SERVICE PROVISION
المؤلف:
PAUL MALORET
المصدر:
Caring for People with Learning Disabilities
الجزء والصفحة:
P83-C5
2025-10-11
257
SERVICE PROVISION
People with learning disabilities often have problems accessing generic mental healthcare services; there are many identifiable reasons for this. Within the recent White Paper Valuing People: A New Strategy for Learning Disability for the 21st Century (Department of Health 2001), an emphasis has been placed on the mental health needs of people with learning disabilities’ being met by generic services with specialist support from learning disability ser vices. Firstly, it is important to establish what is actually meant by ‘generic’ or ‘specialist’ services. The terms ‘generic’ or ‘mainstream’ refer to those mental health services provided for the whole population, and ‘specialist’ services refers to services which provide knowledge, skills and expertise to supplement mainstream services where needs cannot be fully met within those generic services. Specialist learning disability services vary across the United Kingdom; however, they would usually consist of assessment and treatment units, community teams consisting of a wide range of disciplines including community learning disability nurses, psychiatrists specializing in learning disabilities, therapists, social workers and psychologists.
The Foundation for People with Learning Disabilities (2002) reported a wide variation in patterns of service delivery for young people with learning disabilities in the United Kingdom. For example, a teenager presenting with a mental health problem could be referred to the local community pediatric service, the child and adolescent mental health service or the learning disability service, depending upon where s/he lived. Generally, generic services will refer to specialist services at the earliest opportunity, if indeed they are available. People with learning disabilities tend to spend time in acute psychiatric services only during times of crisis or when the specialized learning disability teams are unavailable, such as when an admission may be required outside normal hours. Wallace (2002) suggests that mental health nurses do not have the skills or experience to work effectively with people with learning disabilities; this may be due to education in pre-registration programs for mental health nurses, which are generally not designed to develop these areas of knowledge or skills.
This lack of skills and experience often means that mental health staff are reluctant to offer people with learning disabilities a service; this has an impact on the learning disability services that commonly accept many referrals for people with learning disabilities with mental health issues as their primary need. Wallace (2002) also suggests that this is not ideal either, for the same reason – that learning disability nurses do not have the necessary skills and experience to work effectively with mental health problems. Therefore, it is imperative that both mental health and learning disability services have the appropriate skills, knowledge and experience to be able to support this ‘dual-diagnosed’ population, to provide a service that addresses the ‘whole’ person.
In the last 10 years, mental health education has been a high priority for many learning disability care providers, not only within the health service but also within social care and voluntary sector establishments. Many ‘dual-diagnosed’ service users reside in community homes and are cared for by non-qualified carers; generally, education is purchased for these homes from specialist services or education consultants. Additionally, community nurses from the mental health or learning disability team often support such care homes and advise on issues of care and treatment. For example, if a service user in a community care home has been seen in an outpatients’ clinic by a psychiatrist and his/her medication was changed, a community learning disability nurse could help the staff to monitor the effects and/or side effects of this medication. Additionally, the community learning disability team are able to provide or assist with a range of therapeutic interventions.
The question of whether people with learning disabilities and mental health problems should access mainstream generic mental health services or a specialist learning disability service remains unanswered. Certainly, the generic argument can be found in Valuing People (Department of Health 2001), which states that specialist support (learning disability services) are more appropriately utilized with ‘individuals with significant learning disabilities and mental health problems who cannot be admitted to general psychiatric services. This would suggest that those whose intellectual disabilities are more severe are more likely to receive a specialist service. Meeting the Mental Health Needs of People with Learning Disabilities (Royal College of Psychiatrists 1996) encourages ‘joint working’ between the two teams and the specialist service to help and support the generic service, rather than take over the provision of service.
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