THE ROYAL COLLEGE OF PSYCHIATRISTS – NORTHERN IRELAND DIVISION
CONSENSUS STATEMENT REGARDING THE DEFINITION OF "SEVERE MENTAL HANDICAP"
AS DEFINED IN THE MENTAL HEALTH (NI) ORDER 1986
ENDORSED BY COUNCIL - 24 JANUARY 2005
In the light of issues of definition raised at Mental Health Review Tribunals, some of which have led to
Judicial Review, a Working Group drawn from the Learning Disability Faculty of the Northern Ireland
Division has produced the following consensus statement on behalf of the Royal College of
Psychiatrists.
The statement is grounded in a review of differing terminologies used in Mental Health
Legislation elsewhere in the United Kingdom, the Guide and Code of Practice for the Mental Health
(NI) Order 1986, relevant International Classifications and Diagnostic Guidelines, and definitions of
intelligence.
The purpose of the statement is to clarify the College's view of the interpretation of the term "severe
(1)
mental handicap", defined in the Mental Health (NI) Order 1986 as "a state of arrested or
incomplete development of mind which includes severe impairment of intelligence and social
functioning". While not explicitly stated in the definition, the College views this as meaning an onset
before the age of eighteen.
The Royal College of Psychiatrists believes that the 1986 Order was intended to apply to those
persons who would, under the previous (1961) Legislation, have been defined as "persons requiring
(2,3)
special care"
and that the protections afforded by the Order should therefore apply to people
(4)
whose IQ may fall within the "mild", "moderate" and "profound" clinical sub-divisions of the term
mental handicap as well as those in the "severe" sub category (categories which were purely
determined by performance on IQ tests). The College notes in particular the Secretary of State's
(4)
observations during consultation on the Draft Order
that "while IQ can be a reliable indicator of
intelligence it is not infallible. Intelligence is only one aspect of mental handicap; the other essential
component is social functioning. This includes the ability to eat, control one's bodily functions,
communicate, wash, dress, learn new skills, recognise hazards, and display reasonable judgement
and foresight. The lack of these abilities is now considered to be as much a part of mental handicap
as low intelligence".
The College shares the view of the World Health Organisation that the assessment of intellectual
level should be based on "whatever information is available, including clinical findings, adaptive
behaviour (judged in relation to the individual's cultural background) and psychometric test
(5)
performance".
(6)
This is congruent with the statement in the Code of Practice to the 1986 Order that "severe
impairment of intelligence and social functioning is not meant to restrict these definitions to persons
whose intelligence level, as measured by psychological tests, falls below a particular figure", with Mr
(7)
Justice Weatherup's view that "the nature of intelligence need not be limited to the results produced
by IQ tests" and "there is a real difference between 'test intelligence' and 'world intelligence'", and with
the British Psychological Society's view that "reliance solely on overall figures derived from the
(8)
assessments of intellectual functioning and/or norm based assessments would have limited value".
A properly broad definition of intelligence, therefore, requires the exercise of clinical judgement.
Clinical judgement is a special type of judgement, rooted in a high level of clinical expertise and
(9)
experience (The American Association for Mental Retardation).
There are not currently standardised measures which assist in assessing aspects of intelligence other
than IQ. These other aspects include creative, practical and emotional intelligences which impact on
the person's capacity to learn from experience, to appreciate their own limits, to make judgements, to
anticipate outcomes, etc, and require attention to the broad definitions of intelligence and the exercise
of clinical judgement, as defined above.
Issued by The Northern Ireland Division of The Royal College of Psychiatrists – February 2005
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Deficits in these aspects of intelligence may manifest themselves in an individual's social functioning
in ways which render it difficult to entirely separate intelligence and social functioning deficits.
The College accepts that social functioning should, however, be assessed in its own right in
considering whether or not the Order applies in any particular case.
For the assessment of the extent of impairment of social functioning, the College commends The
American Association on Mental Retardation (2002) "Levels of Support" model and the British
(10)
Psychological Society’s Learning Disability: Definitions and Contexts
which states that "severe
(101)
impairment is indicated by the need for 'extensive' and 'pervasive' supports".
The College interprets the definition of "severe mental handicap" in the 1986 Order as containing the
generally accepted components of onset before maturity, severely impaired intelligence and severely
impaired social functioning. Intelligence is a multifactorial phenomenon, some factors being
measurable and some requiring to be inferred from clinical observation.
The College commends the holistic view of intelligence and social functioning, as outlined in this
statement, which allows the legislation to be used to help people with learning disability access
appropriate protection, care and treatment, as intended by the McDermott Committee and endorsed
by the DHSS Guidance to the Order.
References:
(1)
The Mental Health (Northern Ireland) Order 1986. HMSO, London, 1986.
(2)
Northern Ireland Committee on Mental Health Legislation, HMSO, October 1981.
(3)
The Mental Health (Northern Ireland) Order 1986: A Guide. DHSS, 1986.
(4)
Response from the Secretary of State to the Northern Ireland Assembly Report on
a proposal for a Draft Mental Health (NI) Order 1985.
(5)
The ICD-10 Classification of Mental and Behavioural Disorders.
World Health Organisation, Geneva, 1992.
(6)
The Mental Health (Northern Ireland) Order 1986 Code of Practice. HMSO,
Belfast, 1992.
(7)
Weatherup J. Delivered 28/05/03 No.(2003) NIQB35.
(8 & 10)
Learning Disability: Definitions and Contexts. British Psychological Society.
(9)
Mental Retardation: Definition, Classification, and Systems of Supports,
th
10 Edition, American Association on Mental Retardation, 2002, pp95.
(110)
Mental Retardation: Definition, Classification, and Systems of Supports,
th
10 Edition, American Association on Mental Retardation, 2002, pp152.
Issued by The Northern Ireland Division of The Royal College of Psychiatrists – February 2005
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