In April, 2008, an independent Neurodevelopmental Disorders (ND) Program, distinct from both Child and Adolescent Psychiatry and Neuropsychiatry but with components from both areas, was established in the Department of Psychiatry at UBC. The preliminary discussions around this Program were hosted by Trevor Young (Head of Psychiatry at UBC) and attended by Trevor Hurwitz (Director of Neuropsychiatry Program), Jana Davidson (Director of Child and Adolescent Psychiatry Program), Jon Fleming (then residency training director) and Robin Friedlander (currently Director of the ND Program).
The term Neurodevelopmental Disorders is an umbrella term, which refers to disorders of the developing nervous system, resulting in impaired intellectual and/or adaptive functioning.
This refers to children, youth and adults who have significantly greater difficulty than most people with intellectual and adaptive functioning and have had such difficulties from a very early age (or the developmental period prior to age 18). ‘Adaptive functioning’ means carrying out everyday activities such as communicating and interacting with others, managing money, doing household activities and attending to personal care.
This definition of neurodevelopmental disorder includes children, youth and adults with Autism Spectrum Disorders, Fetal Alcohol Spectrum Disorders and other genetic and metabolic syndromes.
Why is this an area of importance for psychiatrists and other mental health professionals?
Compared to the general population, individuals with neurodevelopmental disability have a much higher rate of psychiatric disorders, yet are typically under diagnosed, misdiagnosed, and/or underserved. It is imperative that we aim to improve mental health outcomes for these individuals, their families, and caregivers.
In British Columbia, long-stay institutions for people with neurodevelopmental disorders have been closed. In 1981, the government announced a commitment to the closures of all long stay institutions for people with neurodevelopmental disabilities. The aim of the policy of de-institutionalization was to provide services closer to home.
Tranquille in the Interior of BC was closed in 1985, and over the next ten years, the institutions of Glendale and Woodlands were closed and individuals moved to the community.
With these closures, specific health and social care protocols were developed between the Ministry of Health (now Ministry of Health Services) and the Ministry of Social Services.
These Ministries created two community-based programs to support people with neurodevelopmental disorders:
- Health Services for Community Living (HSCL)
- Mental Health Support Teams (MHST)
These programs are currently operated and managed by Health Authorities. Health Services for Community Living provides consultation in the areas of home nursing, physiotherapy and occupational therapy as well as nutrition and dental care. The Mental Health Support Teams provide assessment, treatment and consultation for those individuals with neurodevelopmental disorders and mental health needs who require special attention through Mental Health and Addiction Services.
It is important to note that in BC, access to publicly funded community services for individuals with neurodevelopmental disorders is only available to those whose IQ is < 70 – 75 ; i.e. within the Intellectual Disability range of functioning (according to DSM IV criteria for Mental Retardation).
Successful community living requires not just a linkage of community residential and day supports, but also a health care system that is informed and responsive to the needs of this population. Over the last three decades, knowledge concerning the mental health needs of this population has increased significantly, leading to a better understanding of service needs and growing international consensus on key elements of an adequate and responsive health service system.