| Supporting individuals who are both developmentally | | | | mental health issues, especially mood disorders, tend |
| delayed as well as diagnosed with a mental illness is, | | | | to live in a highly emotional environment & draw all |
| at best, a challenging proposition. However, as more | | | | those around them into that atmosphere. In order to |
| & more individuals with developmental disabilities are | | | | make sure that your team makes clear-headed logical |
| successfully supported in their home communities it is | | | | decisions, it is essential to use objective behavioral |
| this portion of the population, which is struggling. | | | | measures to help gage the level & intensity of |
| Frequently, it is the combination of challenges that | | | | changes. Over time, this data will also allow you to |
| keeps them from being adequately served by either | | | | see patterns of behavior & then to anticipate coming |
| support system as they are shuttled back & forth in | | | | mood changes so that mental health episodes are |
| search of a "more appropriate" placement. To stop | | | | approached in a more prepared & conscious manner. |
| this scenario it is essential for ethical human service | | | | 7. Integrate your behavioral & psychiatric information |
| professionals to stop passing the buck & develop a | | | | Once you've collected objective data on the |
| support system sensitive to both the individuals | | | | individuals' mental health patterns, it is essential to |
| cognitive limitations as well as their changes in mental | | | | share this information with your team's psychiatrist. |
| health status. So what are the keys to developing a | | | | Sending the data (& someone who can explain it in a |
| successful plan? Those who have been effective list | | | | knowledgeable & straightforward manner) along to |
| the following 10 things as crucial: | | | | the individual's psychiatric consultation will improve the |
| 1. Double-check your psychiatric diagnosis Because | | | | accuracy of their treatment & allow the individual to |
| the "science" of mental health diagnosis relies so | | | | reach stabilization as quickly as possible, with a |
| heavily on self-report (usually not available or reliable | | | | minimum of medication(s) and side effects. |
| in this population) it is extremely easy to misdiagnosis | | | | 8. Develop a network of support around the individual |
| a psychiatric condition. Frequently when an individual is | | | | Along with the well-trained staff mentioned above, it |
| misdiagnosed the medication prescribed to improve | | | | is advisable to help the individual develop trusted |
| the situation may actually be contributing to the | | | | relationships with a number of other people in their |
| problems. | | | | lives. This gives them a variety of options when they |
| 2. Be aware that many psychiatric conditions can | | | | are feeling insecure or emotionally charged. It allows |
| "look" different in someone with a developmental | | | | them to seek out whoever they feel would best |
| disability. For instance, if you are observing a 30-year | | | | understand their current concern & confide in them, |
| old man & he appears to be talking to himself that | | | | possible avoiding or minimizing a mental health crisis. |
| might be considered a psychiatric manifestation. On | | | | 9. Always have a back up plan! That being said, in the |
| the other hand, if you observing a 30 year old man | | | | best-laid support plans, there will be moments of |
| with developmental delays (& therefore a cognitive | | | | crisis. That, unfortunately, is simply the nature of |
| age of 4) who is talking to himself he may simply be | | | | mental illness. So it is critical to think through as much |
| engaging in verbal rehearsal, a developmentally normal | | | | as possible how crises will be managed before they |
| milestone at that developmental age (4). Bottom line | | | | happen. For instance: |
| -- be sure you know what you're dealing with. | | | | ** When this set of circumstances occur -- we will |
| 3. Do your medication homework Because of the | | | | seek inpatient psychiatric care at hospital X. |
| complex nature of their diagnosis, these individuals | | | | ** If there are legal allegations -- we will follow the |
| tend to end up on multiple medications. As a support | | | | individual justice plan developed in cooperation with |
| person, you need to be highly educated about the | | | | local law enforcement officials. |
| possible side effects & interactions of these | | | | ** If these symptoms reach this level -- we will |
| medications & constantly on the alert. All too often, | | | | increase the individual's access to mental health |
| medication side effects are reported as "new" | | | | counseling to this number of visits per week. |
| symptoms & "treated" with additional medication | | | | ** If these symptoms occur -- we will implement the |
| rather than simply reducing or eliminating the | | | | individual's suicide prevention plan. |
| medication causing the side effect. | | | | ** If the individual cycles in & out of competency to |
| 4. Find the right doctor & psychiatrist to complement | | | | make life decisions -- we will work with the local |
| your team To successfully support individuals with a | | | | court & family members to establish a plan for |
| dual diagnosis you need a knowledgeable team. That | | | | conservatorship or guardianship with criteria for when |
| includes both your doctor & your psychiatrist. To be | | | | and how long it would be necessary. |
| effective they will need to be: | | | | 10. Know when you need help As with any |
| ** familiar with developmental disabilities as well as | | | | challenging field, there will be moments when you and |
| mental health issues | | | | your team will simply be out of ideas & unsure what |
| ** up to date on medications, medication side | | | | to do next. When that moment occurs, don't be |
| effects/interactions & new treatment options | | | | afraid to ask for help. Go to other professionals who |
| ** willing to research unusual symptom presentations | | | | are experienced with this population & seek out |
| & | | | | feedback. Frequently a fresh perspective will get |
| ** willing to listen to input from those who know the | | | | your team back on track or at least offer a direction |
| person best -- namely you & your direct support | | | | to head while you re-group. |
| staff. | | | | One final note: This is a highly complex population & |
| 5. Create flexible, well-trained support staff To be | | | | this article is by no means exhaustive. Please use the |
| successful, especially in a community setting, an | | | | information provided here as a place to start & learn |
| individual with a dual diagnosis will need to be | | | | all that you can about successful treatment methods |
| surrounded by a support network that understands | | | | from our resources & those of others if you are |
| both the nature of their mental health condition, how | | | | supporting individuals within this population. We would |
| it interacts with their developmental disability, & how | | | | also like to express our thanks to Robert Simmons, |
| to adjust their support procedures during mental | | | | one of our consulting psychologists, who provided |
| health episodes. | | | | the tips contained in today's column. |
| 6. Collect & use behavioral data Individuals with | | | | |