Primary mental healthcare for adults with mild intellectual disabilities: Patients' perspectives

Background
People with mild intellectual disabilities (MID) experience more mental health (MH) problems than the general population but often do not receive appropriate primary MH care. Primary MH care is essential in integrative MH care and, therefore, demands high quality. To improve primary MH care for this patient group, account must be taken of the experiences of people with MID. So far, their perspectives have been largely absent from primary MH care research.

Objectives
To explore patients’ experiences, needs, and suggestions for improvement regarding primary MH care for people with MID.

Methods
Qualitative study among adults with MID who visited their GP with MH problems in the previous 12 months. Semi-structured interviews were conducted using a guide based on Person-Centred Primary Care Measures. Transcripts were analysed thematically.

Results
The 11 interviews that we conducted revealed four themes. The first theme, cumulative vulnerability, describes the vulnerability – instigated by the MID and reinforced by MH problems – experienced on a GP visit. The other themes (needs regarding the GP, needs regarding the network, self-determination) arise from this vulnerability.

Conclusion
People with both MID and MH problems are extra vulnerable in primary care but desire self-determination regarding their MH care trajectory. This requires investment in a good GP-patient relationship and the organisation of additional support to meet these patients’ needs, for which collaborative care with the patient, the patient’s network, and other (care) professionals is of utmost importance.

Keymessages

• People with mild intellectual disabilities (MID) feel more vulnerable visiting their GP with mental health (MH) problems than with somatic problems
• Patients with MH problems report additional needs and expectations regarding their care and support network
• GPs face challenges in coordinating care for patients with both MID and MH problems