This research aimed to investigate staff knowledge and attitudes towards working with adults with both a learning disability and a mental health difficulty. Government policy in the UK suggests a shift in service provision such that the treatment of people with a learning disability who have mental health problems should be undertaken by mainstream mental health services rather than specialist learning disability services.Staff members from both specialist and mainstream services took part in a series of focus groups to discuss their experiences and attitudes about working with this group of people. The transcriptions of the groups were analysed to identify common themes. Findings from the study suggest that staff within mainstream services currently feel that they are inadequately trained to deal with the often complex mental health needs of this group. Conversely, staff in learning disability services expressed concern about losing their specialist skills in generic services.The implications of the themes raised are discussed, particularly in relation to future service provision. Care will need to be taken if service redesign is to be achieved without detriment to service users.

Accessible summary• We wanted to find out more information about adults with profound and multiple learning disabilities who lived in our area. • We carried out a survey (audit) using information from the local Community Teams.• We found 61 people. Many of these people had two or more disabilities e.g. physical disability, hearing problems, epilepsy, problems with eating and drinking. • We have set up a multidisciplinary team to work with this group of people.• We have made a register to keep information up to date.• We want to highlight the very special needs of this group of people and make sure they are given a good service. SummaryAn audit was carried out to gain an overview of the profound and multiple learning disabilities (PMLD) population in a local health trust to inform current and future service provision. An overview of the issues faced in developing clear defining criteria is presented. Published definitions of PMLD were used to identify clients from data held on the Special Needs Register (SNR -a data base of people with learning disabilities known to health and social services departments). Information obtained was cross checked with community teams and other professional service records to identify any further individuals who may meet criteria for PMLD. Existing information from individual case notes was then audited to confirm the clients identified meet the criteria for PMLD. The audit identified 61 adults with PMLD; all have complex needs and multiple health care requirements. Eighty-three per cent had two or more disabilities in addition to profound intellectual impairment. Twenty-nine per cent were reported as having problems with dysphagia. People with PMLD should be given priority for health action plans, particularly vision and hearing screening. The audit also needs to be extended to include younger people in transition to adult services. A register of clients with PMLD needs to be established and maintained as part of the SNR register.

Service users and their carers appear to use different information when rating the service users' anger. Service users' self-ratings reflect their internal emotional state and mental health, as reflected by their ratings of anxiety and depression, whereas staff rate service users' anger on the basis of overt behaviours, as measured by challenging behaviour scales.

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