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Illness poorly managed in those with learning disability

Lisa Hitchen

Friday, 14 March 2008

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A doctor is calling for better training in looking after people with learning disabilities whose illnesses are rarely picked up by health services.

In the BMJ today, Dr Afia Ali, a specialist registrar in psychiatry of intellectual disability, cites her own experiences as well as this week’s Joint Commission on Human Rights report on the appalling inadequacy of care for people with learning disabilities.

Diagnostic overshadowing is partly responsible, she says, where symptoms of physical or mental illness are attributed to the person’s learning disability and so not treated.

People with learning disabilities have a higher prevalence of mental illness than those with normal IQs but are less likely to be diagnosed. Similarly, physical conditions such as respiratory illness, epilepsy, cerebral palsy and diabetes are overlooked.

Dr Ali has one patient with autism, learning disabilities and no verbal skills that has been in pain for the last year, she told OnMedica. During this time he has dramatically lost weight and has a BMI of around 12.

"The family got very concerned and took him to the local hospital but what we found was the medics were reluctant to investigate him. They thought that his symptoms were behavioural. He was in hospital a week before they did a blood test," she said.

Dr Ali and the man's family had to fight for tests to be done and finally he had an endoscopy. The patient is now back in the community but is still losing weight and Dr Ali is finding it very hard to get a specialist to look at him.

To address this she suggests greater exposure to people with learning disabilities during health professionals' training.

"Medical schools and nursing schools have a responsibility to train and expose people at an earlier stage. This is what changes peoples' values and opinions and that has a bearing on how they deal with people in the future," she said.

Those working with people with learning disabilities now should watch for changes of behaviour, which can suggest physical or mental illness and should be investigated straight away, she says. And they should make sure they have done everything to improve capacity – such as clear and simple information, advocates and meetings with carers.

GPs could do a lot – ensuring people are referred to secondary care if they suspect someone has further needs. Annual GP health checks, as happen in New Zealand, have been recommended by the Disability Rights Commission as one way to tackle the issue.

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