A Drop in the Ocean

1. A Drop in the Ocean Exploring the need for Medium Secure Mental Health Provision for Adolescents with Learning Disabilities

2. Tim Docking (Divisional Manager) Dr Ruth Andrews (Consultant Clinical Psychologist) Child and Adolescent and Autism Division, Northgate & Prudhoe NHS Trust

3. Northgate and Prudhoe Large specialist LD provider Well established adult forensic service Specialist Child and Adolescent Tier 4 service Stephenson House-8 beds low secure, Adolescent Forensic

4. Background Significant pressure on inpatient service-high referral rates Springhill,St.Andrews-30 beds Adolescent MSU referral criteria No learning disability as primary diagnosis Small number being admitted with limited success

5. Background(cont) Young People with learning disability Learning disability not being identified within youth justice system Held for lengthy periods in secure estate In specialist social care packages Admitted to adult services Being held in higher levels of security Remain in community or at home Risk too high for local teams

6. Background(cont) Issues raised with NSCAG-asked for more information The outline brief Is there a need for a specialised LD adolescent medium secure provision ? What is the unmet need ? If needed, what should service look like?

7. The NSF for Children The Mental Health and Psychological Well Being of Children and Young People (CAMHS module). The external working group had an LD sub group. The Key messages are; Inclusion Early intervention Training and Support to professionals

8. NSF(cont) Adequately resourced Tiers 2 and 3 specialist LD CAMHS Access to Tier 4 CAMHS providing inpatient,day patient and outreach Joint agency planning Comprehensive CAMHS-Performance managed

9. Background (cont) �Minding the Gap� 2004 conference involving speakers from Department of Health, Commissioners, other providers, social services and Home Office. Recognising young people with learning disabilities falling between services �Count us In� Recommends inclusion alongside specialist provision and further investment in learning disability services

10. What we did Explored the existing literature relating to this group Consulted lead clinicians from the existing adolescent MSU�s Consulted clinicians and commissioners from areas of the country where there is currently no such provision Audited the existing adolescent MSU referral data base to establish the number of young people fulfilling the diagnostic criteria for learning disability Accessed referral data bases held at Northgate and Prudhoe NHS Trust to identify young people requiring medium secure provision.

11. Studies in the North East YOT � 26% had IQ less than 70 STC � 32 % had IQ less than 70 Kolvin Clinic �20% had IQ less than 70 Most figures indicate verbal skills more impaired than abstract reasoning skills

12. One US study estimates for all juvenile offenders: 35.6% would be considered learning disabled (ie have specific learning difficulties in the UK) 12.6% would be considered mentally retarded (ie meet diagnosis for learning disability in the UK) (Casey & Leilitz, 1990)

13. Study limitations Unclear definition of learning disability Unclear definition of MSU Time involved in collecting information Could not consult all agencies Screening practices variable Data bases still under development Data bases not designed with audit questions in mind.

14. Findings 15 to 33% of referrals to current adolescent MSU have intellectual disability-this equates to between 8 and 17 referrals per year Northgate and Prudhoe had 9 referrals per year thought to require MSU Annual range is 17-26 referrals with 1 in 3 or 4 female.

15. Findings Lack of clarity around MSU referral criteria Learning disability is not routinely screened Learning disabled adolescents have difficulty accessing therapies in mainstream services Difficulty in accessing education Discharge can be delayed and young people can become stuck in the system

16. Findings (cont) Clinical teams have skills but require further training MSU�s work with young people with complex needs. Adding needs associated with LD makes offering treatment very difficult Adolescents with learning disability can be vulnerable within mainstream peer group Adolescents with learning disability require specialist services and expertise Current provision is �a drop in the ocean� of need

17. Recommendations Systematic screening should be established A comprehensive national database is needed A further more detailed study should be considered Consideration should be given to the commissioning of medium secure services for adolescents with learning disabilities.

18. The options Widening access to current MSU�s to individuals who have learning disability Develop a specialist service within an existing service Develop a specialist learning disability MSU.

19. Where Next Draft report received by NSCAG Under consideration Specialist commissioning ? Currently leading needs assessment within Regional Youth Justice System YOUR QUESTIONS ??