Consumption of Mental Health Services by People with Intellectual Disabilities Mary Jane Spiller, Helen Costello, Agnieszka Bramley, Nick Bouras, Graham Martin, Elias Tsakanikos and Geraldine Holt Institute of Psychiatry, King’s College London, York Clinic, Guy’s Hospital, London, UK Accepted for publication 10 February 2005 Background Although research is starting to identify those factors that predict contact with mental health services in individuals with intellectual disabilities, very little is known about the patterns of service use following refer- ral. Yet, this information is vital for effective service planning and development. We therefore examined the factors associated with service consumption. Methods We constructed a service consumption index based on the number of outpatient clinics attended, con- tacts with the community psychiatric nurses, home visits by a psychiatrist and the number of admissions. This consumption index was used to divide the sample (n = 115) into two groups: heavy and light service users. Results and conclusions Logistic regression analysis indi- cated that, after controlling for the length of service contact, individuals with a diagnosis of schizophrenia spectrum disorder and those with a greater number of affective ⁄ neurotic symptoms were more likely to be heavy service users. Age, living situation and the degree of intellectual disabilities were not found to be signifi- cant predictors of service consumption. The results also suggest that a small proportion of service users con- sumed almost half of the service resources. Keywords: dual diagnosis, heavy service use, mental health services, service consumption Introduction The question of ‘who receives how much of which servi- ces’ has been important in generic mental health service research over the past years (Hansson 2003), and it is an imperative issue for service arrangements and service planning. A range of research has examined the patterns of service use within generic mental health services (e.g. Lavik 1983; Tansella et al. 1986; Giel & ten Horn 1982; Howard et al. 1996), and for more specific patient groups (e.g. Carr et al. 2003; Comtois et al. 2003). In a review of studies on the patterns of care in gen- eric mental health services Hansson & Sandlund (1992) found that a small proportion of service users use a large proportion of resources. Lavik (1983) found an ‘inequality’ of service use, with 10% of service users using 75% of service resources, and Sytema et al. (1989) found that 8% of service users were using 60% of the services. This review also highlighted a number of fac- tors that could be used to predict heavier service use, such as living alone or having no occupation. One study reported men to be heavier service users than women (Lavik 1983), and most studies mentioned in the review found that a diagnosis of psychosis predicted heavier use of mental health services. Research has also exam- ined the role of educational background (ten Have et al. 2003) and socio-economic differences (Lorant et al. 2003). However, a limited number of studies have focused on the patterns of mental health service use and levels of service consumption by people with intellectual disabilities (e.g. Driessen et al. 1997; Jacobson 1998). A study of more than 700 referrals to a mental health service for people with intellectual disabilities found that the majority of the referrals were male (60%) and a large percentage were young adults (mean age 33 years) (Bouras et al. 2003). Individuals with mild intellectual disabilities accounted for the vast majority of the refer- rals, and as in previous research schizophrenia spectrum disorders were the most common psychiatric diagnosis (Bouras & Drummond 1992; Rudolph et al. 1998). Journal of Applied Research in Intellectual Disabilities 2007, 20, 430–438 Ó 2007 The Authors. Journal compilation Ó 2007 Blackwell Publishing Ltd 10.1111/j.1468-3148.2007.00387.x