Roy Ashok, Courtenay Ken, Odiyoor Mahesh, Walsh Patricia, Keane Sarah, Biswas Asit, Marston Geoff, Thirulokachandran Suchithra, Munir Kerim
FRCPsych, Consultant Psychiatrist, Coventry and Warwickshire Partnership NHS Trust, UK. email:
FRCPsych, Chair, Intellectual Disability Faculty, Royal College of Psychiatrists, London, UK.
BJPsych Int. 2021 Aug;18(3):54-57. doi: 10.1192/bji.2021.6.
People with DSM-5 intellectual disability/intellectual developmental disorder (ID/IDD) or ICD-11 disorders of intellectual development (DID) have multiple healthcare needs, but in many countries these needs are neither recognised nor managed effectively. This paper discusses the negative impact that stigma, discrimination and social exclusion have on the identification and care of persons with ID/IDD in low- and middle-income countries (LMICs). It also reviews different models of care for children, adolescents and adults. In discussing some initiatives in LMICs the emphasis is on early diagnosis, with success in providing locally sourced care for affected people and their families. This is where the medical, social and rights-based models of care intersect and is a premise of the person-centred biopsychosocial framework of the World Psychiatric Association's Presidential Action Plan 2020-2023. The plan invites psychiatrists to take a lead in changing the culture of care, as well as medical education, clinical training and research, with a renewed emphasis on workforce integration and service development in terms of community-based rehabilitation strategies.
患有《精神疾病诊断与统计手册》第5版(DSM - 5)所定义的智力残疾/智力发育障碍(ID/IDD)或《国际疾病分类》第11版(ICD - 11)所定义的智力发育障碍(DID)的人有多种医疗保健需求,但在许多国家,这些需求既未得到认可,也未得到有效管理。本文讨论了耻辱感、歧视和社会排斥对低收入和中等收入国家(LMICs)中ID/IDD患者的识别和护理所产生的负面影响。它还回顾了针对儿童、青少年和成人的不同护理模式。在讨论LMICs的一些举措时,重点是早期诊断,以及成功为受影响的人和他们的家庭提供本地来源的护理。这正是医疗、社会和基于权利的护理模式的交叉点,也是世界精神病学协会《2020 - 2023年主席行动计划》中以个人为中心的生物心理社会框架的一个前提。该计划邀请精神科医生带头改变护理文化,以及医学教育、临床培训和研究,重新强调基于社区康复策略的劳动力整合和服务发展。