Scenario: Working with someone who experiences a coexisting intellectual disability and mental health condition

The scenario

You are a disability worker, experienced in assisting people with intellectual disability to develop their daily living and life skills.

Jane is 29 and has an intellectual disability. You are meeting Jane for the first time to begin supporting her in developing daily living skills, specifically cooking and shopping. 

You have been told that Jane has moved into a shared house, with staff support during the day, after the recent death of her mother. The house supervisor, Sue, describes her to you as a positive person, who in most instances is able to communicate her needs in basic language, has no behavioural issues and enjoys social interaction. Sue says that Jane will meet you at the house, no staff will be present, but gives you her number in case you need it. You spoke to Jane on the phone last week to introduce yourself and she said she was happy you were coming to help her.

When you meet Jane, she looks at you suspiciously and does not respond when you say hello. When you try to engage her by reminding her who you are and why you’re there she pays no attention, looks over to the corner of the room, nods and starts to laugh and does not stop for some time. She continues to look to the corner, smiling and nodding and not acknowledging your presence at all. 

Tips for responding in the moment

 It seems that Jane is seeing or hearing things that you can’t. This is a possible sign of psychosis.

• Remain calm and friendly, speak quietly.
• Don’t approach Jane, as she doesn’t know you at all and this may make her anxious.
• Where possible ask questions to clarify what Jane is experiencing.
• Keep any questions you ask simple.
• Give Jane time to process questions and respond.
• Listen to what Jane is saying to gain an understanding of her current reality, showing interest e.g. look at her, nod your head.
• Be respectful, don’t express any judgements about what Jane says she is experiencing.

• State the specific behaviours you are observing that are concerning you e.g. “Jane, you are laughing a lot. Can you tell me why?” or “You are not answering when I speak to you. Is everything alright?”
• Whether Jane responds or not, reassure her that you are there to help and want her to know she is safe. Ask Jane what will help her to feel safe e.g. “What can I do to help?”
• Offer Jane choices of how you can help e.g. “Would you like to call someone to help, maybe Sue (the house supervisor)?” or “Would you like me to call someone to help?”
• Ask Jane if it is okay for you to stay with her until help arrives.

• As far as possible, let Jane set the pace and style of the interaction. Given Jane’s thoughts may be confused and she may be frightened by her thoughts and feelings, she may not respond to your questions.
• Even though Jane may not respond, it does not mean she cannot hear or understand what you are saying.
• If Jane is happy for you to contact Sue, the house supervisor, let her know you will explain you are concerned for Jane’s safety and then seek directions about what to do.
• If Jane says she doesn’t want you to call anyone to help or does not respond at all, state your concern about her wellbeing e.g. “I am worried about you Jane. Is it alright if I stay with you for a while to make sure you are okay until Sue comes back?”
• If Jane wants you to leave, explain to Jane that you need to phone your supervisor to tell them what Jane wants and find out if your supervisor feels that it is okay for you to leave. Follow your supervisor’s instructions and make sure that Jane is aware of what is happening.
• If you become concerned for Jane’s safety, call the Mental Health Line on 1800 011 511.
• Do not leave Jane alone in the house if you feel it is not safe to do so.

• Follow up with the house supervisor to agree on the best approach for your future involvement e.g. making sure a residential worker, or someone Jane knows and trusts, is present at the next meeting with Jane.
• Always follow your organisation’s policies and procedures regarding your own and client safety.
• Look after yourself. Speak with your supervisor and ask for help if the situation has left you with feelings of unease. Many organisations will have an Employee Assistance Program where you can talk to someone confidentially.

Resources

This guideline helps you identify signs that psychosis is developing, and includes how to approach the person, and how to deal with delusions and communication difficulties.
Type: Guidelines (PDF)
Length: 3 pages
Produced by: Mental Health First Aid

The NDIS Code of Conduct Guidance for Workers provides guidance for workers in the NDIS about complying with the NDIS Code of Conduct. The guidance provides information and examples about what the Code of Conduct means in practice.