Assessment of mental health problems in people with intellectual disabilities.

Although it is widely accepted that individuals with intellectul disabilities face an increased vulnerability to developing mental health problems, there is currently a lack of agreement about the most appropriate form of assessment. When applied to people with intellectual disabilities, there is no consensus about which problems should be included in the term "mental health problem," and identifying mental illness is far from straightforward. The adoption of standardized classification systems assumes that individuals with intellectual disabilities have adequate linguistic skills and they present mental health problems in the same way as members of the general population. Yet, individuals with intellectual disabilities are less likely to fulfill verbal expectations that are the basis of current classification systems and many exhibit problem behaviors incompatible with existing criteria. Nevertheless, accurate diagnosis provides a clear direction for interventions. Although there is currently a lack of consensus about which instruments are most effective, the routine use of valid and reliable assessment and monitoring tools may significantly improve the quality of research and care. The complexity of factors influencing the mental health of individuals with intellectual disabilities has implications for how these needs can be effectively met. Clearly, diagnostic classification provides only partial guidance to morbidity and the quality of life experienced and mental health services increasingly adopt a problem-based, "biopsychosocial" approach to assessment and treatment delivered by multidisciplinary teams. The most basic and vital role of carers within this context is the awareness that a person with intellectual disabilities may suffer from a mental illness. Carers play a central role in recognising possible mental illness, making referrals for further psychiatric assessment and providing diagnostic information and treatment feedback. In the absence of information about the manifestation of mental health problems in individuals with intellectual disabilities, it is likely that the signs of mental illness will be overlooked. Training initiatives, aimed at increasing the ability of care staff to recognise the signs of mental illness and to make informed referral decisions, are vital in ensuring adequate access to mental health services by individuals with intellectual disabilities.