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Service systems for people with learning disabilities in Scotland have developed in the context of the Scottish legal system and devolved policy for health. Scottish organisations are responding to the spectrum of mental health needs by working in partnership to improve quality. This article describes this system and the key organisations, and presents some findings of the National Overview Report of services undertaken by NHS Quality Improvement Scotland.

Three separate focus groups were conducted to compare the views of service users, carers and specialist health professionals on community services for adults with psychosis and learning disabilities. Participants were asked which staff, treatments or interventions and methods of working or style of service organisation make a significant contribution to helping people with psychosis and learning disabilities. Although there were few direct contradictions or conflicts between the three groups, the priorities of service users, carers and professionals often differed. Development of community services for adults with psychosis and learning disabilities should incorporate the views of service users and their carers as well as clinicians.

Needs led person centred services are the hallmark of high quality intellectual disability services. Commissioning mechanisms such as Payment by Results (PbR) have been established in acute health services. An outcome focussed version of PbR will be implemented nationally from 2012 in an incremental manner in mental health services for adults and older people. Though intellectual disability services are currently excluded, it is proposed that needs led approaches would improve the quality and efficiency of specialist intellectual disability services. This paper aims to suggest that this approach could be the key to commissioning and designing personalised pathways of care.

Health needs are scoped and care pathways are defined as primarily consisting of Needs, Interventions and Outcomes. The mandated cluster groups to be used for PbR in adult mental health and older people's services are extended to cover the non overlapping needs of people with intellectual disability to provide an integrated framework of health needs usually met by specialist services. A framework of interventions is suggested and components of “assessment” and “therapeutic” activities are outlined. An outcome framework is described. A case example illustrates the application of these components to design a care pathway to provide a personalised, needs led service.

It is possible to use the principles underlying PbR to commission personalised services of high quality, improved efficiency and thus greater value.

The principles underlying PbR can be used to commission personalised pathways of care in intellectual disability services at a time when this approach is being extended to mental health services nationally.

Children and young people with learning disabilities and mental health problems from black and minority ethnic communities face barriers in accessing services. This paper describes a mapping of services used by young people with learning disabilities and mental health problems from Pakistani and Bangladeshi communities. Overall the participants accessed primary health care services through their GPs, had contact with Social Services for support and benefits and the voluntary sector for culturally appropriate services. Most participants did not access statutory child or adult mental health services, or professionals such as psychologists or behaviour nurse specialists. Families reported key barriers such as lack of awareness of services, language difficulties in communication and lack of culturally sensitive services.

Children and young people with an intellectual disability (referred to in this article as young people) have a higher incidence of mental illness and challenging behaviour than individuals without cognitive impairment. Inpatient assessment and treatment in a learning disability‐specific provision rather than mainstream inpatient child and adolescent mental health services (CAMHS) is most beneficial for those young people who experience a more severe intellectual disability or whose presenting complaint is challenging behaviour not associated with a co‐morbid mental illness. Assessment and treatment of this complex group of young people can only be successful if the services which manage them have access to a highly experienced and comprehensive multidisciplinary team. Admission is only worthwhile if recommendations that arise from the assessment can be transferred to the community and those involved in supporting the young person are motivated to work in collaboration with the inpatient team.

Governments are increasingly marketising human services in developed countries, with the aim of giving individuals more choice and control over the support they receive. Marketisation effectively transforms “clients” into “consumers” who are exposed to competitive market conditions and the marketing strategies of service organisations. However, the heterogeneity amongst citizens leaves some segments of populations more vulnerable within marketised systems. The purpose of this study is to examine the impact of the marketisation of human services on the value delivered to consumers of disability services. Given that the nature of disabilities can vary greatly, the study also examines the impact of the degree of disability on value creation and destruction for disability service consumers.

Qualitative, individual-depth interviews were conducted with 35 participants: 17 were consumers of disability services (either because they have a disability or care for someone who does) and 18 were disability service providers (for example, managers of disability programmes).

