#049: Mental Health is Health, with Dr. Yona Lunsky

[4-minute read, 48-minute listen]         

In this episode, I welcome Dr. Yona Lunsky on to the podcast to talk about developmental disability (DD) and Mental Health. Dr. Yona Lunsky is Director of the Azriei Centre for Adult Neurodevelopmental Disabilities and Mental Health, and Director of the Health Care Access Research and Developmental Disabilities (H-CARDD) Program at CAMH. She is Professor and Developmental Disabilities Lead in the Department of Psychiatry at the University of Toronto and Adjunct Scientist at the Institute for Clinical Evaluative Sciences (ICES). In this episode we discuss Dr. Lunsky’s journey into the field of mental health and developmental disability (DD), the state of mental health in the developmental disability community, how to notice mental health challenges, and the different treatment options available.  

Below is a summary of some of the highlights from my conversation with Dr. Yona Lunsky. If you find this read interesting you can listen to the conversation in its entirety by clicking play on the player below, or searching ‘Empowering Ability’ on your podcast player, such as, Apple Podcasts, Spotify, Google Play.

On the podcast, Yona shares that she has an older sister who has a DD, and she tells us about her family experience. She also shares what led her down her career path to support people with developmental disabilities experiencing mental health challenges. Take a listen to the podcast to hear more of Yona’s Journey.

Why should we be talking about health in the Developmental Disability (DD) community?

Paraphrasing from the podcast, Yona shares, “When we are healthy we get to enjoy our lives. When we are unhealthy it restricts us; work, where we can live, how much money it costs day-to-day [living expenses], and the activities we can do. We know people with DDs are less healthy, and have more health problems than people that don’t have DDs. There are lots of reasons why they [People with a DD] are less healthy. It isn’t necessarily the disability, the disability itself is not a sickness, but how they manage their health, and the barriers that come up for people with DDs can impact their health.”

Mental Health in the DD community.

Yona shares, “The likelihood of having a mental illness is much greater for a person with a DD than without. In the general population 1 in 5 people experience mental health challenges. Through H-CARDD we looked at the number of people under 65 [years of age] with a DD that were given a psychiatric diagnosis over a two year period, and found it was 2 in 5 people. These problems are more common for people with DD, and they are less likely to get the help that they need. People with a DD are less likely to understand their emotions, and [are less likely] to be able to put language to it. This puts them at a disadvantage.”

What Does Dual Diagnosis Mean?

Having a DD and also having a mental health problem at the same time.

Dual diagnosis resources from CAMH

Diagnostic Overshadowing:

Yona explains, “If someone with a DD presents with symptoms of depression, the clinician might but look at the person and say oh that is your disability, and miss that the depression is actually there, and it may go untreated.”

Why might mental health be a larger challenge for people with a DD?

Yona explains, “What makes us feel healthy? Are we engaged in meaningful activities?, Do we have strong friendships?, Are we included?, Do we have opportunities to contribute?. People with DD are at a disadvantage here and this all impacts mental health. If the person themself can’t recognize there is a problem, then it becomes up to others to recognize there is a problem and we are worse at recognizing there is a problem when someone has a DD. By the time we do notice, it can be pretty late in the game, and this makes it even more difficult to help them.”

I ask, so what are the antidotes to poor mental health?

Yona shares first there are things we can do to prevent mental health challenges:

  1. Things like bullying are clearly related to mental health, and we can give people skills so they know what to do in these situations. [In an email Yona also adds, we need to build communities that don’t allow bullying]
  2. Building positive social relationships. These are reciprocal relationships and they are not stressful or demanding too much of you.  
  3. Doing things that are meaningful and important for you.

Yona explains the importance of taking action on these prevention steps for young adults with a DD, “There are many people who have mental health issues who are hospitalized in young adulthood. I don’t think this is a coincidence that this happens since when you finish school your activities, your friends and the people who know you really change. Not having anything to do during the day, and watching tv in the basement, losing friends, failing because there isn’t the right supports, all of this impacts your mental health.”

How do we help someone that might be experiencing a mental health challenge?

Yona shares, “Be a detective and notice what has changed. What is different now than before and be able to provide examples in daily life. It is important to notice the change, and it is easier to treat when there is a small mental health issue emerging.”

Yona promotes using the ‘HELP’ model when examining an individual’s mental health.

Yona explains the model on the podcast:

H – Health. First we need to look at what is going on in terms of health that could have changed. Is there a physical change? One thing that looks like depression is hypothyroidism, but this has nothing to do with depression. Constipation is one of the biggest issues leading to aggravation and discomfort for people with DD. And, this is often missed because the person might not be able to put the language to it.

E – Environment. What is going on in the environment? What are the supports and expectations right now? Are things stressful? Too demanding?  Are people expecting too little? Is there a good match between her situation, and what she feels she is able to do? If the match is poor than address it.

L – Life Events. What has happened in the past that might be contributing to this issue? Bullying, ostracized, loss (experiencing grief), etc..

P – Psychiatric. Once health, environment, and life events are examined – could it be depression or anxiety? Treatment for these mental illnesses could include engaging in activity, seeing a counselor, medication, etc.

Here is a video explaining the HELP model.

Families can use this model in order before going to get help from a medical provider, and families can use this model with their mental health professional.

Treatment with Medication:

Paraphrasing from the podcast Yona shares:

“The research shows that the likelihood of being prescribed several medications at the same time is not small [for people with a DD]. These medications interact with each other, and cause other problems. These medications can help, but they can also harm.

In Ontario Canada, medications are paid for (antidepressants, etc) under the disability program. But, other services such as psychotherapy are not covered. The likelihood of filling prescriptions are high, and the most commonly prescribed drug to people with DD are not for cholesterol, diabetes, or asthma, they are for psychiatric issues. The most commonly prescribed drug are antipsychotics. These are pretty heavy duty drugs which require a lot of monitoring.

If doctor prescribed medication to me, I would go on the computer and look at it, get a print out from the pharmacy, I would look at the side effects, and tell the doctor right away if I was noticing any of them. [However,] people with DD aren’t always able to notice the side effects, or to understand why they are taking the medication.”

** Disclaimer on Medications: Do not just stop taking any medication that your doctor may have prescribed to you. Let this be a prompt to you to have a conversation with your doctor about your experience using your medication(s).

Additional reading on, “Stopping over medication of people with a learning disability, autism or both (STOMP)

Let’s Talk About Mental Health

Yona’s final message is, “It is important to talk about it [mental health]. If we don’t talk about it we don’t solve anything by avoiding the problems. Mental health is just as important as any physical aspect of our health.”

On the podcast we discuss some practical ways on how to start the conversation on mental health. Take a listen!

*You can listen to the podcast by clicking below.*

If you received value from reading this blog or listening to this podcast episode, consider sharing it with someone else you feel would benefit. Coming soon there will be a way for you, or your organization, to contribute to this work. Stay tuned for the details.

Love & Respect,

Eric Goll

Resources:

– Talk to Dr. Yona Lunsky on Twitter @yonalunsky

– Books beyond words

– H-CARDD Health Tools for people with disabilities and caregivers

– More on The HELP model

– Dual diagnosis resources from CAMH

– A Family guide to dual diagnosis 

– Video of Dr. Yona Lunsky discussing the HELP ideas

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