Enhanced care needed for long-stay mental health patients with intellectual and developmental disabilities

Individuals with intellectual and developmental disabilities (IDD) account for more than one in five patients who have been in Ontario's mental health beds for over a year, according to a new study from researchers at ICES and the Centre for Addiction and Mental Health (CAMH).

The findings suggest that people with IDD have different support needs compared with patients without IDD as they are more likely to have moderate or severe cognitive impairment, difficulty caring for themselves, and few social supports, which may contribute to challenges transitioning out of hospital and into the community. Enhancing specialized supports both in hospital and in the community could reduce their length of stay and admission rates.

We know what is needed for successful transitions and we have published Ontario Practice Guidance on how to do this well. There are amazing champions out there working hard to support these transitions, but we urgently need to build capacity in the hospital, community and health and social services sectors to work together to achieve widespread change."

Avra Selick, lead author and scientist within the Azrieli Adult Neurodevelopmental Centre at CAMH

Key findings:

Avra Selick, lead author and scientist within the Azrieli Adult Neurodevelopmental Centre at CAMH

• Of the 1,466 patients in Ontario mental health beds for over a year on September 30, 2023, 322 were people with IDD.
• Compared with inpatients without IDD, a higher proportion of those with IDD were younger and had a psychotic disorder. Almost 40 per cent of these individuals were autistic.
• Patients with IDD were more likely to be physically restrained or experience seclusion in hospital, and only five per cent were in specialized units for people with IDD. The remainder were in other psychiatric units where providers were not trained to work with them.
• More than half of long-stay patients with IDD lacked social or familial connections to support their discharge from hospital.

The authors recommend increasing capacity and developing the expertise of providers within hospital settings to deliver appropriate care for patients with IDD. They also recommend enhancing outpatient mental health services, housing, and disability-related supports in the community. These strategies can prevent unnecessary hospitalizations, reduce length of stay and support successful transitions back into the community.

Resources on how to support transitions out of hospital for patients with IDD are available through the H-CARDD program led out of CAMH.

"Adults with IDD make up a substantial proportion of long-stay admissions in units that were not designed to meet their needs, with very few hospital staff trained to support this population," says Yona Lunsky, ICES scientist and Director of the Azrieli Centre at CAMH. "We need to invest in improving their care once they are in hospital while also addressing the challenges that lead to these lengthy hospitalizations in the first place."

The study "Long-stay psychiatric inpatients with and without intellectual and developmental disabilities: an Ontario population-based study" is in the September issue of The Canadian Journal of Psychiatry. 

ICES is an independent, not-for-profit research and analytics institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. ICES leads cutting-edge studies and analyses evaluating healthcare policy, delivery, and population outcomes. Our knowledge is highly regarded in Canada and abroad and is widely used by government, hospitals, planners, and practitioners to make decisions about healthcare delivery and to develop policy.