Improving mental health services for people who

have a learning disability

Dave FergusonConsultant Nurse and Academic Practitioner

Hampshire Partnership NHS Foundation Trust and University of Southampton

Presentation will cover

• Green Light Toolkit Projects – Southampton City and Hampshire (now combined)

• CQC Indicators

• New Horizons

Hampshire

What we found out - headlines

2006/2008

• Some localities have regular liaison meeting between learning disability and AMH

• Some localities have good but informal collaborative working, especially when inpatient unit is involved

• Consultant to Consultant liaison is not consistent across the trust

• There are many champions for learning disability within the AMH Teams and visa versa.

• Learning Disability and AMH have a shared agenda about Primary Care interface.

• Often tension about delayed discharge

• Many AMH practitioners believe that learning disability is outside their area of expertise

• Carers support in learning disability services is often poor

What we found out – headlines2006/2008

• Criteria’ for accessing learning disability and AMH services. No real understanding about each others.

• Duality of learning disability and mental health problems = increased support needs.

‘Often beyond the CMHTs.’

• Information sharing across services is problematic.

• Service user involvement in learning disability service is patchy

• Access to AMH voluntary orgs is dependant on being open to the CMHT

• Crisis teams unanimously request support/training from learning disability teams

Green Light Tool Kit Projects

• Strengths :Strategic focus Powerful user voiceImproved relationships across learning disability / AMH interfaceLocal partnership workingCare planning / joint assessmentGreater shared understanding

Green Light Tool Kit Projects

• Challenges identified:

Transition working / protocol – CAMHS

Information sharing – HECS / RiO / SWIFT

Different criteria in integrated teams - health and adult services (vulnerable adult issues)

Introducing the Green Light DVD

What users said• Early help as sometimes it can be too late• Getting help from someone who understands our needs. Doctors

and nurses who don’t understand us do not help us feel safe.• Having someone to talk to on the ward• Support out of hours by someone who has a copy of our care plan.• Not to be judged and dismissed due to having a learning disability• To be able to go to hospital when we need to• To keep busy and have meaningful things to do• To know our families and carers are being supported

What practical things have come out of the

projects?• Mental health promotion leaflets x 3 • CPA information by users• Health passports• Alert cards • Medicines PIL’s development• Recovery agenda• Virtual teams developed across AMH and LD services• Directorate actively included in NICE guidance development in Trust• Protocols between Directorates – Community and In - patient• Core and locality training inductions• Training into Social Care services• Green Light stakeholder days (2 per year)• MHinLD embedded into all 1st year student nurse curricula (all fields)• Article published with users – Advances in mental Health and Learning Disabilities• Produced a DVD• Carer support workers – accessible!

Southampton City User Reference Group

CQC Indicators - Green Light

• This is a AMH Directorate indicator• AMH reporting split by locality, quarterly review

via steering group of progress against RAG rating

• Steering group has devised evidence / outcome measures against 12 targets - benchmarks set

• AMH Development Managers are responsible for progress in their localities – performance monitoring via Trust dashboard

Benchmarks T2. Local partnership with Primary Care Services

There is an agreement between mental health services about the role and responsibilities of primary care staff, and referral routes for specialist support.

T3. Local partnership with people with learning disability√Cross representation from learning disability and AMH service user groups.√Service user involvement in Stakeholder Day.√Increased number of people with learning disabilities on service user forums.√Practitioners from AMH and learning disability attend User Reference Groups or receive copies of minutes pertinent to learning disability service.(Partnership Boards have a regular agenda item concerning GLTK although this is not within our gift we should be able to influence).

BenchmarksT4. Local partnership with carers of people with

learning disability√Carer Consultants contribute and agree mental health in learning disability service developments.√All carer support workers support carers of people with mental health problems who have learning disabilities who use AMH services.√Carer support workers attend GLTK stakeholder days.√There is a link with family carers on Partnership Board.

BenchmarksT8. Agreed criteria and boundaries between services

√A local service information pack in which describes eligibility is shared with local learning disability and MH teams and ensures that nobody is excluded from either service.√There are local protocols in place.

