The WPA Action Plan 2020-2023^1-3 coincides with a much-needed focus on the mental health needs of people with intellectual disabilities/intellectual developmental disorders (IDD). A Working Group on IDD has been formed and has met for the first time at a Presidential Symposium during the 19th World Congress of Psychiatry in Lisbon, Portugal in August 2019⁴.

A recent international review of service models for IDD⁵ has highlighted that some countries rely on high-quality specialist ser­­vices that are however difficult to reach, while only few countries use trained volunteers to work with family networks to provide care and support, education, training and employment to affected people. It is evident that very few low- and middle-income countries (LMICs) have any significant services for persons with IDD across the lifespan. Furthermore, any mental health care provided entails untrained staff practicing in segregated facilities. Factors that impact the quality of services in LMICs include cultural barriers, social stigma, geography, transport links, poorly developed legislative frameworks, and poor government spending.

The activities of the WPA Working Group on IDD have been envisioned under the World Health Organization (WHO) framework recommended by the ICD-11 relevant Work Group⁶. That framework has been widely acknowledged as the impetus for the paradigm shift in the classification of IDD as a neurodevelopmental condition in both the DSM-5 and ICD-11. This approach recognizes that functional limitations often coexist alongside strengths, and that both are to be considered during the individuals’ assessment; and that descriptions of limitations should be aimed to develop a profile of needed supports. It also underscores the need to identify the underlying etiologies, consistent with the WPA public health mission to emphasize the importance of risk factors and to adopt evidence-based preventive and rehabilitative interventions.

The WPA Working Group on IDD has participated this year in the initiative call­ed Rehabilitation 2030, sponsored by the WHO Department of Noncommunicable Diseases, Disability, Violence, and Injury Prevention, aiming to develop a package of rehabilitative interventions⁷ along with specified resource requirements for their delivery. The overarching goal is the improved care of persons with IDD across the lifespan, with a particular emphasis on LMICs.

Following on these ground-breaking approaches in classification and evidence-based interventions, the Working Group is now promoting a second paradigm shift aiming to include training on IDD within mainstream psychiatry, once again with a particular emphasis on LMICs.

Three important arguments justify this call. First, when polled about their knowledge on the impact of IDD, many trainees in psychiatry recognize the disproportionately high burden of co-occurring mental disorders in persons with IDD⁸. Second, when offered opportunities to interact with persons with IDD during rotations, many trainees in psychiatry regard such experiences as highly formative and inspiring. Third, and most important, psychiatry as a profession has the potential to improve significantly the care for persons with IDD.

Furthermore, the gap in mental health services for persons with IDD is too significant to be compensated by an ad hoc reliance on individual providers and families, and their resilience is not limitless. Moreover, within the context of the COVID-19 pandemic, persons with IDD are facing the utmost intensification of inequities in term of underlying medical liabilities, inability to socially distance, increased infection and mortality risks, challenges to participate in telehealth services, and ensuing social isolation and adverse mental health outcomes⁹.

The Working Group and the WPA leadership invite Member Societies to work collectively to enhance efforts for the development of inclusive training models in the mental care of persons with IDD. The Working Group is ready to provide awareness raising, training, and research collaboration to promote and disseminate effective services and thereby improve the lives and outcomes for persons with IDD. For this purpose, the Working Group is developing an open access handbook focusing on global aspects of the psychiatry of IDD, with authorship from both LMICs and high-income countries. In parallel, the Working Group is developing online educational materials summarizing the key aspects of psychiatric care in people with IDD. These resources will be accessible through the WPA educational portal in 2022.

The WPA Working Group on IDD encourages systematic exposure to and experience in this area for all psychiatrists, so that they can adjust treatments for co-occurring mental disorders and avoid diagnostic overshadowing in which IDD may be wrongly considered the cause of all behavioural problems, and psychiatric, physical as well as environmental factors may be overlooked. Since relatives remain key partners as well as co-providers of services for people with IDD throughout their lives, the Working Group encourages provision of support to families by using local networks, with access to specialists for training and supervision as well as to more intensive forms of treatment for co-occurring problems (e.g., autism spectrum and seizure disorders)⁷. Third, the Working Group calls for the development of targeted mental health services including psychiatrists and allied professionals, who will need additional training to improve their diagnostic and therapeutic skills relevant to IDD. Finally, the Working Group emphasizes the need for person-centered care tailored on abilities and aspirations of affected persons, blending the social and medical models of development and disability within a human rights framework to improve access to health care, education and employment.

These themes have been the subject of presentations in Presidential and State-of-the-Art Symposia at the World Congress in Lisbon, and subsequently at the World Congresses in Bangkok, Thailand in March 2021, and Cartagena, Colombia in October 2021, and will continue to be addressed by the Working Group at forthcoming WPA congresses and conferences.

