title: An alternative model for psychiatric service delivery for people with intellectual disabilities in a vocational rehabilitation center.
abstract: The prevalence of mental illness in the intellectually disabled (ID) population is high. Because of their special characteristics, such as involvement of multiple carers (family, social services, protected housing staff, vocational instructors), linguistic limitations and the need for a familiar and steady environment, these patients require special therapeutic consideration. In Israel, as in many other countries, people with ID (PWID) receive psychiatric services from general psychiatric outpatient clinics and hospitals; their treatment is generally not specifically tailored to their needs, and hence often suboptimal. In this article we will review some models of psychiatric service delivery for PWID and present an alternative model that we have developed. Our service has been operating since December 1998; it is based upon cooperation between the municipal social services and the local psychiatric outpatient clinic, and is provided in a vocational rehabilitation center where most mild to moderate ID individuals in our area, the city of Bat Yam, are employed. During the first five years (1999-2004) of the operation of the service, 42 people (about half the total number of clients passing through the vocational rehabilitation center during this period) were examined by the psychiatrist; 37 of them (88%) had at least one psychiatric diagnosis. There were especially high rates of adjustment disorder (26% of all principal diagnoses) and of behavior disorder (24% of all principal diagnoses). This model for psychiatric service delivery for PWID in a vocational-rehabilitation center, based as it is on cooperation between the different care agencies, facilitates more accurate psychiatric diagnosis and hence the provision of more appropriate treatment, which in practice usually consists of a combination of pharmacological and behavioral treatment together with educational programs and support for families and staff. Based on our positive experience with this model, we believe that it is the most suitable framework of treatment for adults with dual diagnosis, and that it should be adopted in other areas.
authors.affiliation: Adult Outpatient Department, Abarbanel Mental Health Center, Bat Yam, Israel. ya-eli@012.net.il
authors.forename: Yael
authors.initials: Y
authors.lastname: Nehama
authors.forename: Zipi
authors.initials: Z
authors.lastname: Dakar
authors.forename: Mike
authors.initials: M
authors.lastname: Stawski
authors.forename: Henry
authors.initials: H
authors.lastname: Szor
mesh_terms: D000275:Adjustment Disorders / Q000453:epidemiology / Q000534:rehabilitation; D000328:Adult; D003131:Combined Modality Therapy; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000453:epidemiology / Q000534:rehabilitation*; D007557:Israel; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D008605:Mental Health Services; D008875:Middle Aged; D012047:Rehabilitation Centers; D014829:Vocational Education