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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

Copyright © 2013 ICMPE.


 

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

Copyright 2013 ICMPE