Intended for healthcare professionals

Letters Covid-19: shielding high risk patients

Covid-19: challenges for people with intellectual disability

BMJ 2020; 369 doi: (Published 29 April 2020) Cite this as: BMJ 2020;369:m1609
  1. Ken Courtenay, consultant psychiatrist in intellectual disability
  1. St Ann’s Hospital, London N15 3TH, UK
  1. ken.courtenay{at}

People with intellectual disability are vulnerable in society because of their dependence on support from services and other people.1 The prevalence of physical and mental disorders is higher among people with intellectual disability than other people across the age span.

The current pandemic poses specific challenges to people with intellectual disability and their carers that include minimising the risk of infection; access to information on the disease; risks of home support breaking down due to infection of the person or support staff; risk of increased agitation and distress; and placement breakdown because of behavioural challenges. The rapid changes in support structures, such as daytime support provided by local authorities in the UK, is affecting people with intellectual disability and people with autism who find it difficult to tolerate changes in their lives. Families often rely on this daily support for their own wellbeing and to continue their employment.

Psychiatrists working with people with intellectual disability are seeing a rise in requests for psychotropic medication to support people and to assist families and carers manage behaviours that are challenging to them. Self-isolating or shielding a person with intellectual disability for 12 weeks is an immense challenge for families and services, especially when such support might contravene a person’s human rights and liberty.

Adaptive measures are being used by support services and clinicians to ensure continuity of care and to maintain people living in the community. To be successful, such efforts will require a willingness by all agencies to collaborate in supporting services and families to reduce the risk of infection and the impact that environmental changes have on the person.


  • KC is chair of the Faculty of Psychiatry of Intellectual Disability, Royal College of Psychiatrists UK.

  • Competing interests: None declared.