Factors that influence value creation and destruction include quality and turnover of staff, organisation and communication of service providers, ability to advocate effectively, level of funding and accessibility of services. Heterogeneity amongst consumers is also identified as a key factor affecting the creation and destruction of value.

To the best of the authors’ knowledge, this is the first study to apply marketing techniques, such as market segmentation, to identify heterogeneity in relation to value creation and value destruction in the context of human services. It also considers the notion of consumer vulnerability, stemming from disability, as an important lens through which the outcomes of marketised human service systems can be evaluated.

The aim of this chapter is to explore changes since the COVID-19 pandemic in welfare policies and services for people with learning disabilities and autism in England, focusing mainly on educational and health and social care sectors.

A review of official policy documents published on GOV.UK from January 2020 to May 2021 has been conducted using keywords on the topic in question, and semi-structured interviews took place in 2022 with four key informants/stakeholders working in health and social care or education sectors of people with learning disability or autism in England.

The main findings indicate a need to shift practices online due to the pandemic, for both education and health and social-care practice. It is also clear that reforms and adjustments were implemented in guidance, policies and frameworks for the support of persons with learning disabilities and autism. It has been increasingly difficult for people with disabilities to access healthcare services and medication during the pandemic, and this has had an impact on their overall health and wellbeing too. Experts suggested that smoother changes and more support are required, in terms of provision of services, research, access to healthcare, educational services, mental health, employment, as well as more public funding on such services for people with learning disabilities and autism.

The main lessons learned were focusing on the use of online resources, digitalisation of services and access to them, but also difficulty of the system to adapt fast to major changes required in order to support people with disabilities.

Despite laudable intentions and evidence of progress, significant barriers remain in relation to the access to and experiences of child and adolescent mental health services (CAMHS). This article draws on the findings of a literature review and reports a number of barriers and their impact on children and young people with learning disabilities. Children and young people with learning disabilities are at a disproportionate risk of experiencing mental health problems yet access and experience of CAMHS can be highly uneven. Families are often unclear about how to access mental health services and what services are available. Such information and knowledge‐related barriers are particularly significant for certain minority ethnic groups. Barriers related to the CAMHS workforce mix, skills and staff attitudes can also mean that skills required for working with people with both mental health conditions and learning disabilities can be lacking. At a macro level, systems‐related barriers include a lack of joint commissioning and planning, unclear care pathways, the lack of a single point of referral, difficult transition to adult mental health services and a lack of inappropriate services.

The social climate of psychiatric institutions correlates with multiple outcomes related to staff and patients. Research into social climate in Learning Disability services is limited. Staff and patients in Learning Disability services have documented both positive and negative experiences. No research has directly compared the social climate of Learning Disability and non-Learning Disability psychiatric services. The purpose of this paper is to understand how these compare. The study will also compare staff and patient views of social climate and the impact of security on social climate in Learning Disability services.

A total of 64 patients and 73 staff, from Learning Disability and non-Learning Disability psychiatric hospitals completed the Essen Climate Evaluation Schema (EssenCES) measure of social climate.

Patients in Learning Disability and non-Learning Disability services did not differ in their perceptions of social climate. Staff in non-Learning Disability services had a more positive perception of social climate than staff in Learning Disability services. Patients and staff did not differ in their views on climate. Security was negatively related to patients’ Experienced Safety.

The findings suggest that staff perceive that the deficits associated with Learning Disabilities may limit patients’ therapeutic experience and relationships with their peers. Despite this, patients with Learning Disabilities feel supported by their peers, have positive views of the treatment process and feel as safe as non-Learning Disabled psychiatric patients.

This paper explores access to palliative care services by people with learning disabilities. It is based on a study of specialist palliative care professionals in London, involving 32 semi‐structured interviews and 543 postal questionnaires. We focus on one aspect of the findings, related to the current use of specialist palliative care services by people with learning disabilities. The results indicate that such services are under‐used by this group. We discuss possible reasons for low referral rates, including late diagnosis and lack of understanding among both learning disability services and palliative care services about each other's roles. We highlight the importance of collaboration, and the need for further staff training.