Improving mental health services for people who have a learning disability

1. Improving mental health services for people who have a learning disability Dave Ferguson Consultant Nurse and Academic Practitioner Hampshire Partnership NHS Foundation Trust and University of Southampton

2. Presentation will cover Green Light Toolkit Projects – Southampton City and Hampshire (now combined) CQC Indicators New Horizons

3. Hampshire

4. 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

5. 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

6. Green Light Tool Kit Projects Strengths : Strategic focus Powerful user voice Improved relationships across learning disability / AMH interface Local partnership working Care planning / joint assessment Greater shared understanding

7. 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)

8. Introducing the Green Light DVD

9. 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

10. 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!

11. Southampton City User Reference Group

12. 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

13. 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).

14. Benchmarks T4. 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.

15. Benchmarks T8. 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.

16. Benchmarks T21. 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

17. Benchmarks T25. 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 and addressed any culturally specific needs of people with learning disabilities and mental health problems. There are culturally specific services available in the area that meet local assessed needs, and they can appropriately support people with mental health problems who have learning disabilities..

18. Benchmarks T31. Workforce planning There 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 Workforce The 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 Promotion A mainstream mental health strategy is being implemented that includes and adequately addresses the requirements of people with a learning disability.

19. 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.

20. 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

21. New Horizons – what do we need to do? Preventing mental ill health and promoting mental health√ Early intervention√ Tackling stigma√ Strengthening transitions√ Personalised care√ Innovation√

22. 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

23. Any questions?

24. 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.