In this study, the authors examined the impact of living in deprived areas on accessing community psychiatric services.
In people without learning disabilities, a strong association had been found between social deprivation and mental health problems. Area deprivation can be measured by looking at individuals and households in a certain area and their characteristics in terms of education, income, housing and access to health services.
People with learning disabilities are often low educated and few are in fulltime employment. When also taking into account their limited income and poor housing conditions it is not entirely surprising that a large number of people with learning disabilities live in deprived areas.
We also know from previous research that mental health problems are common in this population. However, previous research has not found a higher incidence of mental ill-health in people with learning disabilities living in deprived areas.
The authors put forward the assumption that the higher prevalence of people with learning disabilities in deprived areas is likely to affect that area’s need for psychiatric services due to their higher risk of developing mental health problems. So rather than claiming that area deprivation affects mental ill-health, they suggest that the presence of people with learning disabilities in a certain area would require more psychiatric services to ensure that they have equal access to mental health services.
So instead of comparing the proportion of people with learning disabilities and mental health problems living in deprived areas, this study first looked at how many people with learning disabilities access a community psychiatric service and then investigated whether the people accessing this service were more likely to be living in deprived areas.
Access to psychiatric services was measured using psychiatric records that had been kept over a one year period. The authors focused on a single community psychiatric service for people with learning disabilities in Scotland.
Information was collected about people who were currently receiving services or had received services in the past year. The authors then looked at the number of face-to-face contacts, either at the clinic or home visits.
To assess area deprivation, they used publicly available data to calculate the level of area deprivation for each patient according to their post code. Deprivation status was estimated using the Scottish Index of Multiple Deprivation, which ranks areas’ deprivation based on indicators such as education, income, employment, skills, training, health, housing, crime levels and access to the geographical area.
The authors identified 184 patients who had accessed the community learning disabilities psychiatric service, 179 of which they could calculate valid deprivation scores for and accounting for a total of 543 psychiatric contacts.
Looking at where these people lived, the authors found that a vast majority of these patients lived in areas that were more deprived than average. Using statistical analysis, the authors confirmed that patients with learning disabilities were more likely to live in deprived areas, and even in the ten and fifty per cent most deprived areas, than could be expected by comparison with the mainstream population.
Turning to the frequency of psychiatric contacts, half of participants had between 1 and 3 contacts with the learning disabilities psychiatrist. Although there was a slight positive association between the number of contacts and deprivation of the area the patient was living in this was not significant, despite 48% of these contacts being conducted with people living in the ten per cent most deprived areas and 88% being conducted with people living in the fifty per cent most deprived areas.
While the study did not directly compare people with learning disabilities to those without, these findings would suggest that people with learning disabilities who were in receipt of psychiatric services were more likely to be living in deprived areas than people without learning disabilities accessing such services
Strengths and limitations
The focus on a single catchment area, as used in this study, has both advantages and limitations. If multiple services were included in the study, this would have likely added confounding factors such as case load and efficacy of the learning disabilities team that could have influenced the average number of psychiatric contacts. By contrast, the single catchment area is unlikely to be representative for the entire of Scotland.
In this respect, the authors recognise that sampling took place in a catchment area that was biased towards the more deprived areas.
This may have had a considerable impact upon the findings of this study and their generalizability to both other psychiatric services and other geographical areas.
The decision to use number of psychiatric contacts may have certain advantages from a logistical point of view of data collection, but it may not reflect the true extent of accessing psychiatric services due to the multidisciplinary nature of the learning disabilities teams.
A median of 2 psychiatric contacts would indeed appear low for a population who often present with more complex mental health needs, as this would imply only having an initial meeting and a single psychiatric review meeting. This hardly reflects the true extent of psychiatric work being undertaken with people with learning disabilities by various members of the team: ranging from clinical psychologists and social workers to speech and language therapists.
The number of visits also does not reflect the duration of the contact as visits could have taken place within one month, for example for crisis interventions, or over multiple months.
While people with learning disabilities accessing psychiatric services are more likely to live in deprived than non-deprived areas, certain questions still need answers. It would be worth investigating whether these findings can be confirmed in a study with a sufficiently large sample size and across multiple psychiatric services and catchment areas to draw stronger conclusions.
In addition, future studies should further explore the association between area deprivation and mental ill-health in people with learning disabilities:
- Is area deprivation associated with severity of the mental health problem?
- Is area deprivation a perpetuating factor in identified mental health problems?
- Is psychiatric contact more associated with objective or perceived area deprivation?
- What are the protective factors associated with people with learning disabilities living in deprived areas who are not experiencing mental ill-health?
Nicholson, L. and Hotchin, H. (2015), The relationship between area deprivation and contact with community intellectual disability psychiatry. Journal of Intellectual Disability Research, 59: 487–492 [abstract]