Emotional and behavioural problems in Indigenous adults with intellectual disability

2017-01-15T23:56:42Z (GMT) by Flint, Philip James
Indigenous people experience higher levels of intellectual disability (ID) than the general population. Individuals with intellectual disability also experience higher levels of psychopathology than members of the general population. There is limited data on intellectual disability and the prevalence and nature of psychopathology among Indigenous adults with intellectual disability. This research aimed to provide a profile of Indigenous adults with intellectual disability and investigate the prevalence and nature of psychopathology in Indigenous adults with intellectual disability living in urban, regional and remote communities of South Australia. It also explored the support needs of Indigenous people with intellectual disability and their carers. This research project used the Developmental Behaviour Checklist for Adults (DBC-A), a carer-completed checklist, to investigate the prevalence and nature of psychopathology in Indigenous adults with intellectual disability living in South Australia and the Northern Territory. A further aim was to compare the rates, patterns and differences in the psychopathology of the population of Indigenous adults with intellectual disability to a large community cohort of non-Indigenous Australian adults with an intellectual disability and to better understand the social, cultural, environmental and developmental contexts of disturbed behaviours in Indigenous adults with intellectual disability. The final aim of the research project was to describe the usefulness and limitations of this carer completed checklist (the DBC-A) in the assessment of psychopathology in Indigenous adults with intellectual disability. Carer-completed screening checklists have been shown to be effective instruments with which to assess the mental health of people with intellectual disability and the DBC-A has been proven to be a valid and reliable tool, extensively used within mainstream Australian populations of adults with intellectual disability. In addition qualitative information was collected to further explore various aspects of intellectual disability and psychopathology in the Indigenous Australian population in order to increase understanding of how intellectual disability and psychopathology are perceived by the Indigenous community now, and how that might differ from a traditional perspective. Data was collected from carers who knew the adult with an intellectual disability well using the Lifespan Questionnaire Booklet, which contained the DBC-A and other questions about a range of demographic information about the individual. Potential participants for this study were identified from the South Australian Department of Family and Community Disability Services register. All clients aged 16 years or older who were identified as an Aboriginal and/or Torres Strait Islander on the register were eligible to participate. This information was compared to results from a representative cohort of non-Indigenous Australian adults with intellectual disability. Of a possible 198 adults, 161 participated (an 81% participation rate), thus ensuring confidence in the representativeness of the findings. The results show that 29% of Indigenous adults with intellectual disability experience mental illness which is 40% higher than the non-Indigenous population of adults in South Australia with intellectual disability. These levels of mental health problems decreased over the lifespan for both Indigenous and non-Indigenous participants and were more prevalent in young adult Indigenous males. The research found levels of mental health problems increased the further people lived from major cities and were the highest in remote communities. Considering the findings about the higher levels of psychopathology in the Indigenous cohort, it is surprising that when variables such as age and level of intellectual disability were controlled for, this research showed little difference in the rates of psychopathology between Indigenous and non-Indigenous groups. This is possibly further evidence that it is the presence of intellectual disability that is the main determining factor for the higher rates of mental health needs. While the literature suggests that there are no unique words in Indigenous languages to describe intellectual disability and mental illness, this research found that there were. Further findings suggested that it is traditional understandings and perceptions of intellectual disability and mental health which influences acceptance, care and seeking of services for those with intellectual disability. Indigenous people with intellectual disability and/or mental health problems can experience similar stigma and marginalisation from their community as occurs in the broader Australian population but often Indigenous carers expressed concern and distress about their family member with a disability being taken away from them and placed in accommodation services a long way from home, which disrupts and fragments family based care, personal identity and creates further mental health problems. The DBC-A has a potentially useful role in the assessment and management of mental health problems in Indigenous adults with intellectual disability. It is also likely to be a useful research tool, for example, in service planning and epidemiological studies of psychopathology as long as due attention is paid to the context and environment in which it is administered. A personalised interactive process, undertaken by an assessor who has cultural sensitivity and understanding, or is supported by someone with these qualities, is required for valid results to be obtained.