title: Perspectives: the mental health care gap in intellectual disabilities in Spain: impact analysis and knowledge-to-action plan.
abstract: BACKGROUND
  Intellectual developmental disorder or Intellectual disability (ID) is a prevalent condition with a high impact along the life-span particularly when associated to other mental disorders (MD).
  
  
  OBJECTIVE
  To estimate the unmet needs and to design a knowledge to action plan to reduce the care gap in ID-MD in Spain.
  
  
  METHODS
  We followed a 5-step `maxi' impact assessment and a mixed qualitative/quantitative design including expert panels, secondary analysis of databases and a prospective survey in the 17 regions in Spain. Schizophrenia was used as comparator due to similar prevalence rates and burden.
  
  
  RESULTS
  Persons with ID-MD had ten times less outpatient contacts and hospital admissions than patients with schizophrenia. The outpatient case load was 2.31% in ID and 14.6% in schizophrenia. ID had the lowest hospitalization rate amongst all mental disorders but the highest length of stay. The expert panel estimated that half of persons with ID-MD are not adequately assessed and 95% do not receive the required care in Spain. Basic care needs include 6.5 beds and an ID-MD outpatient service per 1 million population. At least 134 specialized psychiatrists and psychologists and 277 beds are needed to reach the minimum standards in Spain.
  
  
  CONCLUSIONS
  This study quantifies the ID-MD care gap in Spain and the basic specialized services needed. In spite of the societal and health implications of ID-MD the knowledge-to-action plan had a modest impact limited at the regions where ID-MD programmes were already implemented.
  
  
  CONCLUSIONS
  Specific priority setting on ID-MH should be incorporated to mental health strategy at the Ministry of Health within a broader health and ID plan. National and regional policies should incorporate an integrative care approach through the life cycle. The development of excellence centers on ID-MD and a national observatory on this topic should be encouraged.
authors: Centre for disability Research and Policy Faculty of Health Sciences, University of Sydney , 75 East St Lidcombe, NSW 2141, Australia, luis.salvador-carulla@sydney.edu.au.
authors: Luis
authors: L
authors: Salvador-Carulla
authors: Rafael
authors: R
authors: Martinez-Leal
authors: Miriam
authors: M
authors: Poole
authors: Jose A
authors: JA
authors: Salinas-Perez
authors: Javier
authors: J
authors: Tamarit
authors: Jose
authors: J
authors: Garcia-Ibanez
authors: Jose
authors: J
authors: Almenara-Barrios
authors: Javier
authors: J
authors: Alvarez-Galvez
mesh_terms: D006296:Health Services / Q000706:statistics & numerical data; D054625:Healthcare Disparities; D006801:Humans; D008607:Intellectual Disability / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D007902:Length of Stay / Q000706:statistics & numerical data; D008017:Life Expectancy; D001523:Mental Disorders / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D015995:Prevalence; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology