Treating dual diagnoses

About 3 million people in the US have an intellectual disability, and many of them also have a mental health condition complicating their lives and care. A new class teaches students with both diagnoses how to manage their mental illness better

About 3 million people in the US have an intellectual disability, and many of them also have a mental health condition complicating their lives and care. A new class teaches students with both diagnoses how to manage their mental illness better.
(Photo: Students at JEVS Human Services’ “Happy Healthy Life” class with teacher Renee Morin) [audio:100827msdual.mp3]

It’s a big group of people that’s all but invisible says Dina McFalls, director of Philadelphia Coordinated Healthcare

McFalls: I think this is an unknown population – this is the bottom rung of people who you support

McFalls says having an intellectual disability or mental illness often results in being marginalized – but having both means twice the stigma, even though the combination is very common. She says people with intellectual disabilities appear to be at greater risk for mental illness:

McFalls: There are certain conditions that travel with specific diagnoses, but there may be greater prevalence of mental illness in this population because of insults to the brain.

Insults to the brain mean the brain’s functioning is impaired because of the intellectual disability, affecting not just cognition but also parts of the brain that regulate mental health. For example, people with Down syndrome are prone to depression and anxiety. Also – many people with intellectual disabilities experience trauma – abuse, neglect or bullying and that can lead to mental health problems. And yet symptoms of mental illness are often overlooked, or lumped into the general diagnosis of intellectual disability.

To complicate matters further, says McFalls, many mental health professionals believe that people with intellectual disabilities can’t participate in one-on-one or group therapy:

McFalls: It’s a myth – people with intellectual disabilities can participate, and do participate. What happens there is sort of that stigma, you say the words “intellectual disability”, and the therapist says “oh, I’m not trained to work with that population”.

Three students are bent over their notebooks in a classroom at JEVS Human Services in Philadelphia’s Northeast. They are part of a class called the “Happy Healthy Life”. It was specifically developed for people with dual diagnoses to both recognize and manage symptoms of mental illness. Clinical manager Joy Carter says the majority of people with intellectual disabilities fall in the mild to moderate range – and can learn how to do that:

Carter: So that they become less dependent on the mental health system, and more dependent on natural supports, you know, friends, family, people in their communities, their neighbors, so that they are able to identify a crisis, and hopefully resolve a crisis before they have to go into the hospital.

Renee Morin teaches the class, and says she takes her students’ individual limitations into account:

Morin: It’s a lot of one-on-one time, even outside of the group I might have one-on-one counseling and go over the class, different times, we do a lot of role playing

She also relies on lots of repetition and reinforcement of the material. This is the second class of this kind at JEVS – participants in last year’s class had dramatic reductions in hospitalizations and crisis situations. Current student Janet Lord says it has helped her stay out of the hospital:

Lord: I used to go to the hospital every two weeks, for abusing my staff when I got angry, and trying to hurt myself with knives and stuff, biting myself and not being happy.
Scott: And now you haven’t been in the hospital?
Lord: For about seven months.

Back at Philadelphia Coordinated Healthcare Dina McFalls and her colleague, psychiatrist Carol Persons hope classes like this will become more common. They have just completed two years of research and Persons says one issue they found is that too often, mental health symptoms are immediately controlled with medications:

Persons: One of the problems with medication, and this is true in everyone, not just people with intellectual disabilities, is it is it going to affect your functioning, and if you have a brain that has insults to it already, it doesn’t need to have its functioning lowered

McFalls is trying to raise awareness among therapists to become more familiar with clients who have intellectual disabilities. And – she hopes people with both diagnoses will become more visible and vocal.

That’s something 26-year old Cherie Harris says she has achieved thanks to taking the class at JEVS:

Harris: Well I’m living a happy healthy life, and I live on my own, and hopefully, I can live on my own, by myself, where I don’t need any staff to guide me”