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This chapter summarizes how structured clinical management (SCM) has been adapted as an intervention for people with intellectual disabilities (ID). There is no current guidance or qualitative or quantitative reports in the literature about SCM for people with ID. This chapter combines definitional, philosophical, structural, political, cultural, and practical/clinical elements that can inform thinking about SCM in ID and provides a framework for adapting the available materials and piloting them with ID service users. The chapter is structured in two main parts: the first lays out these contextual elements, the second gives some examples of the adaptations made to the SCM workbooks to make them more accessible and acceptable to an ID population.

Children and adults with intellectual disabilities have poorer health and are more likely to die sooner than their non–intellectually disabled peers. There is growing evidence that some of these inequalities in health are avoidable, unjust, and unfair, given that they are driven by the higher rates of exposure of people with intellectual disabilities to well-established social determinants of poor health. People with intellectual disabilities are more likely than their peers to: live in poverty, not be employed (or if employed to work under precarious conditions), be exposed to discrimination and violence, face significant barriers in accessing effective health care, and be less resilient when exposed to adversities. In other words, they are examples of health inequities that arise from “the societal conditions in which people are born, grow, live, work and age, referred to as social determinants of health. These include early years’ experiences, education, economic status, employment and decent work, housing and environment, and effective systems of preventing and treating ill health” (World Health Organization). Future research needs to address three key issues. First, most of the existing evidence is based on the experiences of people with intellectual disabilities in the world’s high-income countries. In contrast, the vast majority of the world’s population live in middle- and low-income countries. The limited evidence available suggests that children with intellectual disabilities growing up in middle- and low-income countries are much more likely than their peers to be growing up in poverty and to be exposed to specific social determinants of poorer health associated with poverty such as undernutrition, poor sanitation, low levels of parental stimulation, violent parental discipline, and hazardous forms of child labor. Second, little research has focused on health inequalities and inequities among two important groups of people with intellectual disabilities: people with intellectual disabilities from minority ethnic communities and people with mild intellectual disabilities. Third, very little research has attempted to test the proposition that people with intellectual disabilities may be more or less resilient than their peers when exposed to social determinants of health. While much remains to be learned about the inequalities and inequities faced by people with intellectual disabilities, the existing knowledge is sufficient to guide and drive changes in policy and practice that could reduce the health inequities faced by people with intellectual disabilities. These include: improving the visibility of people with intellectual disabilities in local, national, and international health surveillance systems; making “reasonable accommodations” to the operation of health care systems (e.g., introducing annual health checks into primary care services, making “easy read” materials available, employing intellectual disabilities liaison nurses in acute hospitals) to ensure that people with intellectual disabilities are not exposed to systemic discrimination; and ensuring that people with intellectual disabilities (along with all other people with disabilities) are included in and benefit equally from local and national strategies to reduce population levels of exposure to well-established social determinants of poor health.

Despite the progress that has been made regarding their rights, people with intellectual disabilities still experience many difficulties with regard to social inclusion. This chapter analyzes the main challenges currently facing social pedagogy as both a discipline and a practice that must contribute to strengthening social inclusion processes for young people with intellectual disabilities. Based on different international research projects that have collected the views of young people with intellectual disabilities regarding difficulties and barriers they encounter in relation to their inclusion in education, work, the community, and in building their life pathways (emancipation and living with a partner), this chapter reflects on the role of social organizations, professionals, and the university with regard to working toward the inclusion of these young people and the implications this has for social pedagogy.

People with intellectual disabilities have a shorter life expectancy and an increased mortality rate across all ages compared to the general population. The main contributors to the health inequalities experienced by people with intellectual disabilities include: \ud (1) Social determinants such as poverty and unemployment; \ud (2) Health problems related to intellectual disabilities (such as congenital abnormalities related to people with moderate to profound intellectual disabilities); \ud (3) Limited communication and health literacy skills, which may reduce their capacity to understand and convey health needs effectively to others; \ud (4) Personal health risks related to diet and sedentary lifestyle; and \ud (5) Organisational barriers to accessing mainstream health care

Psychotropic medications are widely prescribed for people with an intellectual disability (ID) both for the management of mental illnesses and behaviours that challenge. It is generally agreed that people with ID are as likely or more likely as the general population to develop mental illnesses and therefore this has to be treated actively. However the appropriateness and extent of prescribing medication to manage behavior that challenges is a matter of debate and legitimate concern. This chapter summarizes the evidence in this field and sets out a practice framework to minimize the risk of inappropriate prescribing practice.