T9. Transition protocols√Transition of care between child and adolescent services and adult learning disability and mental health services.√Transition between adult learning disability and mental health services and services for older people.

BenchmarksT21. Police and Criminal Justice services

√There is a learning disability representative attending the local mental health law group.

√There is an AMH and learning disability representation at MAPPA and MARAC meetings.

T24. CPA – Sharing information and accessing care plans

√There is learning disability or AMH representation (as appropriate) in CPA meetings.

√Paper records where appropriate are across teams.

√There is routine use of CPA for people with learning disabilities.Care plans can be accessed on HECs via CRHT’s

BenchmarksT25. CPA – Person centred and whole life

√CPA is holistic and addresses all aspects of individual need.

√There is a clear process for integrating an individual’s CPA person centred Health Action plan. (This reflects CPA as part of a person’s HAP as required which should be part of their PCP).

T29. Culturally specific services

√The Community Development Worker in each LIT has assessed andaddressed any culturally specific needs of people with learningdisabilities and mental health problems.There are culturally specific services available in the area that meet localassessed needs, and they can appropriately support people with mental healthproblems who have learning disabilities..

BenchmarksT31. Workforce planningThere is agreed, cross agency workforce planning to ensure that staff knowledgeable and

competent in mental health and learning disabilities are available to support people in any setting.

And – It is integrated into the main mental health and learning disability workforce planning.

T32. Representative WorkforceThe mental health and learning disability services are implementing a comprehensive

strategy to build a workforce reflecting the diversity of the local population of people with mental health problems who have a learning disability and to promote cultural competence in the workforce.

T37. Mental Health PromotionA mainstream mental health strategy is being implemented that includes and adequately

addresses the requirements of people with a learning disability.

New HorizonsA Shared Vision for Mental Health

– A cross-government programme of action with the twin aims to improve the mental health and well-being of the population, and to improve the quality and accessibility of services for people with poor mental health.

– Puts a significant focus on promoting public mental health and the prevention of mental ill health, alongside earlier intervention in proven treatment methods for those who need it.

New Horizons• People with learning disabilities and older people with mental health

problems deserve the same access to care and high-quality services as others.

• Needs assessment and commissioning that includes the needs of vulnerable groups such as looked-after children, young carers, people with learning disabilities, those with neuro-developmental disorders and young parents.

• Lord Bradley’s review of people with mental health problems or learning disabilities in the criminal justice system recommended improved early identification and treatment of mental health problems in offenders

New Horizons – what do we need to do?

1. Preventing mental ill health and promoting mental health √

2. Early intervention √3. Tackling stigma √4. Strengthening transitions √5. Personalised care √6. Innovation√

Next steps

• CQC - Access to health care indicators consolidation

• New Horizons – implement recommendations

• User Consultant posts• Improved links with CAMHS• Improved links with Primary care

Any questions?

Suggested Reading:

• Aldridge J. and Ferguson D. (2007), The Ecology of Mental Health Framework, IN Jukes M and Aldridge J, Person-centred Practices: A Holistic and Integrated Approach, pp 91-123,Quay Books

•DH. (2009), New Horizons A Shared Vision for Mental Health. www.dh.gov.uk/newhorizons

• Eastwood J, Borrows R., Ferguson D., Redding N. and Ricketts M. (2009), Green Light for Mental Health in Hampshire, Advances in mental Health and Learning Disabilities, 3 (2), pp 3-7

• Ferguson D. (2009), Intellectual Disabilities with Mental Health Problems, IN Bollard M, Intellectual Disability and Social Inclusion, pp 59-69, Elsevier.

• Ferguson D. (2009), Mental Health and Learning Disability, IN Jukes M, Learning Disability Nursing Practice, pp 309-326, Quay Books.

• Priest H. and Gibbs M. (2004), Mental Health Care for People with Learning Disabilities, Churchill Livingstone.

• Raghavan R. and Patel P. (2005), Learning Disabilities and Mental Health : A Nursing Perspective, Blackwell Publishing.

• RCN (2007), Mental Health Nursing of Adults with Learning Disabilities, RCN Guidance.

• RCPysch (2001), DC-LD (Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities/Mental Retardation), Gaskell.