Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 16, Issue 3, 2013. Pages: 131-141
Published Online: 1 September 2013

PERSPECTIVES
The Mental Health Care Gap in Intellectual Disabilities in Spain: Impact Analysis and Knowledge-to-Action Plan

Luis Salvador-Carulla,¹ Rafael Martinez-Leal,² Miriam Poole,³ Jose A. Salinas-Perez,⁴ Javier Tamarit,⁵ Jose Garcia-Ibañez,² José Almenara-Barrios⁶ and Javier Alvarez-Galvez⁴

¹Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
²UNIVIDD. Intellectual Disability & Developmental Disorders Research Unit, Fundació Villablanca, IISPV, Universitat Rovira I Virgili, Reus, Spain
³Asociación Científica PSICOST, Jerez de la Frontera, Spain
⁴Department of Health and Social Policy, Faculty of Social Sciences, Universidad Loyola Andalucía, Seville, Spain
⁵FEAPS (Confederacion Española de Organizaciones en favor de las Personas con Discapacidad Intelectual), Madrid, Spain
⁶Facultad de Enfermería y Fisioterapia, Universidad de Cádiz, Cadiz, Spain

* Correspondence to: Prof. Luis Salvador-Carulla, MD, PhD, Centre for disability Research and Policy Faculty of Health Sciences, University of Sydney , 75 East St Lidcombe, NSW 2141, Australia.
Tel.: +61-2-9351 9231
Fax: +61-2-9351 9566
E-mail: luis.salvador-carulla@sydney.edu.au

Source of Funding: None declared.

Abstract

Intellectual developmental disorder or Intellectual disability (ID) is a prevalent condition with a high impact along the life-span particularly when associated to other mental disorders (MD). This study is aimed to estimate the unmet needs and to design a knowledge-to-action plan to reduce the care gap in ID-MD in Spain. We followed a 5-step ‘maxi’ impact assessment and a mixed qualitative/quantitative design including expert panels, secondary analysis of databases and a prospective survey in the 17 regions in Spain. Schizophrenia was used as comparator due to similar prevalence rates and burden. This study quantifies the ID-MD care gap in Spain and the basic specialized services needed. In spite of the societal and health implications of ID-MD the knowledge-to-action plan had a modest impact limited at the regions where ID-MD programmes were already implemented.

Background: Intellectual developmental disorder or Intellectual disability (ID) is a prevalent condition with a high impact along the life-span particularly when associated to other mental disorders (MD).

Specific Aim: To estimate the unmet needs and to design a knowledge to action plan to reduce the care gap in ID-MD in Spain.

Method: We followed a 5-step `maxi' impact assessment and a mixed qualitative/quantitative design including expert panels, secondary analysis of databases and a prospective survey in the 17 regions in Spain. Schizophrenia was used as comparator due to similar prevalence rates and burden.

Results: Persons with ID-MD had ten times less outpatient contacts and hospital admissions than patients with schizophrenia. The outpatient case load was 2.31% in ID and 14.6% in schizophrenia. ID had the lowest hospitalization rate amongst all mental disorders but the highest length of stay. The expert panel estimated that half of persons with ID-MD are not adequately assessed and 95% do not receive the required care in Spain. Basic care needs include 6.5 beds and an ID-MD outpatient service per 1 million population. At least 134 specialized psychiatrists and psychologists and 277 beds are needed to reach the minimum standards in Spain.

Conclusion: This study quantifies the ID-MD care gap in Spain and the basic specialized services needed. In spite of the societal and health implications of ID-MD the knowledge-to-action plan had a modest impact limited at the regions where ID-MD programmes were already implemented.

Implications for Health Policy: Specific priority setting on ID-MH should be incorporated to mental health strategy at the Ministry of Health within a broader health and ID plan. National and regional policies should incorporate an integrative care approach through the life cycle. The development of excellence centers on ID-MD and a national observatory on this topic should be encouraged.

Received 26 October 2012; accepted 28 June 2013