In the UK, it has been suggested that as many as 7% of prisoners have an intelligence quotient (IQ) of less than 70, and a further 25% have an IQ of 70 to 79. The ‘Transforming Care’ programme of work (England) has highlighted that a number of people with intellectual disabilities are within inpatient beds in a range of settings who might be better placed elsewhere. Nurses for people with intellectual disabilities have a key role when working in forensic services, along with their colleagues who work either directly in prisons or as ‘in-reach practitioners’. Nurses can provide focused risk assessment management strategies in order to inform person-centred care and treatment approaches. They will need to understand the complexities of the forensic population of people with intellectual disabilities, the rights, and aspects of mental health legislation, along with the enormous number of agencies involved. This chapter supports this complex arena of practice with a detailed examination of the issues that nurses for people with intellectual disabilities will need to know.

This chapter addresses the spirituality of people with intellectual disabilities with particular focus on those factors that are often critical to understanding their situations and perspectives when ethical topics or dilemmas arise in their mental health care. Basic information on disability and spirituality is provided. Principlism and ethics of care are discussed because these ethical theories are especially suited to enlighten ethical thinking and decision making regarding those with disabilities. Common ways in which spirituality plays out in the lives of people with disabilities are considered. Throughout the chapter, the importance of family and other caregivers is highlighted. Suggestions for mental health providers are offered, and references for additional reading and study are provided.

The Special Olympics organization has humble beginnings—it started in the backyard of Eunice Kennedy Shriver, an American philanthropist, and member of the Kennedy family. The first games were held in 1968, and the Special Olympics has developed to convey a political message of the importance of including people with intellectual disabilities in sports and as members of the larger society. The Special Olympics is a program with more than one million participants and half a million volunteers. Although the Special Olympics is not quite at the scale of the Olympics in terms of international participation, sponsorship, and audience, the games still mimic the spirit of competition and inclusion through sports. The games continue to serve athletes, families, and the community by challenging (often erroneous) conceptions about people with intellectual disabilities. The games provide social interaction and the opportunity for achievement, both on and off the playing field for disabled people. Worldwide, individuals with intellectual disabilities are serious in their endeavor to be physically active. The Special Olympics organization has also been endorsed by local communities in the US territories of American Sāmoa, Guam, and Puerto Rico. Addressing inclusion through sports in the US territories can shed a light on the complicated uneven political relations that the territories or colonies have with the United States—specifically, the unfulfilled promise of inclusion by the United States for the territories when thinking about statehood, citizenship, and representation under the Constitution. The Special Olympics purports a project centered around inclusion and belonging for disabled people within the territories that is often on the periphery of US foreign relations. Disability is a critical category of analysis that can lead to an understanding of how the three aforementioned territories are examples of mapping, control, and subjugation of the human body and mind as core features of colonial conquest. The Special Olympics organization exposes the presence and significance of disability within colonialism—in particular, “how disability remains present in the establishment, maintenance, and continuation of colonial structures of power”—as these territories are often occupied and governed by US jurisprudence, but their citizens do not garner the same rights as US citizens on the “mainland.” The Special Olympics, with its goal of inclusion, is commonly seen as a national project that aims to better the lives of disabled people. Unfortunately, these efforts of inclusion are somewhat limited in scope, especially with regards to the politics of governance, voting rights, and gaining independence in the broader US legislative processes. Based solely on place of residence, people who live in the territories are denied voting representation in the House of Congress, even though Congress possesses plenary authority over local territorial matters. Thus, coupling the spirit of inclusion through sports with the social and political challenges in the territories, may reinforce colonial approaches to inclusion. Here, thinking about citizenship mirrors the difficult situation of those living in the territories—and fuels what some would consider paternalist forms of governance of the territories, a theme that reflects the power relations of the United States with its territories. The complicated relations between the unincorporated territories as military posts for the United States is a pressing issue, as people in these communities continue to fight for sovereignty and demilitarization from the United States. The constant struggle for decolonization is ongoing. In terms of governance, much of the territories are ruled from afar, a point that feeds into paternalist politics of inclusion and condescending policies imposed on territories without their input. For example, this point is further implemented under the Article 4, Section 3, of the US Constitution, known as the “territorial clause,” which gives Congress broad authority to govern US territories. Puerto Rico is the most populous US territory. Others include American Sāmoa, Guam, the Northern Mariana Islands, and the Virgin Islands. They are granted various measures of self-rule but lack their own sovereignty. Given such inconsistencies in political relations, the question then becomes, what does inclusion through sports convey within colonial and occupied territories with longstanding, fraught political relations to the United States?