WPA 行动计划 2020-2023 ^1-3恰逢急需关注智障/智力发育障碍 (IDD) 人士的心理健康需求。2019 年 8 月在葡萄牙里斯本举行的第 19 届世界精神病学大会期间，IDD 工作组已成立并首次在总统研讨会上举行会议⁴。

最近对 IDD ⁵服务模式的国际审查强调，一些国家依赖难以获得的高质量专业服务，而只有少数国家使用训练有素的志愿者与家庭网络合作，以提供护理和支持、教育、培训和就业给受影响的人。很明显，很少有低收入和中等收入国家 (LMIC) 为 IDD 患者的整个生命周期提供任何重要的服务。此外，提供的任何精神卫生保健都需要未经培训的工作人员在隔离设施中执业。影响中低收入国家服务质量的因素包括文化障碍、社会污名、地理、交通联系、不完善的立法框架和政府支出不足。

^{WPA IDD 工作组的活动是在 ICD-11 相关工作组6}推荐的世界卫生组织 (WHO) 框架下进行的. 该框架已被广泛认为是推动将 IDD 分类为 DSM-5 和 ICD-11 中的神经发育状况的范式转变的推动力。这种方法认识到功能限制通常与优势并存，并且在个人评估期间都应考虑到这两者；并且限制的描述应该旨在制定所需支持的概况。它还强调了确定潜在病因的必要性，这与 WPA 公共卫生使命一致，强调风险因素的重要性，并采用基于证据的预防和康复干预措施。

WPA IDD 工作组今年参与了由 WHO 非传染性疾病、残疾、暴力和伤害预防司赞助的名为 Rehabilitation 2030 的倡议，旨在制定一揽子康复干预措施⁷并为其提供特定的资源需求。交货。首要目标是改善对 IDD 患者整个生命周期的护理，特别强调 LMICs。

继这些在分类和循证干预方面的突破性方法之后，工作组现在正在推动第二个范式转变，旨在将 IDD 培训纳入主流精神病学，再次特别强调 LMICs。

三个重要的论据证明了这一呼吁。首先，在对他们对 IDD 影响的了解进行调查时，许多精神病学学员认识到 IDD 患者同时发生的精神障碍的负担不成比例⁸。其次，当在轮岗期间提供与 IDD 患者互动的机会时，许多精神病学学员认为这些经历具有高度的形成性和启发性。第三，也是最重要的，精神病学作为一个职业有可能显着改善对 IDD 患者的护理。

此外，IDD 患者在心理健康服务方面的差距太大，无法通过临时依赖个人提供者和家庭来弥补，他们的复原力也不是无限的。此外，在 COVID-19 大流行的背景下，IDD 患者在潜在医疗责任、无法保持社交距离、感染和死亡风险增加、参与远程医疗服务的挑战以及随之而来的社会隔离和不良的心理健康结果⁹．

工作组和 WPA 领导层邀请会员协会共同努力，加强努力，在 IDD 患者的精神护理中开发包容性培训模式。工作组准备提供提高认识、培训和研究合作，以促进和传播有效的服务，从而改善 IDD 患者的生活和结果。为此，工作组正在编写一本开放获取手册，重点关注 IDD 精神病学的全球方面，作者来自 LMICs 和高收入国家。与此同时，工作组正在开发在线教育材料，以总结 IDD 患者精神科护理的关键方面。这些资源将于 2022 年通过 WPA 教育门户网站访问。

WPA 的 IDD 工作组鼓励所有精神科医生系统地接触这一领域并获得经验，以便他们可以调整同时发生的精神障碍的治疗方法，并避免诊断掩盖，在这种情况下，IDD 可能被错误地视为所有行为问题的原因，以及可能会忽略精神、身体和环境因素。由于亲属仍然是 IDD 患者一生的主要合作伙伴和共同服务提供者，因此工作组鼓励通过使用当地网络为家庭提供支持，并获得专家的培训和监督以及更密集的形式对同时发生的问题（例如，自闭症谱系和癫痫症）的治疗⁷. 第三，工作组呼吁发展有针对性的精神卫生服务，包括精神科医生和相关专业人员，他们需要额外的培训来提高他们与 IDD 相关的诊断和治疗技能。最后，工作组强调需要根据受影响人的能力和愿望量身定制以人为本的护理，在人权框架内融合发展和残疾的社会和医学模式，以改善获得医疗保健、教育和就业的机会。

这些主题已成为里斯本世界大会、随后于 2021 年 3 月在泰国曼谷和 2021 年 10 月在哥伦比亚卡塔赫纳举行的世界大会的总统和最先进研讨会的主题，并将工作组在即将召开的 WPA 大会和会议上继续讨论。