Psychiatric Bulletin (2004) 28: 106-107. doi: 10.1192/pb.28.3.106
© 2004 The Royal College of Psychiatrists
Psychiatric Bulletin (2004) 28: 106-107
© 2004 The Royal College of Psychiatrists
Meeting the Mental Health Needs of Adults with a Mild Learning Disability
Council Report CR115 £5.00 24 pp.
It is generally recognised that people with learning disabilities have a
higher rate of psychiatric disorders than the general population. A total of
98% of people with a learning disability function in the range of mild
learning disability.
Principles of normalisation and Government policy in the UK state that,
wherever possible, people with learning disabilities should use mainstream
mental health services. However, these lack the resources, skills and
expertise to manage this group of patients. Although there are not many
examples of good practice, either in the UK or from around the world,
intensive case management and collaborative systems of care appear to be
beneficial for people with mild learning disabilities.
The following recommendations are made to facilitate a collaborative system
of care for this group of patients.
- At a local level:
- Each district should have jointly agreed protocols between learning
disability services, adult mental health services, primary care Trusts and
social services. Managers of learning disability services should make sure
that the needs of this group are on the agenda of Partnership Boards and Local
Implementation Groups for the National Service Framework (NSF) for Mental
Health. Consultants in psychiatry of learning disability should ensure that
there is a mental health service available for them.
- There should be protocols to share expertise and resources such as day
activities, respite, therapy groups, rehabilitation facilities and outreach
teams. Regular clinical meetings between learning disability and mental health
teams could allocate resources and draw up care plans.
- Trusts providing psychiatry of learning disability services should ensure
that the Royal College of Psychiatrists’ guidelines regarding workforce,
i.e. one whole time equivalent consultant in learning disability psychiatrist
per 80 000 population, is implemented.
- Many people with mild learning disability can benefit from psychological
treatments. Learning disability professionals should specifically work with
other mental health colleagues to meet this need.
- There should be representation from learning disability service providers
on the NSF for Mental Health Implementation Groups to ensure that people with
learning disabilities benefit from the initiative.
- Lead clinicians from learning disability and mental health should be
identified to have a coordinating role.
- People with mild learning disabilities might need support to access some of
the mainstream services. Principles of intensive case management could be used
as they have been shown to be effective for this group.
- At the Strategic Health Authority:
- The Strategic Commissioning Group should be charged with ensuring the
development of services for people with learning disabilities with severe
complex needs.
- Continuing professional development (CPD)
- Joint CPD and audit meetings with psychiatrists from other faculties and
academics will improve liaison with forensic, old age, child and
rehabilitation psychiatrists to ensure a seamless service.
- There should be opportunities for consultant psychiatrists to obtain
competencies to look after the mental health needs of adults with a mild
learning disability.
- Training:
- There should be more opportunities for senior house officers and specialist
registrars in psychiatric specialties to obtain experience in working with
adults who have mild learning disabilities and a mental illness.
- Staff in both learning disability and mental health services should have
training in psychological approaches adapted for use with people with mild
learning disabilities.
