I am a Consultant Psychiatrist and SMO, as well as Acting Clinical Director, for National Intellectual Disability Services, which sits under MHAIDS.
The Intellectual Disability (ID) Service provides specialist mental health care for people with an intellectual disability, some of whom will have come into contact with the criminal justice system. It features secure inpatient services - the national adolescents’ unit, national individualised service units (pictured) and regional service, for individuals who have been placed there by court order - and an outpatient service.
My time is divided between the mahi I do in my Acting Clinical Director role, and my ongoing clinical work. I meet clients, their families, and the communities that support them, and collaborate with colleagues to learn why people have come into - and how we can support them to safely transition out of - our services.
I might be providing advice to a GP about a complex client, introducing training for support workers, spending time with clients on campus or in the community, or attending meetings. Interactions with clients are the best parts of my day!
I've always wanted to work in this sector and aspired to be in a leadership role in the psychiatry of intellectual disability, where I can improve care and advocacy for the most vulnerable and stigmatised in our community.
What is your focus for the next few months?
The team here is an incredibly valuable resource – they are very committed and passionate about the work that they do. I see lots of opportunities for training, both within ID and more widely across MHAIDS.
Mental illness is more common among people with an ID than the rest of the population, and yet there is minimal training available in this specialty. Many kaimahi have no specific training in mental health assessment specific to ID, so it was very exciting this year to be able to establish the first wave of training for our team in Moss-PAS (a mental health assessment tool specifically for people with an ID).
The training helps trainees apply international diagnostic criteria for mental illness when interviewing people whose intellectual function limits their ability to express - or even recognise - their emotional state. Many standard interview questions simply do not make sense to someone with an ID.
It teaches accessible language to help clinicians make direct enquiry and explore the behavioural correlates of mental illness with our clients and their carers, to arrive at a robust mental health diagnosis.
We're hoping this will be an annual training opportunity, and that we can reach outside our little domain into general adult psychiatry to share that expertise and training.
Manawai is making a real difference to the people for whom this service was designed. This is a place for people who are experiencing the most restrictive care in the country, and it gives them an environment in which we can reduce that restriction and start exploring opportunities for their future.
Being able to have a kitchen, a living room, a bedroom and free access to your private toilet has made a huge difference. Those individuals started taking care of their environment, and it was so nice to review the progress, from having apparently no self-help skills to cooking twice a week, making their own hot drinks, and having free access to water and snacks.
What’s your vision for intellectual disability services in Aotearoa?
New Zealand was one of the forerunners worldwide in providing specialised forensic services for people with ID. While this work is really important, what I'd really like to see is more provision of community mental health for people with ID.
Even within the sector, it's tough to get the right treatment or support for people with an ID. We're constantly battling ‘therapeutic disdain’, which stems from a broadly held misconception that people with ID are somehow different. Often people attribute everything to the fact that someone's got an ID - and forget that behaviour is just a way to communicate symptoms of illness and need.
We are using training to try and break down some of that. I had the opportunity to teach the registrar group this year and it was great to see their interest and to be able to share resources, tools and strategies with them.
The future is being able to provide mental health input for people before they make contact with the criminal justice system - before they become inpatients here.
