Meeting the Mental Health Needs of Adults with a Mild Learning Disability

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.

1. (1) At a local level:

   1. (i) 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.

   2. (ii) 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.

   3. (iii) 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.

   4. (iv) 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. (v) 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. (vi) Lead clinicians from learning disability and mental health should be identified to have a coordinating role.

   7. (vii) 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.

2. (2) At the Strategic Health Authority:

   1. (i) The Strategic Commissioning Group should be charged with ensuring the development of services for people with learning disabilities with severe complex needs.

3. (3) Continuing professional development (CPD)

   1. (i) 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.

   2. (ii) There should be opportunities for consultant psychiatrists to obtain competencies to look after the mental health needs of adults with a mild learning disability.

4. (4) Training:

   1. (i) 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.

   2. (ii) Staff in both learning disability and mental health services should have training in psychological approaches adapted for use with people with mild learning disabilities.