Persons With Intellectual and Developmental Disabilities in the Mental Health System: Part 2. Policy and Systems Considerations.

Individuals with intellectual and developmental disabilities (IDD) are at high risk of co-occurring mental health conditions, including major depressive disorder, bipolar disorder, psychotic disorders, anxiety disorders, impulse control disorders, and others. Because of symptoms associated with these illnesses and with the disabilities themselves, these individuals are often served in a mental health service system framework. In this second of two articles on care for persons with IDD in the mental health system, the authors focus on policy and systems considerations to assist practitioners and administrators to provide high-quality mental health services for these individuals by recognizing existing infrastructures of support. The authors describe historical factors, including legislation and case law, that have led to greater inclusion of persons with IDD in mainstream settings; systemic barriers to integrating services for persons with IDD and Medicaid waivers and provisions of the Affordable Care Act designed to overcome such barriers; and considerations for treating persons with IDD in various settings, such as emergency departments and forensic settings. They propose approaches to developing the workforce, such as by training direct service professionals and utilizing the services of board-certified behavioral analysts. A robust continuum of care and service delivery system that is increasingly sophisticated in working with persons with IDD, with and without co-occurring mental illness, is critical to maximize the autonomy and community inclusion of these individuals.

Persons With Intellectual and Developmental Disabilities in the Mental Health System: Part 1. Clinical Considerations.

Individuals with intellectual and developmental disabilities (IDD) are at high risk of co-occurring mental health conditions, including major depressive disorder, bipolar disorder, anxiety disorders, psychotic illnesses, impulse control disorders, and others. Because of symptoms associated with these illnesses and with the disabilities themselves, these individuals are often served in a mental health service system framework. However, treatment for them in these settings has typically not been sufficiently nimble, knowledgeable, or adept. Most mental health professionals receive little training about the needs of this population, and system structures typically bifurcate care, when, in reality, conditions can be complex and overlapping. In this first of two articles on care for persons with IDD in the mental health system, the authors provide a clinical overview of these neurodevelopmental disorders and of mental health and other conditions that co-occur with IDD. Considerations and challenges for treating this population in the mental health system include early recognition of mental health conditions, which often requires caregiver and family input, as well as information from a variety of additional collateral sources; the importance of trauma-informed and person-centered care; the promotion of self-determination through use of decision supports; use of approaches such as applied behavior analysis to develop a frame to address challenging behaviors; and the need to properly assess and provide thoughtful pharmacologic intervention when appropriate. The ability of individuals with IDD to thrive in a wide range of community integration opportunities depends on many factors, and clinicians must understand and use the available approaches for treating them.

PTSD and Use of Outpatient General Medical Services Among Veterans of the Vietnam War.

OBJECTIVE: The primary goal of this analysis was to assess whether recent use of outpatient services for general medical concerns by Vietnam veterans varies according to level of posttraumatic stress disorder (PTSD) symptomatology over time. Another goal was to determine whether PTSD symptomatology was associated with veterans' reports of discussing behavioral health issues as part of a general medical visit. METHODS: Self-reported service use data and measures of PTSD were from a nationally representative sample of 848 male and female Vietnam theater veterans (individuals who were deployed to the Vietnam theater of operations) who participated in the National Vietnam Veterans Longitudinal Study, a 25-year follow-up of a cohort of veterans originally interviewed from 1984-1988 as part of the National Vietnam Veterans Readjustment Study. Four categories of PTSD symptomatology course over 25 years were defined, and logistic regression models were used to assess their relationship with recent use of outpatient general medical services. RESULTS: Male and female theater veterans with high or increasing PTSD symptomatology over the period were more likely than those with low symptomatology to report recent VA outpatient visits. Males in the increasing and high categories were also more likely to discuss behavioral health issues at general medical visits. CONCLUSIONS: Vietnam veterans with high and increasing PTSD symptomatology over time were likely to use VA outpatient general health services. Attention to stressors of the aging process and to persistence of PTSD symptoms is important for Vietnam veterans, as is addressing PTSD with other psychiatric and medical comorbidities within the context of outpatient general medical care.

Complementary and alternative medicine among veterans and military personnel: a synthesis of population surveys.

BACKGROUND: Recent reports reinforce the widespread interest in complementary and alternative medicine (CAM), not only among military personnel with combat-related disorders, but also among providers who are pressed to respond to patient demand for these therapies. However, an understanding of utilization of CAM therapies in this population is lacking. OBJECTIVE: The goals of this study are to synthesize the content of self-report population surveys with information on use of CAM in military and veteran populations, assess gaps in knowledge, and suggest ways to address current limitations. RESEARCH DESIGN: The research team conducted a literature review of population surveys to identify CAM definitions, whether military status was queried, the medical and psychological conditions queried, and each specific CAM question. Utilization estimates specific to military/veterans were summarized and limitations to knowledge was classified. RESULTS: Seven surveys of CAM utilization were conducted with military/veteran groups. In addition, 7 household surveys queried military status, although there was no military/veteran subgroup analysis. Definition of CAM varied widely limiting cross-survey analysis. Among active duty and Reserve military, CAM use ranged between 37% and 46%. Survey estimates do not specify CAM use that is associated with a medical or behavioral health condition. CONCLUSIONS: Comparisons between surveys are hampered due to variation in methodologies. Too little is known about reasons for using CAM and conditions for which it is used. Additional information could be drawn from current surveys with additional subgroup analysis, and future surveys of CAM should include military status variable.