Mental Health and Learning Disability Current ARC projects

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Mental Health and Learning Disability - Current
ARC projects

• David Grundy

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About ARC (www.arcuk.org.uk)

• Member led organisation (mainly voluntary orgs)
• Offers members a voice and representation at a
  national level
• News and policy updates
• Various training LDQ - NVQ etc
• CRB/POVA
• Undertakes a wide range of projects of interest
  to members

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About ARC

• For example -
• Handling Medication In Social Care Settings
• Research project into Hospital Admission for
  People with a Learning Disability in Wales
• Hosting National Learning Disability and
  Ethnicity Network (www.lden.org.uk)
• Moving On Up project (www.movingonup.info)
• The Candle project and the Clear Thoughts project

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Mental Ill Health in Learning Disability

• Having a Learning Disability is the single most
  significant factor identified in increasing the
  risks of mental ill health
• The other common risk factors also apply to
  people who have a Learning Disability
• Family breakdown
• Social isolation
• Poor communication
• Little control or choice over life

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Mental Health in Learning Disability

• Young people with a learning disability have a
  greater chance of being exposed to negative life
  events
• 65 of YP with LD grow up in poverty
• 52 of YP with LD have a parent carer with mental
  ill health
• 51 of YP with LD have a parent carer with no
  educational or vocational qualifications
• 25 of YP with LD have a parent carer with
  physical health needs
• 60 of YP with LD have been exposed to two or
  more of these negative life events
• (Emerson Hatton 2007)

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Mental Health in Learning Disability

• Times of change and transition can be difficult,
  especially for BME communities
• Sometimes the mental health issues are
  overshadowed
• Increasing national focus on positive mental
  health/emotional well-being is this reflected in
  learning disability services?
• Both Candle and Clear Thoughts look at positive
  mental health not just mental ill health

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Interaction between LD MH

• Most young people with learning disabilities were
  not aware of the term Mental Health
• Families were suspicious of the term Mental
  Health and need for a separate, additional label
• Most young people with learning disabilities had
  never heard of CAMHS
• Young people with learning disabilities or the
  people they go to for advice are not well
  informed about mental health and mental health
  services
• Some people from BME communities found situation
  more difficult due to stigma from community
  members
• FPLD (Foundation for People with Learning
  Disabilities) 2006

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Interaction between LD MH

• Diagnostic Overshadowing a tendency to attribute
  health problems to a persons learning
  disability
• (From Equal Treatment Closing The Gap the DRC
  report into health inequalities)
• Challenging Behaviour these behaviours often
  not seen as sign of mental ill health
• Different Presentation -
• Communication -

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Problems of diagnosis

• There are increased difficulties in diagnosis
  when someone has a learning disability.
• Staff need to be aware of these issues (and make
  families aware of them). They can then help the
  professionals making a diagnosis.

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Problems of diagnosis

• Problems of psychiatric interview for people with
  a learning disability
• Anyone communicating with someone who has a
  learning disability needs to consider the
  following factors
• People can have a tendency to answer Yes to
  questions
• People can have a tendency to agree to with
  questions/statements

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Problems of diagnosis

• People can have a tendency to agree with a list
  of statements/questions as they struggle to
  remember the order of the points within a
  statement
• People can have difficulties in reporting
  timescales -yesterday, last week, last year, 5
  years ago etc
• People can give an impression of understanding
  (they understand the word but not its meaning,
  importantly some words can have a range of
  different meetings in different contexts)

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Related Issues

• Autism
• Sensory Impairment
• Cultural Issues
• Medication

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Cultural Issues

• 2001 census information - the mixed race group
  had the youngest age structure - half (50 per
  cent) were under the age of 16. The
  Bangladeshi, Other Black and Pakistani groups
  also had young age structures 38 per cent of
  both the Bangladeshi and Other Black groups were
  aged under 16, and 35 per cent of Pakistanis also
  fell into this age group. This was almost
  double the proportion of the White British group
  where one in five (20 per cent) were under the
  age of 16.
  www.statistics.gov.uk

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Cultural Issues

• Cultural behaviours that may not be mental health
  issues - withdrawn teenagers, dominoes
• Many people from BME communities have had
  negative experiences when accessing (all)
  healthcare services
• Families worry about responses and attitudes of
  others both within and outside their community
• Cultural differences in perceptions of health and
  illness - Western Medical Model may differ from
  cultural norm

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Autism

• Autism is not a learning disability
• Too often mixed in in CAMHS
• However - better than not dealt with at all!
• YP can have LD, Autism and mental ill health
• Similar but different skills and abilities
  required to work with Autistic YP
• Sensory impairment (or over-stimulation)
  essential aspect of Autism - no eye contact as YP
  may not able to use hearing and vision senses
  together without over-stimulation

