Developing local services for people with a learning disability and a psychiatric disorder

Abstract

Recent ministerial statements and health circulars have identified a key role for the NHS in providing services for people with a learning disability who have a mental illness or a severe behaviour disorder (NHS Management Executive, 1992). This is not an insignificant task, given that psychiatric disorders (including both mental illness and/or severe behaviour disorders) occur among approximately 30% of people with a moderate or severe learning disability (Corbett, 1979; Lund, 1985). Patients with psychiatric disorders have proved particularly difficult to resettle from mental handicap hospitals, and form a substantial proportion of the patients who become long-stay residents of mental handicap hospitals despite the development of community-based services. It is therefore essential that each district health authority defines the most appropriate pattern of services for this group of patients, as part of their purchasing strategy for mental health. The type of service required was discussed by the department of Health report Needs and Responses: Services for Adults with Mental Handicap who are Mentally Ill, who have Behaviour Problems, or who Offend. This noted that no consistent pattern of services has yet emerged, and that suitable alternatives included admission to a specialised mental illness unit in a mental handicap hospital, admission to a general psychiatric ward, admission to a small staffed house, or treatment by a community support team.

Bed Blockage in an Acute Admission Service for People with a Learning Disability

“…In place of lifetime hospital care, NHS trusts have increasingly focused on meeting specialist healthcare needs, particularly the acute treatment of mental illness and other abnormal behaviours (Bailey & Cooper, 1997). No common model has emerged for these specialist units (Roy & Cumella, 1993;Gravestock & Bouras, 1995), and there have been reports of small units based in adapted housing, purpose-built on hospital sites, and services for people with a mild learning disability and a mental illness (Claire & Murphy, 1993;Day, 1993;Hurst et al, 1994). A small number of studies (e.g.…”

Use of specialist occupational therapists within residential learning disabilities: a justified case?

“…These programmes may be creative and practical. There exists no set provision of occupational therapy (OT) services to this client group and specialist teams have developed in different ways ( Roy & Cumella 1993). Case loads for specialist occupational therapists can vary greatly from six to 120 clients per therapist ( Pimental & Ryan 1996).…”