Working with mainstream mental health services and across health and social service boundaries delivers effective mental health care for people with intellectual disabilities.

Accessible summary• People with learning disabilities have told us what it was like to be looked after in general psychiatric wards and in our local psychiatric ward where four of the beds are for people with learning disabilities. • People who used mainstream wards found it quite frightening to begin with and things were not always explained very well. People who used the local ward were less worried when admitted and settled in quicker. • People who used general psychiatric wards did not always feel that their medication was explained to them properly. People who used the local ward still had some concerns about this but generally felt that medication was explained properly. • Most people said that they got on well with the other people in both types of ward and they felt that social contact with others was one of the most positive things about their admission. • People using both types of ward liked to have one nurse on the ward who they could go to if anything needed to be sorted out. SummaryDuring the 1990s, a decision was made within the Learning Disabilities services of Camden & Islington to develop a local integrated service for people requiring an acute psychiatric admission. There had been little research at the time on the experiences of people with learning disabilities within the type of inner London acute mental health service within which beds were to be located. In order to inform the development of the new service, we undertook to interview a number of service users with learning disabilities who had experienced acute admissions to general psychiatric wards during the previous three years. The information that was provided was then incorporated into the service's development process. Subsequently, a further round of interviews took place with people who had used the new service to determine whether experiences had changed and to identify areas for further service development and improvement.

Background English policy argues that people with intellectual disabilities should be supported in their local communities. There is considerable evidence that this aspiration is not being achieved. This paper seeks to look at the subsection of people with intellectual disabilities who have expensive care needs because of challenging behaviour, to identify the decision-making processes that have led to current service provision and expenditure and to suggest improvements. Materials and Methods We carried out a survey within five North London boroughs to investigate the characteristics of a cohort of people with intellectual disabilities and challenging behaviour in high-cost accommodation (over £70 000 ⁄ annum). Postal questionnaires and face-to-face interviews were conducted with stakeholders with intellectual disabilities and patterns of current costs were estimated from existing data provided by the commissioning authorities in the five boroughs. Results Two hundred and five individuals with intellectual disabilities and challenging behaviour were identified. They were accommodated in placements provided by 97 separate providers, both in and out-of-area. Those more likely to be placed out-of-area were younger, had multiple health problems, significant challenging behaviour and mental health problems including autistic spectrum disorders. The local community intellectual disabilities teams identified a number of difficulties in meeting the needs of those service users. Conclusions Expenditure on all placements for service users with intellectual disabilities is significant. There is a notable lack of investment in local service development. A coherent approach is required, often across service boundaries. The authors suggest a model for targeted investment aimed at supporting effective local services, and reducing the need for and expense of out-of-area placements.

BackgroundSeveral studies have showed that people with intellectual disabilities (ID) have suitable skills to undergo cognitive behavioural therapy (CBT). Case studies have reported successful use of cognitive behavioural therapy techniques (with adaptations) in people with ID. Modified cognitive behavioural therapy may be a feasible and effective approach for the treatment of depression, anxiety, and other mood disorders in ID. To date, two studies have reported group-based manaulised cognitive behavioural treatment programs for depression in people with mild ID. However, there is no individual manualised programme for anxiety or depression in people with intellectual disabilities. The aims of the study are to determine the feasibility of conducting a randomised controlled trial for CBT in people with ID. The data will inform the power calculation and other aspects of carrying out a definitive randomised controlled trial.MethodsThirty participants with mild ID will be allocated randomly to either CBT or treatment as usual (TAU). The CBT group will receive up to 20 hourly individual CBT over a period of 4 months. TAU is the standard treatment which is available to any adult with an intellectual disability who is referred to the intellectual disability service (including care management, community support, medical, nursing or social support). Beck Youth Inventories (Beck Anxiety Inventory & Beck Depression Inventory) will be administered at baseline; end of treatment (4 months) and at six months to evaluate the changes in depression and anxiety. Client satisfaction, quality of life and the health economics will be secondary outcomes.DiscussionThe broad outcome of the study will be to produce clear guidance for therapists to apply an established psychological intervention and identify how and whether it works with people with intellectual disabilities.Trial registrationISRCTN: ISRCTN38099525

Accessible summary• People with learning disabilities can have mental health problems like anyone else.• People with learning disabilities should be able to use the same mental health services as anyone else. • In this article we say how we have tried to make this happen. SummaryIt is now well recognized that people with learning disabilities experience the full range of psychiatric disorders. Public policy in the United Kingdom advocates that people with learning disabilities should access mainstream mental health services.Here we discuss the challenges this policy presents, and then describe the somewhat tortuous and unpredictable processes we went through to set up a service that properly enabled such access. We describe the service model in some detail, then reflect on overcoming barriers to implementation, and how we maintain the service model. Finally we draw some lessons for future service development initiatives.