Adults with intellectual and developmental disabilities (IDD) make up more than 1 in 5 patients who have been in mental health beds in Ontario for 1 year or more and are substantially overrepresented among long-stay psychiatric inpatients, according to new research.

The findings suggest that patients with IDD have special support needs that are not being met and that keep them in the hospital far longer than they need to be. Compared with patients without IDD, patients with IDD are more likely to have moderate or severe cognitive impairment, difficulty caring for themselves, and scant social supports, which make it challenging for them to transition out of the hospital and back into the community, the researchers wrote.

“While there are amazing healthcare and social services providers doing fantastic work, there aren’t enough resources for everyone, and it can be hard to provide support to everyone who needs to transition out of the hospital,” lead author Avra Selick, PhD, scientist at the Azrieli Adult Neurodevelopmental Centre at the Centre for Addiction and Mental Health in Toronto, told Medscape Medical News.

The study was published on September 29 in The Canadian Journal of Psychiatry.

Specialized Services Needed

The proportion of people with IDD is 1%-3%, but when we looked at all of the mental health beds in Ontario, that proportion of people with IDD is much higher, added senior author Yona Lunsky, PhD, professor of psychiatry at the University of Toronto.

“That’s the most important finding from this study. It’s not just 1%-3% of the long-term population; it’s 22%, and so you would expect that we would have services designed to support this population, as well as increase our understanding about why they are getting into the hospital and not leaving,” Lunsky told Medscape Medical News.

The researchers examined the prevalence of IDD among long-stay inpatients and compared the characteristics of those with and without IDD. Using administrative health databases, they identified all patients older than 18 years who were in a psychiatric inpatient bed in Ontario on September 30, 2023, and had been hospitalized for at least 1 year.

Of the 1466 patients who were in the hospital for more than a year, 322 (22%) had IDD. Compared with other long-stay inpatients, those with IDD were younger (mean age, 44.3 years vs 47.6 years), and a higher proportion were men (64.3% vs 50.1%).

Within the IDD group, 125 patients (38.8%) had autism. Compared with patients without IDD, higher proportions of patients with IDD had a psychotic disorder (73.3% vs 54.0%), had epilepsy (16.5% vs 5.6%), and were living with nonrelatives before their admission (28.3% vs 9.4%).

The median length of hospital stay overall was 3 years, and the mean length of stay was more than 4 years. Patients with IDD were more likely to be admitted because they were considered a threat to others or unable to care for themselves, whereas those without IDD were more likely to be admitted because they were considered a threat to themselves.

Only 5.3% of patients with IDD were in specialized units for patients with IDD. The remainder were in other psychiatric units, including acute care units (41.0%), longer- term units (32.3%), and geriatric units (6.5%), where providers were not trained specifically to work with them.

A greater proportion of IDD long-stay inpatients were subject to restraint use (12.4% vs 8.0%) and seclusion (20.2% vs 11.2%), compared with patients without IDD. They were also more likely to have difficulty with activities of daily living (39.8% vs 15.0%), severe cognitive impairment (29.5% vs 9.6%), and fewer social contacts, including family members, to facilitate discharge from the hospital (59.3% vs 48.6%).

Psychiatric Hospitals’ Challenges

The findings reflect the challenges that psychiatric hospitals across Canada are facing, commented Angela Russolillo, PhD, assistant professor at the University of British Columbia’s School of Nursing in Vancouver.

The challenges relate to “the complexity of care for people with IDD and psychiatric disorders, but also the complexity of care for many psychiatric patients who do not have IDD, which has increased substantially over the last number of years, with co-occurring disorders like substance use and other physical health issues that are really affecting our population,” Russolillo told Medscape Medical News. She was not involved in the study.

“My understanding is that the prevalence of IDD within the psychiatric population is quite high, around 40%. Inpatient psychiatric spaces are not designed to support folks who have those two types of challenges happening simultaneously. They are really about acute stabilization of a psychiatric illness, which has a different treatment trajectory compared with treating someone who has complex or additional challenges around intellectual development,” she said.

“As a psychologist, I see firsthand how cognitive impairment and limited social support complicate discharge planning for these patients,” Simon B. Sherry, PhD, professor of psychology and neuroscience at Dalhousie University in Halifax, told Medscape Medical News.

This study validates many clinicians’ observations that standard psychiatric pathways often fail to meet the complex needs of this population. Adults with IDD face systemic barriers to discharge, Sherry said.

“If we’re serious about deinstitutionalization and recovery-oriented care, we must look beyond psychiatric diagnosis and symptom stabilization. We must invest in specialized units, transitional resources, and coordinated community support, housing, developmental services, and mental health. Without integrated models that address cognitive, functional, and social dimensions, these patients remain at risk of indefinite institutionalization.”

The study was funded by the Institute for Clinical and Evaluative Sciences, which is supported by the Ontario Ministry of Health and the Ministry of Long-Term Care. Selick, Lunsky, Russolillo, and Sherry reported having no relevant financial relationships.