Transcript Recognising and Supporting People with a

Recognising and Supporting
People with a Learning Disability
who Access Mental health
services
Ross Orford
Green Light facilitator
Session Aims
• Definition and recognition of Learning
Disability
• Increased Risk factors for mental health
Problems in learning disability
• Common issues in supporting someone
with a learning disability
• Extra support that may be needed and
where to find some of it
What is a Learning Disability
• The World Health Organization defines learning
disabilities as: “a state of arrested or incomplete
development of mind”. (WHO 1993 cited by
Gates 2005)
• Three internationally recognised criteria
regarded as requiring to be met before learning
disabilities can be identified:
• Intellectual impairment
• Social or adaptive dysfunction
• Early onset
(BILD)
Valuing People 2001defined
learning disability as:
• A significantly reduced ability to understand new
or complex information, to learn new skills
(impaired intelligence), with;
• A reduced ability to cope independently
(impaired social functioning);
• Onset before adulthood, with a lasting effect on
development.
(DOH 2001)
IQ ranges in defining Learning disability
• 71-84 Borderline
• 50-69 Mild
• 35-49 Moderate
• 20-34 Severe
• Profound for people with additional
sensory, physical communication or
behavioural complexities where IQ
assessment would be exceedingly difficult
(BILD)
Learning Difficulties
• Learning disability is different from
specific learning difficulty which
means that the person finds one particular
thing hard, but manages well in
everything else.
(RCPsych 2004)
Recognition that someone may
have a Learning disability
• Can they read/write.
• Can they communicate.
• Do they understand what is being said and can
they remember it.
• Do they remember things like home address,
birthday, year.
• Do they live in supported care/have community
support.
• Did they attend a special school.
(Adapted from RCN 2007)
Valuing People 2001 says
• Ensure that people with learning disabilities,
•
including those from minority ethnic
communities, have the same right of access to
mainstream health services as the rest of the
population.
This includes mental health services
Other Relevant Reports/Legislation
• Mental Health national service framework
(1999) Standards Two and Three
• Valuing people Now (2007)
• Good practice in Learning disability
nursing (2007) Benchmark Five
• Services for people with learning
disabilities and challenging behaviour or
mental health needs (Mansell 2007)
Increased Risk Factors for Mental
Health Problems
Social and Economic Factors
Psychological and Emotional factors
Increased Risk factors For Mental
Health Problems
Socio-economic
• Prejudice and Discrimination
• Financial Disadvantage
• Smaller Social Network
• Exclusion
• Poor Transition
• Vulnerability to abuse/exploitation
(Adapted from Hardy et al 2006)
Increased Risk factors for mental
health Problems
Psychological and Emotional
• Low self esteem
• Negative Learning experiences
• Bereavement
• Lack of choices
(Adapted from Hardy et al 2006)
Issues that people with a learning disability
and mental health problems may face.
• Relationships with staff, family, friends and
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other individuals can become strained. There is
a risk that people can become isolated.
Their behaviour may jeopardise their places at
day services, employment and residential
establishments.
They are less likely to access the same
treatment facilities as other local people without
a learning disability. More likely to be placed in
‘specialist units’
Issues Continued
• They may develop physical health problems, e.g.
due to self-neglect, and may try treating
themselves by increasing alcohol, drug or
cigarette use.
• There may be an overuse of medication and
limited use of other treatments, such as
psychological interventions.
• They may have less choice and have fewer
opportunities to express their views and
opinions.
(Adapted from Hardy et al 2006)
Issues arising in supporting someone
with a learning disability.
• Communication/Understanding
• Delivery of psychological therapies
• Challenging Behaviours
• Physical Heath Issues
• Mental Capacity Act and Deprivation of
liberty safeguards 2005
What Additional Input May be
required?
