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Mental Health and Wellbeing Practice Guide for Psychologists Who Support People with Disability

Mental Health and Wellbeing for People with Disability January 2016 6

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Mental Health and Wellbeing for People with Disability January 2016 6

Table of contents

1 Purpose of practice guide 5

1.1 Purpose 5

1.2 The practice improvement framework 5

1.3 Core standards program 6

1.4 Copyright 7

1.5 Disclaimer 7

2 Introduction 8

3 Risk and resilience in mental health 9

3.1 Risk factors 9

3.2 Protective factors 9

4 Key factors influencing mental health 10

4.1 Quality of life and subjective well-being 11

5 Assessment of mental health in intellectual disability 12

6 Models of recovery from mental ill-health 12

6.1 Therapeutic input for individuals with intellectual disability and mental health needs 13

6.1.1 Developing individual attributes and behaviour linked to well-being 14

Self esteem and confidence 14

Social connectedness 15

Cognitive therapy techniques 15

Positive view of the self 16

Valued roles and attributes 17

Relaxation programs 18

Progressive muscle relaxation 18

6.1.2 Managing stress and distress 19

Emotional competence 19

Mindfulness 20

Mindfulness program 20

Soles of the feet program 21

6.1.3 Problem solving 22

Problem solving techniques 22

6.1.4 Communication skills 23

6.1.5 General health and fitness 24

6.1.6 Individual and group treatment for mental disorders 24

6.1.7 Evidence-based treatment modalities and research designs 25

Cognitive Behaviour Therapy (CBT) 25

Eye Movement Desensitisation and Reprocessing (EMDR) 27

Dialectical Behaviour Therapy (DBT) 27

Psychodynamic Psychotherapy 28

Behavioural Activation 28

Adapting traditional treatment therapies 29

6.2 Person centred treatment planning 29

6.3 Improving social and economic circumstances 32

6.3.1 Social support network: 32

6.3.2 Positive family interaction 33

6.3.4 Sense of achievement in academic or vocational pursuits 35

6.4 Environmental factors 35

6.4.1 Access to services 35

6.4.2 Social integration/inclusion 36

6.4.3 Physical safety and feeling secure 36

6.5 Standardised outcome measures of well-being 36

Outcome measures for adults: 37

Outcome Measures for children and young persons: 38

7 References 40

Mental Health and Wellbeing for People with Disability January 2016 6

1  Purpose of practice guide

1.1  Purpose

Welcome to the Mental Health and Wellbeing practice guide for psychologists who support people with disability. This practice guide provides evidence based, up to date information regarding people with intellectual disability and co-occurring mental disorders. It also is to promote good communication channels and collaboration between services.

This practice guide is to provide additional information important for psychologists to know and use in their everyday person centred work. This practice guide whilst being part of the psychology specific core standards is also linked to the Practice Improvement Framework.

1.2  The practice improvement framework

The practice improvement framework (PIF) is available at http://PIF.learnflex.com.au

Psychologists (and others) who do not have login details, will need to register an account and set up a password to access the information.

The PIF contains the ‘Positive Approaches to Behaviour Support” (PABS) which supports the content of the Behaviour Support: Policy and Practice Manual (FACS, 2009) and provides practitioners not only with the knowledge they need to deliver behaviour support services in the disability context but also with a process for translating that knowledge into their work practice.

This framework also contains a range of Extension Skills Topics. One of these topics is titled, ‘Mind matters: supporting the mental health of people with an intellectual disability’.

Prior to reading this practice guide, it is recommended that FACS psychologists complete the mind matters extension skills topic. This practice guide will expand on some of the specific considerations for psychologists, as well as the practical implementation of behaviour support in the context of a person with an intellectual disability and co-occurring mental disorder.

