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Published Online: 18 December 2020

Predictors of Mental Health Crises Among Individuals With Intellectual and Developmental Disabilities Enrolled in the START Program

Abstract

Objective:

Individuals with intellectual and developmental disabilities disproportionately use emergency psychiatric services compared with their neurotypical peers, suggesting that such individuals and their supports are at increased risk for crisis events. This prospective study examined the timing, outcomes, and predictors of mental health crises for this population.

Methods:

The data came from Systemic, Therapeutic, Assessment, Resources, and Treatment (START), a national model that provides mental health crisis services for those with intellectual and developmental disabilities in the United States. The study included 1,188 individuals from four U.S. regions enrolled between 2018 and 2019. The outcome was urgent crisis contacts with the START program. Baseline and clinical predictors were examined with multivariate regression analyses.

Results:

More than a quarter had at least one crisis contact, and 9% had three or more. Contacts increased within the initial 3 months of START enrollment, followed by a steep drop-off thereafter; few contacts happened after 1 year. Almost 45% of the contacts occurred after hours, and 30% involved police. Clinical factors predicted crisis contact most robustly, followed by lack of occupational supports. After START crisis intervention, 73% of individuals remained in their primary setting.

Conclusions:

For individuals with intellectual and developmental disabilities and mental health needs, crisis stabilization resources are needed, including after hours. Results clearly identify times and risk factors for mental health crisis contacts, including frequent involvement with emergency responders. Importantly, gainful employment conveyed benefits for community stabilization. Findings may be leveraged to develop effective mental health crisis intervention services and supports for this underserved group.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 273 - 280
PubMed: 33334153

History

Received: 30 April 2020
Revision received: 8 July 2020
Accepted: 23 July 2020
Published online: 18 December 2020
Published in print: March 01, 2021

Keywords

  1. START program
  2. Mental health crisis
  3. Intellectual disability
  4. Developmental disability
  5. Crisis response
  6. Crisis prevention and intervention

Authors

Details

Luther G. Kalb, Ph.D. [email protected]
Kennedy Krieger Institute, Baltimore, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Kalb); Institute on Disability and National Center for START Services, University of New Hampshire, Durham (Beasley, Caoili); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire (McLaren); Department of Psychiatry, University of North Carolina, Chapel Hill (Barnhill).
Joan B. Beasley, Ph.D.
Kennedy Krieger Institute, Baltimore, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Kalb); Institute on Disability and National Center for START Services, University of New Hampshire, Durham (Beasley, Caoili); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire (McLaren); Department of Psychiatry, University of North Carolina, Chapel Hill (Barnhill).
Andrea Caoili, L.C.S.W.
Kennedy Krieger Institute, Baltimore, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Kalb); Institute on Disability and National Center for START Services, University of New Hampshire, Durham (Beasley, Caoili); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire (McLaren); Department of Psychiatry, University of North Carolina, Chapel Hill (Barnhill).
Jennifer L. McLaren, M.D.
Kennedy Krieger Institute, Baltimore, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Kalb); Institute on Disability and National Center for START Services, University of New Hampshire, Durham (Beasley, Caoili); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire (McLaren); Department of Psychiatry, University of North Carolina, Chapel Hill (Barnhill).
Jarrett Barnhill, M.D.
Kennedy Krieger Institute, Baltimore, and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Kalb); Institute on Disability and National Center for START Services, University of New Hampshire, Durham (Beasley, Caoili); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire (McLaren); Department of Psychiatry, University of North Carolina, Chapel Hill (Barnhill).

Notes

Send correspondence to Dr. Kalb ([email protected]).

Funding Information

Dr. McLaren has received grant support from the Natalia Mental Health Foundation and Thomas Marshall Foundation. She has received travel support from Autism Speaks and honoraria from Mad in America. She and Dr. Kalb also have served as consultants to the Center for START Services. The other authors report no financial relationships with commercial interests.

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