions other from cognition are necessarily
impaired in the intellectual disability (ID) person. It can be instead
assumed that these functions may represent the fulcrum of the whole
psychic functioning as well as an interface for the interaction with the
environment. We describe the theoretical basis for the construction of
a new rehabilitative environment for people with severe ID with or
without mental health problems. Architecture should facilitate usability
and identification by offering a wide range of logical, archetypal,
emotional, or spiritual shapes. The environment should communicate
a sense of continuity between inside and outside. It should offer
a sense of protection and safety, but it should also transmit involvement
with the external. Some spaces and rooms should be equipped
for multi-sensorial stimulation. Walls and floors could be covered
with different combinations of materials and developed like reflexologic
tools to improve sense of balance.
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