network of care for intellectually disabled individuals with mental illness in the uk professor...
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Network of care for intellectually disabled
individuals with mental illness in the UK
Professor Iqbal Singh
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People with learning disabilities & mental health problems have the same right to high standards of assessment and treatment, and as good a quality of life as other people
Historically, these people’s mental health needs have been given low priority, which is further compounded by Their often very complex mental health needs Difficulties in diagnosis of mental health problems Requirement for specialist multi-professional
involvement
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In recent times the care for people with learning disabilities and mental health problems has been improved greatly as these people are viewed much more favourably, and we have better understanding of psychological processes, neurosciences, genetics and neuro-imaging. There are also more effective treatments based on biopsychosocial models.
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There is wide variation in the development of services between different countries of the world, with services in their infancy in most of the third world countries. There is a now a general trend towards a more humane form of treatment and a move away from large institutional care to community-based care.
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Most writers date the Western history of learning disability from 1790
Modern developments were inspired by Philippe Pinel, who is credited with removing
chains and other abusive treatments The publication of The Wild Boy of Aveyron, by
Jean-Marc Itard
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Industrialisation led to major changes in population centres and saw the growth of large institutions. These became total institutions.
The Eugenics Movement
The Eugenics Movement, promoted by Sir Francis Galton, played a significant part in the growth of these institutions
Survival of the race was seen in keeping imbeciles locked away from the general population
The Eugenics Movement
The quality of care for such people consequently suffered: Diverse physical & mental health needs not assessed No effective treatments Research was limited
After 1945 the Eugenics Movement was discredited and human rights extended to people with learning disabilities
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Over some decades the process of de-institutionalisation gathered pace and most of the larger hospitals have been closed and replaced by purpose-built small specialist units, or the facilities have been merged with generic services.
Normalisation
The UK King’s Fund Report ‘An Ordinary Life’ (1981) was influential in speeding up the process of normalisation
Changes in Social Security regulation provided massive expansion of public funds for resettling people from large hospitals
Normalisation
Between 1971-2000 the number of hospital beds fell from 50,000 to less than 2,000 (DH 2001)
A down-side to this rapid move meant that some clients were not properly prepared for their move and others’ complex needs were not properly assessed or reprovided
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Eventually the DoH and the Dept of Social Security agreed that there are 3 overlapping groups of people with learning disabilities whose special needs require specialist attention: Those with mental illness Those with severe antisocial behaviours Those who commit crimes
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This has led to an uneven pattern of specialist services throughout the country, including Specialist acute mental illness services A small number of inpatient forensic units A diverse range of challenging behaviour services
Services in a typical district
Population around 200,000 Number of LD clients on register: 600-700 Number of LD clients with mental health
problems: 200-300 A Partnership Board, Social Services and
National Health Services Pooled budgets
Services in a typical district
Community Team for People with Learning Disabilities consists of:• Manager• Senior nurse and other nurses• Psychologists• Speech & Language Therapist• Occupational Therapist• Challenging Behaviour specialist• Epilepsy Specialist Nurse• Consultant Psychiatrist
Services in a typical district
Most clients live at home Some live in supported accommodation Others live in specialist accommodation Small in-patient facilities (generic vs.
specialist)
Services in a typical district
Other specialist services Tertiary assessment and treatment services Medium secure services
Private sector
Provision of healthcare for people with learning disabilities
Jointly funded across the region Integrated clinical information systems Evidence-based practice Identifiable pathways to care
Provision of healthcare for people with learning disabilities (2)
Clear responsibilities/accountabilities Comprehensive services for all ages & abilities Regional Codes of Practice and Standards for
Professional Carers Regional planning for workforce and training
Provision of healthcare for people with learning disabilities (3)
In-patient facilities:
Assessment and treatment Rehabilitation Slow stream rehab 24-hour nursing care (residential) Neuropsychiatric disorders
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Unmet need
Distt
Regional/Supra Distt
Forensic
Traditional Role versus New Role
Traditional role Seeking aetiology of mental retardation General health care Administration of health facilities Unit-based service
New role Focus on diagnosis, treatment and
prevention of mental illness Community-based service
Generic vs. Specialised Services
Generic services by defaultGeneric services by designSpecialised Psychiatric Services