Eliminating Health Care Disparities
Equality for all citizens is valued in our society. However, disparities exist in our society despite this value. Health care disparities can occur across populations due to various factors such as income, gender, education, disabilities, cultural, racial or ethnic backgrounds, and/or geographic locations (Gehlert & Browne, 2012). Adults with intellectual and developmental disabilities (IDD) are one of the marginalized populations regarding health care, specifically mental health.
Adults with intellectual and developmental disabilities are a vulnerable and an underserved population. According to Robinson, Dauenhauer, Bishop and Baxter (2012), in the year 2000, there were over 640,000 adults with IDD over the age of 60, and this number is expected to double by the year 2030. This population is experiencing increased longevity due to better improved medical knowledge, better access to health care, deinstitutionalization and better living conditions (Robinson, Dauenhauer, Bishop & Baxter, 2012). Despite these improvements in the lives and care of this population, disparities still exist. One area of disparity is that of mental health.
Determinants of Mental Health Services
The National Association for the Dually Diagnosed (NADD) (2019) estimates that 30-35% of persons with intellectual and developmental disabilities have a psychiatric disorder. However, persons with intellectual and developmental disabilities often do not get diagnosed with mental health illnesses due to diagnostic overshadowing. The term diagnostic overshadowing occurs when psychosocial or other health problems are not diagnosed due to a primary diagnosis of intellectual and developmental disabilities (Robinson, Dauenhauer, Bishop & Baxter, 2012). This diagnostic overshadowing creates a challenge as it is difficult to distinguish the symptoms of mental illness from physical illness, use appropriate assessment and screening tools, communication problems, presentation of symptoms, and treatment possibilities (Robinson, Dauenhauer, Bishop, & Baxter, 2012). For example, overshadowing may occur if the person is exhibiting symptoms of aggression, but it is seen as part of the intellectual and developmental disability instead of the underlying mental health issue. The service provider may not be able to assess the person properly due to standard diagnostic tests not accommodating individuals with special needs, specifically it relies on self-report when the individual is not able to fully verbalize their symptoms. If service providers can diagnose the mental health issue, then it would allow for more appropriate and overall treatment of the individual with intellectual and developmental disabilities.
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Many adults with intellectual and developmental disabilities are not receiving proper mental health treatment, if receiving any treatment at all, due to a variety of factors such as geographic location, lack of or limited health coverage, and limitations of education. These factors can individually or collectively affect a person’s lack of healthcare. Many persons with intellectual and developmental disabilities may live in rural areas. Often, these rural areas do not have public transportation or taxi services for residents which may make it difficult for individuals to attend medical appointments if they do not have personal transportation or caregivers to transport them.
Medicaid is the primary health insurance coverage for much of this population and health care providers a) do not accept Medicaid insurance and/or b) limit the number of patients covered by Medicaid that are under their care (Robinson, Dauenhauer, Bishop, & Baxter, 2012). Again, living in rural areas may limit the practitioners available to provide treatment as well as limit the types of services provided. Many rural areas have counseling centers or clinics that are overbooked and understaffed and are not able to provide the necessary treatment the mental health issues in conjunction with the intellectual and developmental disability.
Education also plays a part in the lack of mental health treatment of individuals with an intellectual and developmental disability. Again, in rural areas the service providers may not have much if any experience working with persons with intellectual and developmental disabilities. There is a need for education among service providers, including physicians and mental health treatment providers, caregivers, social workers and other persons who work with this population. Symptomology can be different than what is typically known with the general population and if staff is trained to ask questions and recognize the varying symptoms then the mental health disorder may be identified sooner rather than later, if it is identified at all (Holub, Horne-Moyer, & Abar, 2018).
Social Work Interventions
Social workers can play a key part in addressing this health care disparity that occurs in the population of intellectual and developmental disabilities. As a social worker, I would be responsible for the assessment. To complete a valid assessment, I would need to be educated regarding symptomology of mental health disorders in the intellectual and developmentally disabled population. Having this knowledge can be helpful in identifying a potential mental health disorder and in utilizing the proper assessment and screening tools. Recognizing the underlying symptoms can diminish diagnostic overshadowing and enable recommendations and implement the proper treatment interventions which could allow for the person to be treated as a whole, and not just their symptoms.
Another intervention is coordination of care. This may include arranging transportation for medical appointments and to treatment providers as well as linking the person and their family to other services within the community.
It could include being a member of a multidisciplinary team where the social worker acts on behalf of the person’s best interest regarding needed services.
- Ervin, D.A., Williams, A., & Merrick, J. (2014). Primary care: Mental and behavioral health and persons with intellectual and developmental disabilities. Frontiers in Public Health, 2, 1-5.
- Holub, A., Horne-Moyer, L., & Abar, B. (2018). Mental health considerations in developmental disabilities: Associated issues, impacts, and solutions. Families in Societies: Journal of Contemporary Services. 99:1, 11-15.
- Koslowski, N., Klein, K., Arnold, K., Kosters, M., Schutzwohl, H.J.S., & Puschner, B. (2016). Effectiveness of interventions for adults with mild to moderate intellectual disabilities and mental health problems: Systematic review and meta-analysis. The British Journal of Psychiatry, 209, 469-474.
- National Association for the Dually Diagnosed (NADD) (2019). Information on dual diagnosis. Retrieved from http://thenadd.org/resources/information-on-dual-diagnosis-2/
- Robinson, L. M., Dauenhauer, J., Bishop, K. M., & Baxter, J. (2012). Growing health disparities for persons who are aging with intellectual and developmental disabilities: The social work linchpin. Journal of Gerontological Social Work, 55(2), 175–190.
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