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Care for mental health

Individuals with intellectual disabilities are, by most accounts, more vulnerable for the emergence of psychological (and psychiatric) difficulties and disorders than are individuals without intellectual disabilities. This is a result of several mutually intertwined factors, with individual's developmental aspect being the most prominent one – whenever adverse circumstances override someone's coping abilities, psychopathological mechanisms are likely to occur. But at the same time, a person's behavior and emotional well-being are influenced by several other internal characteristics (e.g. personality, type of sensory processing, pain) and external conditions (e.g. developmentally inappropriate environment, stressful events, conflictual interpersonal relationships).  It is common for individuals with intellectual disabilities to manifest their distress solely in the form of problem behavior(s), even more so if they are nonverbal.  In essence, problem behaviors are unfavorable interaction styles between the person and their environment that have various detrimental consequences for the person her/himself (e.g. disfigurement and pain after self-injurious behavior, more restrictive placement due to aggressive outbursts) and the environment (e.g. physical harm to peers, burnout of support staff, financial cost of psychotropic medication).


We had had been trying to effectively address the problem of problem behaviors at Dornava institution for some time, but in 2009, it was finally decided to systematically tackle this perplexing issue. Our longterm hope at that time (and now, also) was to effectively respond not just to behavioral crisis of our residents but of fostering optimal environment that would serve as a protective factor for their mental health.

A team for mental health of individuals with intellectual disability was established, in which five proffesional disciplines collaborate and strive to build an interdisciplinary approach, where holistic view of the residents is emphasized and treatment plans are integrative.

Mental health team Dornava

In the implementation phase, care is taken to avoid compartmentalization and fragmentation of services. Our team consists of 3 special educators, 2 psychologists, a social worker, an occupational therapist and a nurse. Since every succesful intervention starts with a good case conceptualization, we see the initial assessment as the cornerstone of our work. At this stage, team members individually perform their evaluations, but the final assessment and diagnosis are a joint effort of all. From this, interventions are designed collaboratively, usually by creatively integrating expertise of all team members. The ensuing process of communicating relevant aspects of case conceptualization to staff, implementing  the proposed intervention plan and addressing the need for formal evaluation is overseen by one team member - the case coordinator. Our end goal is for the individual with intellectual disability to be at peace with him/herself and others around him/her.

Yes, it can become quite tough and sometimes even overwhelming, but it is a way of hope. The history of mental health in intellectual disability has thought us that there are no quick fixes, no simple magical interventions and that we cannot push the person with intellectual disability to change when we cannot or will not change ourselves. We this is mind, we are comitted to better the lives of residents – and, consequently, our own.

Team members:


1. http://www.rcpsych.ac.uk/files/pdfversion/cr144.pdf
2. http://www.mhid.org/ (see Documents, DATABID QRG final version 15.01.2007.pdf)
3. https://www.iassid.org/sirgs/challenging-behavior-a-mental-health
4. http://gra.midco.net/pdkolstoe/MHS/
5. http://www.apa.org/divisions/div33/effectivetreatment.html
6. http://thenadd.org/resources/information-on-dual-diagnosis/