Mental Health

Mental Health Guidelines

HOW TO READ THE GUIDELINE RECOMMENDATIONS

Icons used in these guidelines

Recommendations with are strongly recommended; the symbol indicates clinicians’ top recommendations; or indicates that reviewed publications pertain to the guideline background; blue indicates a subtype that increases the strength of the recommendation.

Types of knowledge

The guideline recommendations are based on four different types of knowledge: empirical knowledge; knowledge about the health care ecosystem; clinical expert knowledge; and experiential knowledge. The subtypes of knowledge are related to the strength of recommendation.


Learn more about types and subtypes of knowledge

Strength of Recommendation

These guidelines outline standards of care for which there is a good basis in current knowledge. Other factors, however, were considered for deciding whether a proposed action is “strongly recommended” or “recommended”, including availability and use of resources.


Learn more about strengths of recommendations

The guidelines in this section present a comprehensive and systematic approach to assessing the mental health and well-being of adults with intellectual and developmental disabilities. The recommendations emphasize screening for distressing life experiences and environmental stressors that sometimes contribute to behaviours that challenge. These can occur when the health, developmental and personal needs of people with intellectual and developmental disabilities are not fully understood, or when necessary supports or environmental accommodations are not provided.

The guidelines in this section also provide family physicians with advice on the appropriate use of psychotropic medications and standards for reviewing them. The recommendations are based on concerns about health risks and unwanted side effects associated with long-term use of psychotropic medications or combinations of medications by adults with intellectual and developmental disabilities.

Key top recommendations for family physicians regarding behaviours that challenge and mental health concerns among adults with intellectual and developmental disabilities are:

  • Use a systematic approach (HELP), first ruling out a physical health cause of behaviours that challenge
  • Seek the input of the adult with intellectual and developmental disabilities, caregivers, and the support of an inter-professional team
  • Do not use antipsychotic medications as a first-line or routine treatment
  • Always screen for trauma and abuse

Family physicians have the skills to assess physical and mental health, social history and life events of their patients. However, an inter-professional team can help to assess, for example, the environment, supports and best methods of communication of a patient. These guidelines provide a step-by-step approach and links to tools for assessments that are adapted for adults with intellectual and developmental disabilities. Advocacy to ensure that these resources are accessible is an essential part of the equitable care of this population.

Lead:

Elspeth Bradley

MBBS PhD FRCPC FRCPsych, Associate Professor, Department of Psychiatry, University of Toronto; consulting psychiatrist and psychotherapist in intellectual disabilities

Authors:

Kerry Boyd

MD, FRCPC, Associate Clinical Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University; Chief Clinical Officer, Bethesda Community Services

MacKenzie Ketchell

MS, BCBA

Yona Lunsky

PhD, C. Psych, Clinician Scientist, Centre for Addiction and Mental Health; Professor and Developmental Disability Lead, University of Toronto

Shirley McMillan

BScN, PhD, Clinical Nurse Specialist, Surrey Place, Toronto

Dr. Laurie Green (MD, CCFP-EM) is a family physician with a general practice at St. Michael’s Hospital in Toronto and special interest in the primary care of adults with intelllectual and developmental disabilites.