What is dual diagnosis? 

People with learning disabilities are at greater risk of mental ill health than the general population. When a person has mental health issues as well as a learning disability, this is called a dual diagnosis.

It is important to understand that mental health problems are commonly overlooked in people with learning disabilities or autistic spectrum disorder (ASD).

This is because they may develop and present in different ways from people without learning disabilities or ASD. The usual signs or symptoms may not be observable or reported. People with learning disabilities and ASD can develop mental health problems for the same reasons as people without learning disabilities, for example, because of financial worries, bereavement or relationship difficulties.

Click to see why people with learning disabilities and ASD are at greater risk of mental ill health…

1. Biology and genetics may increase vulnerability to mental health problems.
   
2. Some symptoms are attributed to the person’s learning disability, rather than the true problem.
   
3. Assessments to detect mental health problems in people with a learning disability are not always well developed as mainstream assessments so symptoms can go unrecognised and untreated.
   
4. There is a gap between mental health services and learning disability services and often they do not join together to provide support so treatment often comes late.
   
5. Stigma and discrimination in relation to people with ASD and learning disabilities.
   
6. People with ASD and learning disabilities may not be able to recognise and or communicate their symptoms.
   
7. People with ASD and learning disabilities may have access to fewer resources and coping skills.
   
8. People with ASD and learning disabilities have a higher incidence of negative life events.
   

During the assessment special attention should be given to include…

• Speaking to the person directly, rather than talking about or over them.
• Using clear, straightforward and unambiguous language. Communicating at a pace that is comfortable for the person and arranging longer or additional meetings or treatment sessions if needed. Regularly checking the person’s understanding.
• Assessing whether communication aids, an advocate or someone familiar with the person’s communication methods are needed. Using concrete examples, visual imagery, practical demonstrations and role play to explain concepts. Using different methods and formats for communication (written, signing, visual, verbal, or a combination of these), depending on the person’s preferences.
• Making adjustments to accommodate sensory impairments (including sight and hearing impairments).
• Explaining the content and purpose of every meeting or session.
• Checking that the person has communicated what they wanted.
• Allowing enough time for the individual to make an informed choice if they have decision-making capacity. If they do not have capacity, then providing enough time for the people advocating for them to contribute fully.

When supporting people with learning disabilities and ASD, the possibility of a mental health problem should be considered if the person shows any changes in their behaviour.

Referrals to the appropriate professionals should be made. 

Everyone with a dual diagnosis should have a person-centred care and support plan, which they have been involved in creating. Individuals should receive information about their care and support in a format that they can understand. They should receive appropriate support to help them communicate, in line with the  Accessible Information Standard (AIS).

You may find our Accessible Information Standard (AIS) course useful.

In this course we explain what the AIS is, why we need to know about it, who it applies to and how to apply it.