This practice guide is designed to complement existing organisations policies and procedures, rather than replace them. This practice guide supports FACS practitioners in their clinical work and can be used by them in a number of different ways:

·  alongside clinical knowledge, skills and experience to guide clinical practice

·  as a basis for self directed learning

·  as part of FACS core standards learning

·  for reference and clarification

·  for part of the induction of new staff

·  in conjunction with professional supervision

Although not specifically designed for other practitioners, sections of this practice guide may be of interest to other practitioners; for example behaviour support practitioners, occupational therapists or speech pathologists in the context of the practitioner’s scope of practice, their organisational policies and procedures, and their professional obligations.

There is an appraisal accompanying this practice guide that is designed to support psychologists to translate their knowledge regarding mental health and wellbeing for people with intellectual disability into their everyday practice.

This guide forms part of the supporting resource material for the core standards program developed by the Clinical Innovation and Governance Directorate, Ageing Disability and Home Care, Family and Community Services, NSW, Australia.

Please note that the information contained in this package is designed specifically for psychologists working with people with disability in Australian settings.

Your feedback on this Mental Health and Wellbeing Practice Guide is welcome and should be sent by email to with the words Mental Health and Wellbeing as the subject of the email.

1.3  Core standards program

ADHC has developed an overarching program of core standards. Four common core standards with practice guides, appraisals and other resources are available for practitioners[1] who provide support to people with disability. These are located on the ADHC website. Definitions of disability and other key areas for psychologists are covered in the common core standards.

The common core standards cover the following areas for practitioners who support people with disability:

·  Professional Supervision

·  The Working Alliance

·  Philosophies, Values and Beliefs

·  Service Delivery Approaches.

1.4  Copyright

The content of this practice guide has been developed by drawing from a range of resources and people. The developers have endeavoured to acknowledge the sources of the information provided. The practice guide also has a number of hyperlinks to documents and internet sites.

Please be mindful of copyright laws when accessing and using the information through hyperlinks. Some content on external websites is provided for your information only, and may not be reproduced without the author’s written consent.

1.5  Disclaimer

This resource was developed by the Clinical Innovation and Governance Directorate of Ageing, Disability and Home Care in the Department of Family and Community Services, New South Wales, Australia (FACS).

This practice guide has been developed to support practitioners who are working with people with disability. It has been designed to promote consistent and efficient good practice. It forms part of the supporting resource material for the Core Standards Program developed by FACS.

This resource has references to FACS guidelines, procedures and links, which may not be appropriate for practitioners working in other settings. Practitioners in other workplaces should be guided by the terms and conditions of their employment and current workplace.

Access to this document to practitioners working outside of FACS has been provided in the interests of sharing resources. The Information is made available on the understanding that FACS and its employees and agents shall have no liability (including liability by reason of negligence) to the users for any loss, damage, cost or expense incurred or arising by reason of any person using or relying on the information and whether caused by reason of any error, negligent act, omission or misrepresentation in the Information or otherwise.

Reproduction of this document is subject to copyright and permission. Please refer to the ADHC website disclaimer for more details http://www.adhc.nsw.gov.au/copyright.

The guide is not considered to be the sole source of information on this topic and as such practitioners should read this document in the context of one of many possible resources to assist them in their work.

Practitioners should always refer to relevant professional practice standards. The information is not intended to replace the application of clinical judgment to each individual person with disability. Each recommendation should be considered within the context of each individual person’s circumstances.

When using this information, it is strongly recommended practitioners seek input from appropriate senior practitioners and experts before any adaption or use.

The information contained in this practice guide is current as at 20 December 2015 and may be subject to change. Whilst the information contained in this practice guide has been compiled and presented with all due care, FACS gives no assurance or warranty nor makes any representation as to the accuracy or completeness or legitimacy of its content.

FACS takes no responsibility for the accuracy, currency, reliability and correctness of any information included in the information provided by third parties, nor for the accuracy, currency, reliability and correctness of references to information sources (including Internet content) outside of FACS.

2  Introduction

A commonly used definition of mental health is, ‘… a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.’ (WHO,2001, p.1).

