Mental Health in People With Intellectual Disabilities

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People with intellectual disabilities are at higher risk for various health problems. In general, they tend to be engaged in less physical activity. In Canada and the U.S. alike, people with intellectual disabilities have poorer physical and mental health. These individuals are also likely to use more health care services than those without intellectual disabilities (Lin et al., 2019; Ervin et al., 2014).

Special Olympics, a not-for-profit organization offering athletic programs for people with intellectual disabilities, has been working hard to break down barriers and provide individuals with intellectual disabilities athletic opportunities. Not only do the athletes engage in physical activity in this organization, but it is also a space for them to connect with each other and build a community.

Special Olympics has evolved over the years, developing the Healthy Athletes program in 1997 that includes health support tailored for individuals with intellectual disabilities, such as vision and hearing checks. A recent addition to the Olympic events has been the Strong Minds program, which offers an incredible opportunity to teach these athletes (and their coaches/parents/workers) hands-on mental health strategies.

Mental health has been a topic of slow evolution and continues to be stigmatized in the general population, and particularly in individuals with intellectual disabilities. Researchers have found that even staff working in emergency departments at hospitals tend to have a poor understanding of mental health in individuals with intellectual disabilities. These individuals are often ignored when attempting to express themselves and they tend to report feeling dismissed or disrespected by health care staff (Spassiani et al., 2017). Yet, research has shown that at least 40% of people with intellectual disabilities living in the community experience comorbid psychiatric disorders (Cooper et al., 2015).

In my recent involvement with the Strong Minds program in Grand Falls, Newfoundland, the athletes were excited to learn about the mental health strategies, though they had the tendency to talk about “happy” and avoiding any notion of “stress” despite the nature of stress coming into play in sports. Moreover, these individuals denied ever feeling stressed, noting just “happy” feelings. Indeed, Special Olympics research has found that the majority of these athletes use avoidance strategies (e.g., watching TV) to cope with any negative feelings that may arise.

The question thus becomes: How do we help normalize the different feelings individuals with intellectual disabilities have and break down the mental health stigma? Because as strong as the Strong Minds program is, it is unlikely to have a lasting impact if there is limited to no insight or discussion of the range of emotions these individuals have.

While work needs to be done in educating clinicians in emergency settings where individuals with intellectual disabilities turn to for support, mental health education in people with intellectual disabilities also needs to be the focus for people that are closest to them: parents, coaches, friends, and coworkers.

Practically speaking, in addition to emphasizing further education about mental health and intellectual disabilities, here are a few ways we can do better in optimizing the mental health of people with intellectual disabilities:

1. Explore the different emotions and building of awareness in people with intellectual disabilities without judgment and with acceptance and patience. For example, one may explain that there is no such thing as “good” or “bad” emotions and that we all show emotions differently. Visual supports, such as zones of regulation may be helpful in this exploration.
2. Exploring where our emotions sit in our bodies may also help build awareness and understanding of how our emotions and body connect. Visual explorations along with practice (e.g., body scans) may be helpful. Once awareness is built, progressive body relaxation exercises may be done to strengthen the ability to control the body and emotions.
3. Finally building connections to how powerful thoughts are in our emotions is an important way to build awareness and ways to cope with stressful emotions. Visual aids are important in supporting understanding for people with intellectual disabilities. One such way would be to explore thoughts through a mind jar, which provides an opportunity to explore different thoughts and feelings visually through hands on engagement. Another way is to provide an opportunity to identify some powerful/helpful thoughts and positive affirmations that these individuals can use during stressful times.

While it is important to acknowledge how far we have come in understanding the health needs of people with intellectual disabilities, there is work to be done. By practicing mental health promotion in everyday life through strategies that have been found to be helpful for people with intellectual disabilities (i.e., identification and exploration of different emotions, how to cope with stressful emotions), we can take steps to strengthen their resilience and their own self-regulation.