Understanding mental health comorbidity, treatment and service use in adults with intellectual impairment

Adult Psychiatric Morbidity Survey (APMS 2014) is a key dataset as it is the only source to combine data on intellectual impairment and mental illness and treatment use in a probability sample of the whole adult population. The initial APMS 2014 report included one table showing that predicted verbal IQ is strongly linked with mental illness, with people with learning impairment being twice as likely as those with high verbal IQ to have an anxiety disorder or depression (25% compared with 13%). The disparity was even more pronounced for rates of probable psychotic disorder. This analysis is powerful because the experiences of those with intellectual impairment are compared with the rest of the population. The dataset can be used to classify the population in a categorical way (cases and non-cases) as well as in a dimensional way (looking at the population as a spectrum).

The Department of Health would now like further analysis of APMS data to describe the circumstances of people with learning impairment and the wider inequalities they face (such as whether or not are more likely to have particular physical health conditions or unmet needs for treatment and services) compared with others.

The analysis would involve data management to derive analysis variables and the production of descriptive tables. These will be written up as a simple report for DH, with data presented in aggregate form only (min cell size 30 cases).

For the assessment of intellectual impairment – Natcen intend to use the National Adult Reading Test (NART) as the primary measure. The NART generates a reliable prediction of verbal IQ, identifying people with likely borderline intelligence of a level that would require assistance and support to manage everyday functioning. The dimensional nature of the measure means that both a sufficient number of people with greatest need can be identified and that comparisons can be made with other across the population.

For the measure of self-reported learning disability – in the most recent APMS a new module of questions was added. All participants were asked ‘Do you have a difficulty learning or an intellectual disability?’ Those responding positively were followed up with questions about whether the condition has a name, what the condition is, how severe the difficulty is, and how often it limits the amount or kind of activities that they can do. This information was not included in the main survey report, and analysis of it could form part of this study, providing an additional and alternative indication of learning impairment.

The 2014 APMS dataset is held on behalf of NHS Digital by the UK Data Service (UKDS) (www.ukdataservice.ac.uk ) and UKDS are responsible for dissemination under direction by NHS Digital. The customer will get the whole dataset; there is no facility to select individual variables. They will be able to download the dataset from UKDS for the period specific within the DSA and they must securely destroy all local copies of the dataset when the DSA expires and notify DARS in line with standard procedures.

This 2014 version of the dataset available via DARS has been redacted on Disclosure Control Procedure advice to minimise the likelihood of individuals being able to identify anyone taking part in the survey.

All organisations party to this agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data).

No data will be shared with 3rd parties.

The data will only be used for the purposes described in this agreement.

The data will not be linked to any other dataset.

The planned output is a short descriptive report to the Department of Health. The report will only include figures based on aggregated data, and figures will not be presented where the base size for the cell is less than 30. The aim of the report would be to document the inequalities and life circumstances of people with a learning impairment compared with the rest of the population. It will be designed to provide an evidence base to inform the design and targeting of interventions and services. Because APMS is the primary source of data to provide current information on psychiatric morbidity and treatment and service use among people with intellectual impairment across the ability spectrum, the output will address an evidence gap. And because the dataset covers both people with and without impairment, it enables comparisons to be made and inequalities to be documented.

All outputs will be aggregated with small numbers suppressed in line with the HES Analysis Guide

Adults with a learning impairment, especially those whose learning impairment may not be severe enough to qualify them for additional public support, may be a particularly vulnerable group facing pronounced adversities and yet remaining largely invisible in much research and monitoring. This report aims to highlight the circumstances they face, and whether or not they access treatment and services to the extent that their needs warrant. Where it highlights that needs are not being met, this information will be key to informing decisions about resource allocation and the design and targeting of interventions and services. The report will address a major gap in the current evidence base, and provide much needed insight into circumstances. This information will be useful both to third sector organisations lobbying for change, and to government policy development officials designing programmes of support.

Yielded Benefits is not a requirement for new applications.