It is generally recognised that people with learning
disabilities have a higher rate of psychiatric disorder than the
general population. 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:
1. 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 NSF for Mental Health. Consultants in psychiatry of learning
disability should ensure that there is a mental health service
available for them.
2. There should be protocols to share expertise and resources
such as day activities, respite, therapy groups, rehabilitation
facilities and outreach teams. Regular clinical meeting between
learning disability and mental health teams could allocate
resources and draw up care plans.
3. Trusts providing psychiatry of learning disability services
should ensure that the Royal Collage of Psychiatrists’ guidelines
regarding manpower, i.e. one WTE consultant in learning disability
psychiatrist per 80,000 population, is implemented.
4. 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.
5. 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.
6. Lead clinicians from learning disability and mental health
should be identified to have a co-ordinating role.
7. People with mild learning disabilities may 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:
8. 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)
9. 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.
10. 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
11. There should be more opportunities for SHOs and Specialist
Registrars in psychiatric specialties to obtain experience in
working with adults who have mild learning disabilities and a
mental illness.
12. Staff in both learning disability and mental health
services should have training in psychological approaches adapted
for use with people with mild learning disabilities