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Borderline intellectual impairment: raising awareness of a hidden population with needs

Posted on 26 November 2018 by Sally McManus, NatCen Associate .

By Angela Hassiotis, UCL and Sally McManus, NatCen

Earlier this month a major review about people with learning disabilities was published. It found that most research with this group focused on children, often including only those with a diagnosis. This matters when the identification rate for learning disabilities is low. New analysis - published today – highlights the pronounced inequalities faced by adults with mostly unrecognised learning or intellectual impairments.

England’s main national mental health survey included an assessment of intellectual functioning. The survey data allow us to estimate participants’ verbal IQ and group together those who, while able to take part in a long general survey, scored below 80. These are people who might be described as having ‘borderline intellectual impairment’, and their circumstances are described in a new report for the Department of Health and Social Care.

About one person in ten may have borderline intellectual impairment. The data reveal that these people often face pronounced disadvantages in life compared to the rest of the population.  They have higher rates of anxiety disorders and depression, and are twice as likely to have severe mental illnesses such as psychosis or bipolar disorder. They experience higher rates of post-traumatic stress disorder, problem gambling, eating disorder, attention-deficit hyperactivity disorder (ADHD) and drug dependence, and they are more likely to have attempted suicide. They also face physical multi-morbidity: with poorer general health, more chronic health conditions and higher rates of limiting sensory impairments (especially sight loss) at the same age as the rest of the population. 

Our analyses show how this group faces challenges when doing many of the things that people need to do each day to get by. We asked about fundamental self-care tasks (such as washing, dressing, toileting and mobility), as well as about the sorts of tasks that enable people to live independently (like being able to clean the home, manage money, prepare meals, shop and take prescribed medicines). People with intellectual impairment were more likely than the rest of the population to say that they need help with every one of these tasks. A fifth said that they had difficulty getting out and using public transport, while a third struggled with paperwork. They were also three times more likely than the rest of the population to need assistance with managing finances.

What previous research there has been with this group has painted a similar picture of disadvantage: this study confirms that these inequalities persist. The people described here may form a ‘hidden population.’ They may experience pronounced restrictions on their ability to participate fully in life but their impairments are unlikely to be considered severe enough for them to be eligible for additional support. Their use of mental health treatment and services do not appear to be commensurate with their levels of need, indicating that they are underserved compared with the rest of the population.

People with borderline intellectual impairment are a sizeable part of our communities. The evidence here shows that they should be recognised as a high-risk group in work on health inequalities and suicide prevention.  Health care, employment support, finance, welfare and other service providers need to take into account the adjustments needed by this group so that they can participant fully and independently.

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