People with learning disabilities experience poorer health than the general population. They are more likely to have chronic physical and mental health conditions than those without disabilities, and are less likely to access health prevention programmes such as cancer screening.
This coupled with low rates of physical activity and high rates of obesity (Rimmer et al, 2010) means that they are particularly vulnerable in terms of health care.
There is increasing recognition of the health inequalities experienced by people with learning disabilities but little has been achieved to tackle them.
Many barriers to healthcare experienced by people with learning disabilities underlie these disadvantages: Emerson (2011) describes intrinsic health vulnerabilities (biological and psychological), social determinants of poor health (including economic disadvantages), communication difficulties and poor health literacy and lifestyle risk factors as contributing to their health inequality.
People with learning disabilities primarily receive mainstream healthcare, however doctors receive little specific training in treating this population. Similarly, disability support staff receive little specific training in health care. Optimal care of this population requires inter-professional cooperation, for example across GPs, support staff and mental health services.
However, the attitudes, knowledge and skills in caring for people with learning disabilities of health care professionals are in some ways lacking, which results in gaps in both understanding and responsibility.
For example, people with learning disabilities may require more time for doctor’s appointments due to cognitive, physical or communication difficulties. Time pressures on medical professionals can result in only acute presenting symptoms being attended to and long-term health, preventative health and health promotion activities being ignored, ultimately resulting in poorer health outcomes for disabled individuals.
Medical staff acknowledge that there are gaps in their knowledge and skills in caring for this population and demonstrate willingness to combat these issues in order to maximise positive outcomes for individuals with disabilities.
Tracy and McDonald (2015) describe new initiatives in Australian medical education aimed at tackling health inequalities by promoting specific medical training in treating people with learning disabilities.
The WHO (2011) has identified training in working with individuals with disabilities for medical graduates as a priority.
However, in Australia there are no specific requirements for medical graduates to undergo such training. Medical graduates cannot deliver the high standard of care that the mainstream population would expect to individuals with learning disabilities because they are not appropriately prepared to do so.
Addressing the medical needs of individuals with learning disabilities as part of medical student training would benefit not only those with disabilities in terms of improving their care, health and functioning, but also medical students as it would widen their experience and provide them with skills and confidence in treating this population.
In 1991 an initiative led by the Victorian State Government, Monash University and the University of Melbourne established small academic Intellectual Disability units within two medical schools in Victoria, whose aims were to provide focus on research, clinical and educational activities designed to improve health outcomes for people with learning disabilities.
Working directly with individuals with learning disabilities was a key part of this initiative, and disabled individuals were involved in the teaching and training of health professionals. This encouraged respectful, positive attitudes towards disabled people and facilitated the development of confidence and comfort on the part of medical students who might otherwise encounter problems in working with individuals with cognitive and communication difficulties. Individuals with disabilities also benefited in that they developed skills such as self-advocacy and public speaking.
Disability training has wider applicable relevance for medical students; core competencies such as understanding the importance of multidisciplinary partnerships in health care and identifying strategies for effective communication with patients are applicable to other vulnerable patient groups and will be widely utilised.
Australian medical students have the option to go on to specialist training programs which have care of disabled people among their core competencies. Such initiatives raise the profile of this issue and highlight the responsibility of medical practitioners to address the health needs of individuals with disabilities.
Whilst this is an excellent step in the right direction, currently initiatives such as this rely on individual ‘champions’; Government policy and enabling systems and structures need to be in place to ensure that this issue is taken seriously and medical education changes in lasting and sustainable ways.
Summary and Comment
If health care is properly supported, individuals with learning disabilities can maintain optimal physical and mental health and wellbeing in order to take full advantage of opportunities for participation in their communities. However, individuals with disabilities experience barriers to adequate health care.
One strategy to overcome these barriers is to educate and train health professionals in working with this population, and to offer opportunities to develop additional knowledge and expertise for those wishing to specialise in this area of practice.
Good health care for people with learning disabilities is dependent on a three way framework including the individual, their support network and their healthcare professionals. Disruption at any point can damage access to optimal health care. In this way medical staff and care staff need to understand and respect each other’s roles. Support workers are likely to be the first to notice a change in a patient’s behaviour which could indicate illness and they must be educated to ensure they can play a crucial role in communicating health concerns to doctors.
Tracy and McDonald describe an example of good practice in the health care of individuals with learning disabilities; however it must be noted that this approach is framed in the context of benefits for medical students and how the approach can fit into an existing curriculum, as opposed to focusing on improving outcomes for people with learning disabilities.
This is especially relevant considering that the paper does not refer to ways in which the approach has specifically impacted outcomes for people with learning disabilities.
Furthermore, as both authors are affiliated with Monash University, which has implemented the approach, some level of bias can be assumed, causing us to approach the findings with some caution.
Finally, this approach is purely from an Australian perspective. A similar examination of other countries’ medical education programs would be beneficial and this will hopefully stimulate such a process.
Health and Disability: Partnerships in Health care (2015) Tracy, J. and McDonald, R. Journal of Applied Research in Intellectual Disabilities: 28 22-32 [abstract]
Emerson, E. (2011). Health status and health risks of the hidden majority of adults with intellectual disabilities. Intellectual and Developmental Disabilities: 49 155-165
Rimmer, J.H., Yamaki, K., Davis Lowry, B.M., Wong, E., Vogel, L.C. (2010). Obesity and obesity-related secondary conditions in adolescents with intellectual/developmental disabilities. Journal of Intellectual Disability Research: 54 (9) 787-794