There is real concern the carers' dispute will lead to confusedmedication with the potential for serious consequences, writesDr Muiris Houston
Intellectual impairment or mental handicap is not a discrete entity like many physical diseases. It represents a spectrum of illness with a number of causes.
Mental handicap is divided into three broad categories - mild, moderate and severe - based on the measurement of I.Q. The mildly handicapped have difficulty acquiring skills to look after themselves and earn an independent living. Those with severe impairment will have difficulty communicating, caring for themselves and will require on-going care.
Severe intellectual impairment is found in some people with Down's syndrome and other chromosome disorders.
It is also associated with other recognisable diseases, such as the after-effects of meningitis or damage to a baby in the period just before or just after birth. The majority of cases of mild mental handicap have no apparent associated disorders.
In practical terms, many clients of organisations such as St Michael's House require 24-hour supervision, not just to ensure their basic survival but also to allow their personal development in terms of relationships and social activities.
Other clients have physical disease as well as intellectual impairment, the symptoms of which are controlled using a cocktail of drugs, which have to be administered in a certain way at a specific time. There must be real concern that medication will be confused or even omitted during the dispute, as people are moved away from those who are familiar with their needs. If an emergency carer in a new unit is unsure about a medication issue, many of the clients will be incapable of confirming the exact type or dose with the potential for serious consequences.
Epilepsy, heart disease and diabetes all require regular preventive medication if the condition is to remain stable. Many older clients with intellectual impairment have these conditions.
But it is at an emotional level that one must be most concerned for those affected. Much effort goes into getting the right "mix" of clients in group homes so as to encourage personal development. Friends are now separated, roommates altered and familiar carers gone.
The repercussions of these changes in routine will be felt long after the dispute is resolved.