Inequalities in health and service use among people with borderline intellectual impairment

The Department of Health and Social Care (DHSC) commissioned the National Centre for Social Research, University College London, and Leicester University to undertake analysis of Adult Psychiatric Morbidity Survey (APMS) data to profile the circumstances of people with borderline intellectual impairment. APMS is one of the most authoritative and comprehensive national household surveys to assess both intellectual functioning and mental health in adults. This report quantifies the extent to which people with borderline intellectual impairment face inequalities in health and use of services compared with the rest of the population, and seeks to improve awareness of these inequalities. Borderline intellectual impairment is common, affecting about one adult in ten in England. The term is used here to refer to people with good verbal skills and living in private households, but who may experience cognitive impairments not evident without a detailed assessment. The findings in this report are consistent with previous research: people with borderline intellectual impairment are a disadvantaged group who are not well understood despite their relatively high levels of need for care. APMS data show that adults in this population face high mental health morbidity, poorer general health, and many limitations in their daily lives. Their level of use of mental health treatment and services does not appear to be commensurate with their higher level of need. This indicates that they are underserved compared with the rest of the population. This may be due to a lack of professional awareness of their needs, to services not adapting enough to meet those needs, or to difficulties the individual faces in seeking treatment and support. Existing advice from the General Medical Council, Public Health England and the National Institute for Health and Care Excellence about delivering reasonable adjustments and tailored healthcare for people with an intellectual impairment, along with focused training, signposting of support, and the promotion of self-help interventions, can all play a role in improving health outcomes. Adults with borderline intellectual impairment constitute key users of primary and secondary health care, and employment, education and welfare support. Improving awareness of the needs and circumstances of this group should form part of wider plans to reduce inequalities in health and service use in England. This report presents a profile of people with borderline intellectual impairment who are living in private households and who have the cognitive and verbal ability to participate in a general household survey. It could not cover people with intellectual impairment who live in residential settings or who lack the cognitive or verbal skills to participate in a general survey of this kind