Positive mental health is important not only for individuals but also for communities, because it promotes higher levels of productivity, education, employment, earnings, healthy living, engagement, and physical health. In addition, individuals may be better able to cope with difficult situations they are faced with and more able to reach their full potential (Friedli, 2009).

It has been suggested that individuals with intellectual disability are more vulnerable to developing mental health problems and this may be related to increased social disadvantage (e.g. Einfeld, Ellis, & Emerson, 2011; Gentile & Jackson, 2008; Deb et al. 2001). Further, they are likely to experience difficulties in accessing mental health services. This may be partly related to the perceived confidence and skills of mental health practitioners and diagnostic issues (McNally & McMurray, 2015).

Until relatively recently, there were very few research articles focusing on therapeutic approaches for supporting individuals with intellectual disability, and treatment generally focused on medication (Cooray & Bakala, 2005). This guide was developed to assist psychologists supporting people with disability to collaborate with the surrounding system in developing a comprehensive, evidence-based approach to supporting an individual with an intellectual disability and mental health issue.

In addition, this guide aims to encourage psychologists to use preventative strategies to prevent the emergence of mental ill-health and to increase quality of life, well-being, and life satisfaction in the individuals they support.

3  Risk and resilience in mental health

Resilience has been defined as, ‘…a psychological trait that aids a person’s ability to cope and adapt to changes throughout their life.’ (Conder, Mirfin-Veitch & Gates,2014,p.573).

The interaction between risk factors and protective factors is the key in determining an individual’s ability to adapt and cope with a particular stressor (Mrazek & Haggerty, 1994).

3.1  Risk factors

Risk factors are variables that increase the probability of a person developing a disorder, including those of a biological or psychosocial nature (Mrazek & Haggerty, 1994). Risk factors may also vary depending on age and stage of development. Risk factors may include individual vulnerabilities, which may arise from genetic predisposition, chronic illness, life adversity, and abuse or neglect (O'Grady & Metz, 1987).

Factors identified as increasing the risk of mental ill-health for people with an intellectual disability include social isolation, exposure to violence, feeling less valued, stigmatisation, unfulfilled dreams of parenthood or intimate relationships, mothers with an intellectual disability experiencing removal of children, unemployment, death of one’s parents, dysfunctional family upbringing, and entering residential care (Taggart et al. 2009a,b, 2010).

Risk factors in children developing psychiatric disorders include physical health, family dysfunction, and psychiatric illness in a parent (Wallander et al. 2006). In addition, there is an increased risk of mental ill-health in children who have greater cognitive and language impairments, lower social and adaptive skills, those with a single parent, and those with a lower socioeconomic status (Koskentausta, Livanainen & Almqvist, 2007).

Despite the increased risk for people with intellectual disability, it is well established that not all individuals exposed to risk factors will go on to develop a mental disorder, and this has highlighted the importance of protective factors (Gilmore, Campbell, Shochet & Roberts, 2013).

3.2  Protective factors

Protective factors are, ‘…those factors that modify, ameliorate or alter a person's response to some environmental hazard that predisposes to a maladaptive outcome.’ (Rutter,1985b, p.600). Protective factors can include personal characteristics such as temperament or social competence, or they may be environmental, such as supportive family dynamics or previous history of positive experiences (Gilmore et al. 2013).

Protective factors that have been identified in the research as buffering the risks for people with intellectual disability include: strong relationships with family and friends and opportunities for social interaction; a sense of autonomy; feeling happy; keeping busy; maintaining physical fitness; healthy eating; having structured routines; medication; emotional literacy; community involvement, early responses to signs of mental ill-health and support through recovery (Taggart et al. 2009a; Taggart et al. 2010; Conder, Mirfin-Veitch & Gates, 2014).

Other general protective factors for young people with intellectual disability include having an attractive appearance, low levels of family stress, a sense of competence, ability to be understood by others, the ability to adapt one’s behaviour to the situation, and an accepting community environment (O’Sullivan, Webber & O’Connor, 2006).