Case vignette: Down

syndrome and mental illhealth

Doris
Doris is a 46 year old woman who has lived for the past four years in a
community residential home for people with learning disability, having
previously lived with her parents. Doris has Downs syndrome and as a result
has a moderately severe learning disability. She works for three days a week
in a supported caf project, and on other days is supported to use other
community facilities. Her favourite activity is swimming. Her health has
generally been good although she does have a lot of chest infections.
Staff in the community home have become increasingly concerned over the
past four months. Doris has been refusing to go to her job in the caf on and
off, and has not been at all in the last month. She has also been much less
keen on swimming, saying she is frightened of the water. She has been asking
to see her parents, but they died two years ago. When she is reminded of this
she becomes very upset. Staff also say that Doris has stopped doing her own
washing, and they are now doing this for her.
How would you further assess Doriss problems?
What are the possible explanations for the changes in Doriss behaviour?
What advice would you give about management?