Network of care for intellectually disabled individuals with mental illness in the UK Professor Iqbal Singh.

Network of care for intellectually disabled

individuals with mental illness in the UK

Professor Iqbal Singh

Network of care

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

Network of care

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.

Network of care

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.

Network of care

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

Network of care

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

Network of care

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

Network of care

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

Network of care

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

Network of care

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