The objective of this study was to explore whether people with intellectual disability from ethnic minority groups have higher rates of mental health problems and access different care pathways than their White counterparts. Clinical and socio-demographic data were collected for 806 consecutive new referrals to a specialist mental health service for people with intellectual disabilities in South London. Referrals were grouped according to their ethnic origin. The analyses showed that there was an over-representation of referrals from ethnic minority groups with diagnoses of schizophrenia spectrum disorder. In addition, Black participants were more likely to have an autistic spectrum disorder. Referrals of ethnic minority groups were considerably younger than White referrals, and less likely to be in supported residences. The results are discussed in the context of cultural and familial factors in particular ethnic groups that may play an important role in accessing and using mental health services.
In the UK, some ethnic minority communities have been found to have an increased incidence of psychotic illness and access different care pathways to their White counterparts (Bhugra et al., 1997, Fearon et al., 2004, Fearon et al., 2006 and Morgan et al., 2005). Various psycho-social and cultural factors have been suggested to explain such ethnic effects (e.g. Bhui and Bhugra, 2002, Gabel, 2004, Hutchinson et al., 1996, Ndetei and Vadher, 1984 and Sharpley et al., 2001). It is important that clinicians and care providers are aware of such effects in order to promote equality and consistency within the mental health services.
Individuals with intellectual disabilities are at an increased risk of developing mental health problems including schizophrenia spectrum disorders (e.g. Cooper et al., 2007 and Deb et al., 2001). Explanations for this increased vulnerability usually focus on the biological, cognitive, and social deficits that accompany intellectual disability, and how they may render an individual less able to deal with some of life's difficulties (Matson & Sevin, 1994). The role of ethnicity in individuals with intellectual disabilities is an area of increasing interest in recent years (McCarthy, Mir, & Wright, 2008), although there is little evidence on whether certain ethnic groups have an increased incidence of mental health problems and access different care pathways. The current study was designed to investigate whether the ethnic differences observed in severe mental illness in general adult mental health (Bhugra et al., 1997, Fearon et al., 2004, Fearon et al., 2006 and Morgan et al., 2005) were also present in a large sample of adults with intellectual disabilities.
The current study has shown that there are substantial ethnic differences in the prevalence of severe mental illness, diagnosis of autism spectrum disorders and use of community services for adults with intellectual disabilities. Because people with intellectual disabilities are increasingly likely to require psychiatric attention (e.g. Cooper et al., 2007 and Deb et al., 2001) and to utilise various care facilities, the presence of ethnic differences should be a highly prominent issue in designing and planning specialist services. It is also crucial to raise awareness of these issues and to ascertain the causes of these differences. Some possible psycho-social explanations have been offered in the discussion. However, additional research is needed if we are to understand the relationship between psycho-social and socio-cultural factors, and the association (if any) with biological factors that impact on prevalence of psychiatric disorders in individuals with intellectual disabilities. Further studies are required on whether approaches used in mental health services for minority ethnic minority service users improve access and allocation of community resources to individuals with intellectual disabilities and carers from similar communities. Finally, this unpicking of risk factors may lead to a further understanding of severe mental illness and developmental disorders across ethnic communities.
