Mental health conditions can affect anyone, including people with developmental disabilities. In fact, there is a special term used to describe having both a diagnosis of a developmental disability and a mental health condition – this is called having a "dual diagnosis". The term dual diagnosis and this meaning are unique to the field of developmental disabilities. It has been estimated that between 30% and 70% of individuals with a diagnosis of developmental disabilities may also have a diagnosis of a mental health condition, and need psychiatric care.

As a direct support professional, some of the individuals who you support may have a dual diagnosis. Or, you may have concerns about the mental health of other individuals, even if they have not been diagnosed by a doctor as having a mental health diagnosis. By improving your understanding of mental health conditions, their signs and symptoms, and how they can be treated, you will be better able to assist all of the individuals you support.

What is a mental health condition?

A mental health condition is an illness of the brain. The brain’s job is to organize our thinking, feeling, and behavior. So, when someone has a mental health condition, he will probably exhibit signs of unusual thinking, feeling, or behavior. For example, individuals with mental health conditions may start to do or say things that don’t make sense. They may hear voices or think that people are trying to hurt them. They may feel so sad or hopeless that they do not want to get out of bed or even live anymore.

There are many different types of mental health conditions seen in individuals with developmental disabilities, and each of these conditions can affect the way people think, feel, and act in different ways. Some basic categories of mental health diagnoses include:

• Anxiety disorders – People with anxiety disorders respond to certain things or situations with an increased amount of fear or dread and experience physical signs of nervousness such as a rapid heartbeat or sweating. Anxiety disorders are the most common category of mental health diagnoses found among people with developmental disabilities. Common anxiety disorders include phobias, generalized anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder, and social anxiety disorder.
• Mood disorders – People with mood disorders often have long lasting feelings of sadness, or have fluctuations from extreme happiness to extreme sadness. Common mood disorders include depression and bipolar disorder.
• Psychotic disorders – People with psychotic disorders often have hallucinations (that is, seeing things or hearing voices that are not really there) and delusions (that is, false beliefs that are strongly held despite evidence to the contrary). One of the most common psychotic disorders is schizophrenia.

You can learn more about specific mental health conditions by checking out the websites listed at the end of this article.

Who is at risk?

Anyone can develop a mental health condition, but certain people are more likely than others to experience this type of disease.

• Mental health conditions can sometimes run in families. If an individual you support has a family member with a mental health condition, that individual may be more likely to develop a mental health condition as well. You can encourage individuals to let their doctors know if there are family members who suffer from mental health conditions; this will help the doctor know that he or she should pay special attention to the individual’s mental health.
• Mental health conditions can also be triggered by certain stressors in a person’s life. These stressors can include the death of a family member or friend, changing jobs or schools, or moving to a new living environment. Of course, it is normal for a person to feel sad when someone dies or feel nervous when moving to a new home, but if these feelings last longer than usual or get in the way of the person’s normal life, it may be time to talk to a doctor. As a direct support professional, you can make sure to pay special attention to the behavior and mood of individuals who are going through stressful life events such as these.

How do mental health conditions affect people with developmental disabilities?

Mental health conditions affect all people in similar ways; however, mental health conditions are more likely to go undiagnosed and untreated among people with developmental disabilities.

• Some people with developmental disabilities may not be able to communicate changes in the way they are feeling, thinking, or acting as well as other people. This can make it hard for a doctor to diagnose their mental health condition.
• Doctors and others may wrongly think that changes in behavior are due to the person’s developmental disability instead of a mental health condition. This can also make diagnosis and treatment more difficult.

As a direct support professional, you play a very important role in helping health care professionals to make sure that mental health conditions are recognized and treated among the individuals who you support. If you notice any unusual behavior or moods among the individuals you support, you can let the person’s doctor know right away.

What can happen to a person who has a mental health condition?

Mental health conditions that are not treated can get worse over time. As mental health conditions get worse, they can affect the way a person is able to function in daily life. For instance, some people with untreated mental health conditions can:

• Lose their jobs or do very poorly in school
• Lose their friends
• Hurt themselves or others
• Commit suicide

On the other hand, with the proper treatment many people with mental health conditions are able to get better or manage their condition so that they can live their lives as they want. You can support individuals to get the treatment that they need by talking to the person’s doctor if you notice any unexpected changes in the way the person is acting, feeling, or thinking.

What signs and symptoms should I watch out for?

Different mental health conditions have different signs and symptoms, but all mental health conditions will make people think, act, or feel differently than they are used to.

We all feel sad, anxious, or angry some of the time, but if these changes in mood or behavior

• go on for longer than usual,
• occur in unusual settings and situations,
• are not affected by consistent behavioral interventions, or
• are affecting the person’s quality of life,

then, it may be a sign that the person may have a mental health condition.

It is often difficult for people who have a mental health condition to admit to themselves or others that they are ill. Changes in mood, thoughts, and behavior can be a frightening and uncomfortable topic for people to talk about; many people who have a mental health condition will not come forward to talk about how they feel. You can assist the individuals who you support by paying attention to their behavior and moods and encouraging them to talk to a medical professional when you notice changes that are affecting their lives.