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Sensory Issues

• People with a learning disability are more likely
  to have problems with their hearing and vision
  than the general population.
• Core basic physical ill health often also present
• All these needs should be checked. Might want to
  be something services suggest happens during any
  waiting for an appointment.
• Poor hearing - Missing verbal messages, no-one
  picking up signs possible challenging behaviour
  referral
• Poor sight - Missing visual messages, no-one
  picking up signs possible challenging behaviour
  referral

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Medication

• People with a learning disability are
  over-prescribed medication (as a rule of thumb)
• Norah Fry Centre project gives some evidence
• Talking therapies need to be available to all
• Any medication must be explained by prescriber in
  a manner which can be understood by patient
• Implications of the Mental Capacity Act

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Legislation and Best Practice
Valuing People - Government White Paper focused
on Learning Disability - 2001 6.23 Most
psychiatric disorders are more common amongst
people with learning disabilities than in the
general population. As for their other health
needs, peoplewith learning disabilities should be
enabled to access general psychiatric services
whenever possible. This will require mainstream
mental health services to become more responsive,
and specialist learning disability services to
provide facilitation and support.

• Disability Discrimination Act
• Disability Equality Duty
• Disability Rights Commission (now Equality and
  Equal Rights Commission)
• Mencap Death by Indifference and Independent
  Inquiry undertaken by Governement.
• Mental Health Act
• Mental Capacity Act
• CAMHS Evidence Based Practice Unit - Anna Freud
  Centre
• Need I go on!

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ARC Resources

• Candle
• Clear Thoughts
• Moving On Up
• (www.movingonup.info)
• Services For All
• LDEN
• (www.lden.org.uk)

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ARC Mental Health in Learning Disability Projects

• ARC currently undertaking 2 projects regarding
  mental health (both DoH funded)
• Clear Thoughts - a knowledge centre for
  individuals, their families and frontline staff
• The Candle Project - CAMHS and New Directions in
  Learning Disability and Ethnicity

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Mental Health in Learning Disability Projects

• Clear Thoughts - a knowledge centre for
  individuals, their families and frontline staff.
  Website looks at positive mental health and
  mental illness
• A mainly web-based resource offering information
  and links to other sources of advice and support
• Aims to be clear, accessible and easy to navigate
  around
• Will offer passive and active resources
• Involvement of a range of other organisations and
  professionals
• 18 months into a 3 year project - time for
  amendment and improvements

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Mental Health in Learning Disability Projects

• The Candle Project - guidance and resources for
  Tier 1 (frontline) staff working with children
  and young people who have a learning disability
  and mental health issues
• Large resource covering the key areas of Mental
  Health, Learning Disability, Ethnicity and
  Transition
• Will be of use in a range of settings and
  services
• Focus on practical steps people can take
• Makes the links between an
• Individuals development
• Their culture
• Their lifestyle
• Their environment
• and their mental health

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The Candle Resource

• The resource is easy to use and offers guidance
  that can be used in a number of ways, these
  include
• A pick up and read resource for teams and
  individuals facing general or specific problems.
• A tool for discussion within team meetings or
  with other professionals.
• For individual personal development and training.
  
• Developing a training programme for staff.
• A signpost to other resources and material that
  will assist staff.
• A signpost to other organisations and government
  departments involved in CAMHS provision

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The Candle Resource

• Additional sources of advice and support are
  highlighted throughout the resource and these can
  help with specific problems
• Individuals or organisations can freely photocopy
  the handouts, case studies and tips
• These can be used to help think through the key
  issues individually or as a team during team
  meetings, away days or informally

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The Candle Resource

• The development of the resource has involved
  professionals from all aspects of care and
  support for young people and their families
• It encompasses a range of research projects
  involving families and young people themselves
• It highlights and encourages good practice
  throughout
• It aims to equip people who would not consider
  themselves to be experts to identify early
  warning signs of mental health issues and how to
  intervene appropriately

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The Candle Resource

• Candle is a resource not a full training package
• There is no need to complete it
• As much as Id love you to use all of it - it can
  be broken down into much smaller section
• Some of the sections will be more useful to
  different areas of work than others
• Pick and Mix to fit your needs

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Mental Health in Learning Disability Projects

• The Candle Project - is a FREE resource!
• It is free to download from the Clear Thoughts
  website
• www.clearthoughts.info
• Or available in hard copy - 25.00 for BW or on
  CD 5.00

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Mental Health in Learning Disability Projects

• Separate page on the site for the Candle Project
  resource from which files can be downloaded -
  link on the homepage
• www.clearthoughts.info
• Hopefully you will find both of them useful

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A final plea!

• Everyone is different - we are made up of a range
  of influences, abilities and background
• Without considering the whole person diagnosis,
  treatment and recovery will be much harder
• Professionals must get out of their boxes
• Ensure respect and value differences
• Treating people as individuals not conditions or
  cultures
• Finally a personal plea for the removal of
  separate cultural awareness learning
  disability and mental health training days
• We must be holistic

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Thank you

• Any questions?
• david.grundy_at_arcuk.org.uk