This review was written by Ellie Firth. Ellie is the founding director of Umbrella Yoga; she has a PhD in Cognitive Science and a background in mental health, autism and learning disabilities.

Adults with learning disabilities (LD) are a diverse group, with varied experiences, backgrounds, values, goals and abilities. Like everyone, their mental health can change throughout their lives, and we know they are capable of experiencing a full range of emotions, from happiness to sadness, frustration to delight, from embarrassment to pride (1). Yet, people with LD are twice as likely to suffer from poor mental health than the non-LD population (2) . Further, those with profound and multiple LD are the most likely to experience challenges and the least likely to receive support (3).  Why? 

First, what is a learning disability? Learning disabilities affect a person’s ability to learn, to communicate, and to carry out everyday tasks. The Department of Health, in England defined LD as a combination of: 

✦ a significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence); along with 

✦ a reduced ability to cope independently (impaired social functioning) 

✦ an onset of disability which started before adulthood, with a lasting effect on development.

A learning disability is a lifelong condition and one of the most common forms of disability in the UK, affecting 1.5 million people (2% of the population; Public Health, 2016). Note: a Learning Disability is different from a Learning Difficulty.  A learning difficulty is a specific area of difficulty in a person’s learning which is not associated with their overall level of intelligence – for instance, dyslexia is a learning difficulty which affects reading.

Why are Mental Health problems more common in people with LD?  There are a number of reasons why adults with LD may experience heightened mental health problems. A brief overview of some of these follows.

Difficulty recognising and communicating emotions. Many of us learn to recognise subtle changes in our own behaviours, routines and physical symptoms that might suggest something was up. From quick breathing, to trouble sleeping, to changes in appetite… we’re all different, and some of us are better at recognising our own indicators and triggers than others. But people with LD may have particular trouble recognising these changes, and moreover, communicating these problems with the people around them.

Lack of coping skills. Most of us have a sense of what we can do to make ourselves feel better. For instance, activities we enjoy, exercising, talking to friends, using mindful practices or breath-work to self-regulate.  People with LD may be less able to develop and engage coping skills.

Sensory sensitivities. Imagine never being able to turn the volume down. We are constantly processing (or filtering out) sensory information. Substantial evidence suggests people with LD are less able to do this (4) meaning many experience sensory overload, leading to stress, confusion, and triggering of the ‘fight-flight-freeze-’ response. When this happens regularly, mental health problems are more likely to develop.

Physical ill-health, pain and medication. We know that living with chronic or temporary pain, and having underlying health conditions, can negatively impact our mental state. People with LD are 2.5 times more likely to have a health condition (5). Their life expectancy is far lower than the general population: the risk of dying before the age of 50 is a huge 58 times higher in the LD population (6).  Moreover, many people with chronic conditions (with or without LD) are on medication, potentially with side effects that impact mood and anxiety.  Combined, it’s unsurprising that people with LD may suffer higher levels of mental health problems as well. 

Reduced social networks. Having a strong social network and good quality friendships is a well-established preventative factor in mental health problems (7).  Many people with LD would like to maintain friendships, but may struggle to do so. Building healthy relationships is a priority for many brilliant organisations supporting people with LD at the moment – including our collaborators at Kirklees Involvement Network – a self-advocacy group for adults with LD in Kirklees.

Discrimination. People with LD experience high levels of discrimination and exclusion. The impact on their mental health is unsurprising.

A note on Downs Syndrome.  People with Downs are actually less likely to experience mental ill health – with the exception of dementia; they are 4 times more likely than the general population to develop dementia, with an 50% exhibiting dementia symptoms by the time they are 50 (8).

Why are mental health difficulties overlooked in the context of LD? 

There may be a general opinion that people with an LD are not capable of experiencing a full range of emotions – evidence demonstrates this is not the case (1). However, typical indicators of poor mental health may go unnoticed or be masked in LD. For instance, neglecting self-care and lack of interest in appearance are common indicators of depression.  Someone with an LD may receive support in these areas, meaning a lack of interest does not result in a change in behaviour.

Symptoms of poor mental health are sometimes mistaken as artefacts of the learning disability. For instance, a period of lethargy or lack of interest in activities might be attributed to a lack of understanding, when in fact they are symptoms of low mood or depression

Are there any protective factors? Absolutely. I would argue that people with LD are susceptible to mental health challenges for the same reasons as the wider population, only they are more vulnerable to many of the risk factors (as discussed above). Likewise, the protective factors largely overlap with the wider population. To briefly mention some of these (see Hardy et al (9) for a detailed discussion):

✦ Improving physical health

✦ Feeling secure and safe from harm

✦ Bring given choice and control 

✦ Developing communication skills

✦ Building social networks

✦ Developing coping skills

✦ Having employment and meaningful daytime activities

✦ Being supported through change and transition

✦ Being supported in a person-centred way

✦ Having access to support services

✦ Having one’s various and unique needs recognised and met.

Can yoga help? Yes! Yoga can make a direct positive impact across multiple factors listed above. At Umbrella Yoga we teach ‘breath-led’ yoga to support the development of skills such as mindfulness, breath control and self-awareness. Self-awareness is crucial, because our physiological indicators can serve as an “early warning” system for mental health changes. Practicing yoga helps us to recognise these indicators, gives us the tools to communicate changes and potentially to manage symptoms.

Physical health and activity levels can be improved. A supportive and safe environment, in which an individual can exert control and choice, can be developed.  A group yoga session is a wonderful way to build social bonds and a sense of connectedness to others in the group. 

In the wider population, increased awareness and understanding of mental health vulnerabilities of people with LD in our yoga sessions will enable us to recognise subtle changes in a person, and to support them to also acknowledge, communicate, and seek help for their mental health problems.

References.

1. Cooper S & van der Speck R. (2009) Epidemiology of mental health in adults with intellectual disabilities. Current Opinion in Psychiatry 22(5):431-6 
2. Cooper SA, Smiley E, Morrison J, Williamson A & Allan L (2007) Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. British Journal of Psychiatry 190, 27-35.
3. Disability Rights Commission (2006). Equal Treatment: Closing the Gap. A formal investigation into physical health inequalities experienced by people with learning disabilities and/or mental health problems. 
4. Engel-Yeger et al., (2011) Sensory processing dysfunctions as expressed among children with different severities of intellectual developmental disabilities. Research in Developmental Disabilities. 31(5). 1770-1775.
5. Hollins et al., (1998). Mortality in people with learning disability: risks, causes, and death certification findings in London.  Developmental Medicine & Child Neurology 40(1). 
6. Leigh-Hunt N et al., (2017). An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health. 152. 157 -171.
7. Sheehy K & Nind M. (2005). Emotional well-being for all: mental health and people with profound and multiple learning disabilities. British Journal of Learning disabilities 33(1), 34-38. 
8. National Institute of Aging. https://www.nia.nih.gov/health/alzheimers-causes-and-risk-factors/alzheimers-disease-people-down-syndrome
9. Hardy S, Chaplin E & Woodward (2010). Mental health nursing of adults with learning disabilities. Royal College of Nursing. 

 

Photo Credits:

 

Chris Chinnock, Our Creative Connection: https://www.ourcreativeconnection.org/

Featured Partner Organisations, Kirklees College, and Waves Provision.