Some general behavioral signs and symptoms that may indicate mental health conditions include:

• Changes in sleep patterns - excessive sleep, little or no sleep, or interrupted sleep
• Changes in appetite - a lack of appetite or being fearful of food and inspecting or refusing food
• Excessive worry – constant and excessive talk about particular daily events, repetitive behavior rituals to either ensure or prevent an event
• Excessive anger – being threatening or hostile to others, appearing to be angry at strangers, anger that is excessive for the situation
• Excessive happiness – being excessively happy over a period of time, having grandiose thoughts and ideas
• Excessive sadness – having a depressed mood over a period of time that is not related to loss or grief, a loss of interest in pleasurable activities, talking about death or hurting oneself
• Hearing voices – staring to the side or corners and appearing to be involved in a conversation, covering ears
• Seeing things that are not there – covering eyes, brushing unseen material off body
• Change in cleanliness habits – refusing to bathe and shower or bathing and showering excessively
• Bruises or cuts – accidental or purposeful self-harm

For more information on specific signs and symptoms of different mental health conditions you can check out the resources at the end of this article. Also, this Safety Net article contains checklists for depression, mania, and psychosis.

You can use these checklists to keep track of the behavior of the individuals who you support and then share them with the individual’s doctor to help with diagnostic efforts.

What should I do if I think an individual I support has a mental health condition?

If you think that an individual who you support has a mental health condition, you can ask the person about it and also call their health care professional with your concerns. When you call the person’s doctor, be ready to report the behavior you have noticed and to describe how this is different from the way the individual usually acts. It may help you to write this information down before you call. You can report:

• The individual’s usual behavior (for instance, the individual usually enjoys spending time with friends)
• The new behavior you have noticed (now the individual only wants to spend time alone and doesn’t like to leave his or her room)
• When this behavior started (last month or last week)
• How often it is happening (everyday or just some of the time)
• Any stressors in the individual’s life that may be the cause of the new behavior (for instance, if this individual recently had a fight with a friend or had a friend or family member die)

The doctor will talk with you about your concerns and may ask that you bring the individual in so that he or she can talk with the person face-to-face. The individual’s primary care doctor may also refer him or her to a psychologist or psychiatrist for testing and diagnosis.

What are the treatments for mental health conditions?

If an individual who you support has a mental health condition, the person’s doctor will find the treatment that is right for that individual. Different mental health conditions may need to be treated in different ways, but some common treatments for mental health conditions include medications and therapy.

The medications that people take for mental health conditions are called psychotropic medications. There are many different types of psychotropic medications that are designed to treat different mental health conditions. Before the individual’s doctor prescribes a psychotropic medication, you should let the doctor know the other medications that the individual is taking. The doctor will know which medications can work together and which cannot.

Another way that people are often treated for mental health conditions is through therapy. This can include:

• Therapy sessions with a psychologist, psychiatrist, or therapist where the person will be able to talk with the therapist about their thoughts and feelings
• Art or music therapy where a person can express their thoughts and feelings through art or music

The doctor will decide which treatment or treatments are right for the individual. Treatment techniques may need to be adjusted based on the individual’s communication abilities, medical, and family history. Therefore, individuals with the same mental health condition may be treated in different ways.

How can I support individuals who are being treated for mental health conditions?

As a direct support professional, there are many ways that you can support individuals who are being treated for a mental health condition.

• If an individual’s doctor has prescribed a medication for their mental health condition, you can support the individual to take this medication as instructed. For instance, some medications may need to be taken with food or drink or at certain times of day. Make sure that you and the individual understand all of the directions for each medication and ask a doctor or pharmacist if you do not.
• Even if an individual starts to feel better, they should continue to take their medications until the doctor tells the person to stop. You can remind individuals to keep taking their medications.
• You can also support the individual to attend all of their scheduled therapy sessions. Both medication and therapy may be important parts of an individual’s treatment.
• During the individual’s treatment, keep track of any changes in mood or behavior that you notice or that the individual talks about. You can share these changes with the individual’s doctor so that she can tell if the treatment is working or needs to be adjusted.
• Lastly, you can encourage individuals to be open and honest with their health care professionals about any changes in how they feel, think, or act. The person who you support is the best source to learn about how they are feeling and what they are thinking. If an individual’s treatment is not working, the doctor will find another treatment that may work better.

Where can I go to learn more?

To learn more about specific mental health diagnoses, including their symptoms and treatments, you can check:

• WebMD: Mental Health
• National Alliance on Mental Illness

You can learn more about mental health diagnosis among people with developmental disabilities at these websites:

• The Arc
• The Missouri Developmental Disability Resource Center

Also, be sure to check out these DDS Safety Net articles and presentations:

• Articles for direct support professionals and family members:
  • Dual Diagnosis and your Family Member
• Presentations for individuals with developmental disabilities:
  • Understanding Mental Health Conditions