All people have a right to equal healthcare without discrimination on the basis of disabilities. In practice, however, health inequalities still remain. Ideally we would define future public health having sufficient attention to minority groups and their specific needs. One of these groups is people with intellectual disabilities (ID), defined by severe limitations in adaptive and functional behaviour. As a result of these limitations, people with ID suffer from worse health, higher hospitalisation rates and higher premature mortality compared to people without ID. In reducing these health inequalities acquiring accurate information on disease epidemiology in people with ID compared to those without ID is crucial. However, this crucial information is still lacking. This workshop will dive into disease epidemiology in people with ID by highlighting different aspects of health and the difficulties that arise when researching people with ID. First, It has been proven difficult to identify ID in existing data sources. ID-diagnoses in medical records are not too reliable, physicians do not always recognise IDs, or people are embarrassed of their ID-diagnosis. By gaining information on received services or supports specifically for people with ID a more complete representation of the ID-population is gained. Second, prevalence rates on chronic diseases in people with ID are often inconsistent across the literature, probably due to different age and sex patterns of chronic diseases and chronic comorbidities compared to people without ID, but these patterns are often not taken into account. By reporting on chronic disease prevalence and comorbidity patterns in people with versus without ID, a novel insight is gained in comparative epidemiology of chronic diseases of people with and without ID. Third, although it is known that people with mild ID suffer more mental health disorders dan people with no ID, exact prevalence rates and data on the care provided to these people in mental health services is missing. A retrospect database study performed in Dutch mental health care gives insight in this knowledge gap, not only for those people whom are recorded with their mild ID in these mental health services, but also for those people who were not recorded as such. Fourth, the current pandemic of a novel infectious disease stresses the strong need for accurate knowledge of disease epidemiology, particularly concerning high-risk groups such as people with ID. A large-scale registration of COVID-19 in people with ID living in residential settings was developed in the Netherlands, to provide necessary insight in the medical impact of COVID-19 among people with ID and inform policy makers and care providers on specific risks and consequences of COVID-19 in the ID population as compared with the general population. Key messages Insight in disease epidemiology and disease care in people with intellectual disabilities compared to people without intellectual disabilities is crucial in reducing health inequalities.Although it is difficult to identify all people with intellectual disabilities in data sources, using multiple methods and data sources results in a more complete overview of this group of people.

In high-income countries, about 5/1000 adults have intellectual disabilities. Population prevalence of intellectual disabilities is higher in children/young persons than adults, and prevalence decreases in older age groups to about 2/1000 over the age of 65. Intellectual disabilities are more common in boys/men, and in low-income countries; prevalence varies with geography and over time. Mental ill health is more common in people with intellectual disabilities than in the general population, with a point prevalence of 41% in adults and 36% in children/young people. Physical health problems and disabilities are common, and multi-morbidity and polypharmacy typical in people with intellectual disabilities; hence, clinical assessment and management are complex. The lifespan of people with intellectual disabilities is currently about 20 years less than that of other people, and more than 37% of their deaths are preventable deaths amenable to high-quality health care. Improving health care for people with intellectual disabilities needs to become a priority for clinicians, service commissioners, and policymakers.

Historically, many people with intellectual disabilities were considered unable to take part in psychological therapies. This view has changed considerably, and there has been an increasing focus on the development of psychological therapies for people with intellectual disabilities, including methods to help improve the accessibility of treatment. Within this chapter, cognitive-behavioural therapy, mindfulness, dialectical behaviour therapy, behavioural therapy, and psychodynamic therapy are reviewed. There is emerging evidence to indicate that a range of psychological therapies are effective with people who have intellectual disabilities, but a lack of large scale and well-designed clinical trials investigating a range of psychological interventions remains problematic.