Co-occurrence of mental illnesses and the incomplete picture of the NDIS access diagnosis
Studies on psychiatric comorbidity suggest that up to 27% of people with a diagnosable psychiatric or behavioural condition, will also have two other such conditions that will impact functioning and long term disability outcomes. In this blog I discuss what you should be looking for as a family member/carer/support coordinator.
What does psychiatric comorbidity look like?
Psychiatric comorbidity is the presence of two or more psychiatric disorders in one person at the same time. For example:
- Autism and co-occurring ADHD
-Schizophrenia and PTSD
-Intellectual disability and substance use disorders
-Bipolar disorder, bulimia, and generalised anxiety disorder
Barriers to recognising comorbidity
-Systemic factors: Creating support plans based solely on the access diagnosis can result in co-occurring conditions going undiagnosed or inadequately managed due to under-funding.
- Access diagnosis is so severe that it overshadows other underling conditions: Comorbidity may fly under the radar for families and carers, especially if the access diagnosis is a condition with severe and pervasive functional impact.
-Participant capacity to report on other difficulties they may be experiencing: Participants themselves may have poor insight, apathy or diminished motivation, denial (particularly with substance abuse) as well as difficulties communicating, to recognise that they are experiencing more than one condition and report it to family, carers, GPs, or support coordinators.
How does comorbidity complicate outcomes for participants
-Reduced effectiveness of current supports/therapies: For example, someone with MS-related mobility problems may not responding well to physical therapy appointments due to underlying PTSD (from hospital-related trauma) and social anxiety disorder (panic-like symptoms when meeting people), thus interfering with their attendance of appointments and in-session engagement.
-Reduced life expectancy due to undiagnosed or inadequately managed conditions affecting both physical and mental health.
-Functional decline and poor quality of life as a result of complicating, co-occurring disorders that add to the factors affecting functioning.
-Poor prognosis and risk of self-harm or suicide as a result of complicating factors, inadequate support relative to needs, declining mental health and increased sense of hopelessness about the future.