• Alternative or supported communication
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(accessible writing, Carer support, visual aids,
more time)
Adapted Therapeutic approaches
Input from Learning Disability Community
Partnerships (LDCP)
The Green light team
Additional resources books, internet, colleagues
Knowledge and skills training
Communication issues
• People with Learning disabilities may:
• struggle to communicate their needs and
emotions.
• appear to understand what is being said
when in reality they have not
• use verbal visual and social ‘cues’ to try
and fit in
• Illiteracy may be a factor
Adapting your communication
• Remove sources of distraction
• Use gesture and facial expression to
support what you are trying to say.
• Don’t use jargon or abbreviations.
• Ask open questions if possible.
• Don’t ask questions with lists or multiple
statements
• Check that the person has understood
what you have said (Get them to repeat
back or paraphrase it)
Adapting Communication
• Use easily referenced dates and times eg
birthdays, Christmas, before lunch, “on
the same day as” (a regular event)
• Use objects, photos, drawing etc to help
to get your message across
• Think about any written communication,
can this be simplified or provided in
another format
(Adapted from Cornwall NHS Trust 2006)
Issues concerning Delivery of
Therapies
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Impaired communication
Lack of understanding
Poor communication of feelings
Potential Vulnerability in Relationships with
Others
• Lack of Choices and Control
(RCPsych 2003)
Adapting therapies
• Simplify
• Reinforce through homework and practice
tasks
• Be flexible
• Involve carers/support staff (where
appropriate)
(Adapted from Hurley et al 1998 cited by Whitehouse et al 2006)
Challenging Behaviours
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Are not just assaultative behaviours
May serve as part of the persons communication
May have physical causes (pain,)
Can lead to isolation and lack of services
May be caused or increased by mental health
issues
Physical health
People with learning disabilities may
• find it much harder than other people to access
assessment and treatment for general health
problems that have nothing directly to do with
their disability.
• be more likely to have tooth decay, loose teeth,
gum disease, higher levels of untreated disease
and a larger number of extractions. This can be
due to lack of access to dental care and poor
oral hygiene.
(Micheal 2008)
Vulnerability
• Problems often arise when people with
Learning disabilities and mental health
problems are admitted to generic mental
health wards. Vulnerable clients can be
put at risk of abuse from other clients.
(Bouras et al 2003)
Mental Capacity Act 2005
• Does the person have capacity to make
•
decisions about their care
does a capacity assessment need to be
carried out.
are you acting in their best interests
does an IMCA need to be appointed.
Are your decisions depriving them of their liberty
and does authorisation need to be sought under
the Mental Capacity Act 2005 deprivation of
liberty safeguards
What to do when completing
assessments
• Communicate at a level that means you’re
understood – get support from other
disciplines
• Allow more time than you generally might
also allow time to go back and check that
the person has understood you.
• Involve carers or family where appropriate
but ensure that you take time to listen to
the individual
Completing Assessments continued
• Find out if the person has a person
centred plan or a health action plan that
gives some pointers.
• Use the CPA process (MH+LD= Complex
needs) get everyone involved
• Get as complete a history as you possibly
can in order to see changes in the persons
presentation
Where to Start
Books beyond words – published by the
Royal College of Psychiatry
www.rcpsych.ac.uk
• Easy to understand leaflets about
medication www.elfrida.com
• www.easyhealth.org more accessibly
written material (and lots of it is free)
Suggested reading
• Mental Health Nursing of Adults with Learning disabilities
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From www.estiacentre.org look in free publications (in
conjunction with RCN)
Meeting the health needs of people with learning disabilities.
From www.estiacentre.org look in free publications (in
conjunction with RCN)
• Supporting Complex Needs A practical guide for support staff
working with people with a learning disability who have
mental health needs. From www.estiacentre.org look in free
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publications
Practice guidelines for the assessment and diagnosis of
mental health problems in adults with intellectual disability.
From www.estiacentre.org look in free publications
Make it Clear. A guide to making easy read information from
www.mencap.org.uk